Many healthcare professionals (HCPs) play an imperative role in the breast cancer pathway, and none work in isolation. It is essential that there is collaboration and partnership at every step of the journey to deliver the best possible care to all women.
Following Breast Cancer Awareness Month, it seems a pertinent time to reflect on the evolving field of breast health across the Breast Continuum of Care pathway.
The patient: central to all decisions
Patients are the focal point of all decisions along the Breast Continuum of Care. Crucially, all decisions considered should be based on a patient’s situation and experience, with clinicians ideally able to tailor treatment plans to each individual. This way, patients feel included and understood throughout the process.
When someone first receives a diagnosis, they receive a huge amount of information that they may not necessarily remember or understand. Breast cancer encompasses many types of the disease1, and when you add the details of staging, it becomes very complex. It’s important that patients receive this information in simple, clear terms that demystify complicated medical terminology, while also giving them adequate time to absorb the details. They should also be given the opportunity to discuss the information, from the point of diagnosis and throughout their complete breast cancer care pathway, with their HCP.
Radiology: a connective thread throughout the whole continuum
The initial responsibility of detecting breast cancer lies with the radiologist. They also often have the critical role of breaking the news that cancer has been detected and preparing the patient for the journey they are about to undertake, alongside other oncology HCPs.
Turnaround time is a key metric for this discipline, but it is essential that accuracy is not compromised by speed. As with other areas across the Breast Continuum of Care, radiology is feeling the strain of the staffing shortages being experienced across the world2. The UK radiologist workforce is short staffed by 29%, and needs nearly 1,700 more fulltime radiology consultants to ensure appropriate services3. Although the workforce has increased by 6% in 2021, it is still not enough to address the overall shortfall and increased pressures on the healthcare system3.
Despite these challenges, radiology is at an exciting crossroad. Digital imaging technology and artificial intelligence (AI) could speed up diagnoses. Also, disease and treatment outcomes could be predicted in the near future, but it is only with the support of radiologists that this could become a reality.
When it comes to treatment, radiology is also crucial in establishing how effective treatment has been and keeping track of the patient’s progress in years to come.
Surgeons: striving for efficiency and accuracy
Breast surgeons are reliant on their colleagues to prepare them as thoroughly as possible for procedures. Lesions can be small and difficult to locate – they need to work in step with radiology, which works to identify and mark them accurately for excision.
Surgical removal of a breast, or both breasts, can take a huge emotional toll on patients and their loved ones. Not only is it a major surgery, but the cosmetic and psychological impact can also be debilitating. Over recent decades, surgeons have been more concerned about over-treatment and have adopted more minimally invasive methods. Here, the interdisciplinary team is essential as the surgeon needs to have all information available to make a decision on the best course of treatment – the size and location of the lesions, their pathology and potentially the genomic profile of the patient for example.
Pathology: guiding the treatment path
While pathologists are among the healthcare professionals who have least interaction with patients, their role and the amount of the time needed to deliver an accurate result has a huge impact.
Similar to radiology, pathology has been facing workload pressures, with staff shortages meaning that patient turnaround times can suffer. In the UK, these pathology staff shortages existed well before the pandemic, where just 3 in 100 departments had enough staff to meet clinical demand4.
Digital pathology has the potential to be a gamechanger. The easy-to-navigate digital imagery will help to provide a more complete picture. This means increased flexibility in ways of working, as images can be readily shared with people working remotely or in other centres. When combined with AI, it will also mean less manual searching as an algorithm will quantify the number of nuclei, rather than pathologists counting manually.
Like radiologists, pathologists must work side by side with the interdisciplinary care team, as they need to constantly monitor results, make an assessment on the success of a course of treatment and suggest new approaches, should these be required. In this respect, horizon scanning is very important. Breast cancer is an extremely dynamic field of medicine. There are constantly new markers, new drugs and treatment techniques that need companion diagnostics, for which pathology is responsible.
Genomic testing is an increasing area of focus in pathology, as genomic markers help to provide treatment recommendations in early-stage breast cancers5. It is also becoming part of the conversation when it comes to personalised screening, given inherited genes can be a predictor for developing cancer – notably BRCA1 and BRCA26. Pathologists must not be forgotten when making policy decisions related to risk stratification, given the potential impact on workload when resource is already stretched.
Hologic: supporting innovation and advancing partnership
At Hologic, our commitment to the Breast Continuum of Care extends beyond product innovation and puts partnership at its core. Innovation rarely happens in isolation – it requires partnership between clinicians, scientists, engineers and technologists who share a vision for patient care and a mission to improve breast cancer survival and patient outcomes.
Breast health is a fast-paced, constantly evolving field. We are hopeful about the future and relentless about our quest to use science-based evidence to keep up the pace and deliver better outcomes for the women we serve.
Tim Simpson is General Manager at Hologic, UK & Ireland
1 American Cancer Society [Internet]. Types of breast cancer. 2021. Available at: https://www.cancer.org/cancer/breast-cancer/about/types-of-breast-cancer.html Last accessed October 2023
2 Radiology Society of North America [Internet]. Radiology facing a global shortage. 2022. Available at https://www.rsna.org/news/2022/may/Global-Radiologist-Shortage Last accessed October 2023
3 RCR Clinical radiology census report 2021. Royal College of Radiologists. https://www.rcr.ac.uk/rcr-clinical-radiology-census-report-2021#:~:text=The%20consultant%20radiologist%20workforce%20shortfall%20currently%20stands%20at,%283%2C166%20WTE%29%20by%202026%20factoring%20in%20rising%20demand. Last accessed October 2023
4 Breast Cancer Research [Internet]. Pathology staff shortages causing delays to cancer diagnosis, says report. 2018 Available at https://news.cancerresearchuk.org/2018/09/18/pathology-staff-shortages-causing-delays-to-cancer-diagnosis-says-report/ Last accessed October 2023
5 Ehsani S, Wisinski K B. Genomic Testing in the Management of Early-Stage Breast Cancer. J Clin Outcomes Manag. 2017; 24(5): 229–238.
6 NHS [Internet]. Predictive genetic tests for cancer risk genes. 2021. Available at: https://www.nhs.uk/conditions/predictive-genetic-tests-cancer/. Last accessed October 2023