The discovery in Canada of an extremely large margin of error in reading breast cancer pathology slides and the subsequent preventable deaths that occurred have lead to public outrage and the demand for national standards. But don’t think that misreading of pathology slides is only a problem that can occur up north in the land of socialized medicine. The financial push behind our cost controlled medical system in the U.S. doesn’t exactly incentivize long, thoughtful, diligent behavior in any other part of our care, so why would the laboratory be an exception?
As the bad-ass, proactive, young adult cancer patient I hope you are, my guess is you grill your oncologists and radiologists, but how about raking your pathologist over the coals? If you look closely on your medical record you might see typed in the corner the name of the white lab coat clad pathologist who was huddling over a microscope determining the future of your life, but that is as close as we get to meeting “the man” behind the curtain. Well, I say screw that.
Demand a second opinion on your pathology when the results seem to not fit the pattern of your disease or leave your doctors scratching their heads. Perhaps your insurance or medical care coverage will balk at the expenses at first, but you just might win using the good argument that pathology is what determines how much treatment and surgery you need and you may save them bundles in the long run.
If you cannot get a second opinion from the pathologist, at least have your doctor talk to the pathologist, live on the phone. I asked a doctor to do this once for me and strangely enough when they took a second look they decided well, maybe he would actually classify the cell type differently.
Reporter Allison Gandey wrote an article on the Canadian crisis in which she interviewed Jared Schwartz, MD, president of the College of American Pathologists. He asked this question for oncologists: “Do you know who is examining and interpreting your pathology?” In Gandey’s article Dr. Schwartz suggests that doctors adopt a more collaborative approach and work more closely with one another. “You have to have a relationship with the person looking at that slide. And clinicians, like patients, should have the ability to request a second opinion.”
For a brief, cliff notes-like lowdown on pathology, visit the National Cancer Institute website and read Pathology Reports: Questions and Answers.