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What Happens After the Scan? Dr Kenneth Bloom on Pathology, Detection and Treatment

DR. K BLOOM (CLARANT)-2 smallDr. Kenneth Bloom, Chief Medical Officer, Clarient Diagnostics

Breast cancer awareness has come a long way. Today, the fight to find a cure and the campaign to encourage early detection has garnered support from survivors, family members, researchers and fundraisers around the world. Thanks to their efforts, most of us are now in the know and familiar with terms like “mammogram,” “early detection,” and “breast cancer screening”.

But what happens after the scan? Following an imaging procedure, if an abnormality is detected, a chain of procedures is set off, beginning with biopsy and ending with a precise diagnosis, answering questions like: “is this cancer?” and “if it’s cancer, what kind?”

Cancer treatments are not one size fits all, and selecting the right treatment requires some important analysis on individual cancer biopsies. You may be surprised to learn that those important questions are not always answered by the physician themselves; rather, pathologists play the key role, running tests on analyzing cancer biopsies test results to tell us exactly what type of cancer we are dealing with, and equip patients with information about which targeted therapy will benefit them the most.

Oftentimes, a pathology lab will neither have the resources nor the capacity to test and analyze all patients’ biopsies. Samples are instead sent to pathology labs like Clarient, one of the largest testing facilities for breast cancer in the world that evaluates more than 30,000 breast cancers each year.

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Biopsy

When a patient is screened for breast cancer, their physician takes notes of any spots on their scan that could potentially be a tumor. Any abnormalities have a small percent chance of being cancer, so as a precaution, the physician will biopsy the lump and turn it over to a pathology expert for analysis.

Prognosis & Precise diagnosis

In the US, only 20% of the time will that biopsy indicate cancer is present[1], but the pathologist’s role is to give a lot more information than simply a positive/negative cancer determination. In the past, if a patient received a diagnosis indicating their biopsy was malignant, the immediate next step would be to the lump surgically removed altogether.

Today, however, some invasive cancers are treated with chemotherapy or targeted therapy, with surgery being used as a last resort.  Pathologists can help identify the best course of action for a patient by analyzing the cancer’s aggressiveness and its susceptibility to certain treatments. It is this information that tells physicians exactly which type of cancer they are dealing with, and which targeted therapy will best tackle it.

With only 20% of biopsies indicating cancer, that leaves approximately 80% of biopsies performed turning out to be free of malignancy altogether. But even in these cases, pathologists can provide valuable information:  Many of these biopsies, while not cancerous, can be indicative of changes that are associated with an increased risk of breast cancer in the future.

Treatment decisions

Working as a team, pathologists and radiologists ensure that oncologists and surgeons understand the biology of a tumor before making decisions about treatment. This relationship leads to less invasive procedures, more precise treatments, and ultimately, a better chance of survival for patients.

References

[1] http://www.breastcancer.org/symptoms/testing/types/biopsy Accessed 15 October, 2015.