Breast Pathology

There can be a scarcity of breast fellowship-trained professionals, leading to a limited pool of expertise in the subspecialty. Additionally, the workload in breast pathology can be quite high, with a considerable number of blocks and slides produced per case, often exceeding the allotted relative value unit. This high workload may necessitate additional fellowship training beyond general pathology. From a personal perspective, some pathologists face challenges transitioning from specialized breast and gynecological pathology to general pathology, requiring time to adapt to the broader scope of practice.

Typically, just one year.

On-call responsibilities typically revolve around handling frozen sections when covering those cases. This aspect of on-call duty ensures prompt and accurate diagnoses for patients undergoing surgery, particularly in urgent situations requiring intraoperative consultation for margins and sentinel lymph nodes and in nipple-sparing mastectomies.

Breast pathology typically involves a high case volume—how high, of course, depends on the institution. This subspecialty contributes significantly to the total workload of a pathology lab, especially in tertiary care centers. Cases often include complex specimens that require thorough examination, making them time-consuming compared to more straightforward biopsies seen in other specialties. Ancillary tests such as immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and molecular tests are common in this field, particularly for diagnoses that necessitate additional characterization and precision.

Breast pathology involves extensive interaction with various medical specialties, contributing to a multidisciplinary approach in patient care. These specialties include gynecologic oncology, obstetrics and gynecology, breast surgeons, radiologists specializing in breast imaging, hematopathologists, general surgeons, radiation oncologists, and oncologists. This collaboration often extends to multidisciplinary conferences where pathologists, radiation oncologists, radiologists, and breast surgeons converge to discuss and plan patient-management strategies, ensuring comprehensive and coordinated care for individuals with breast-related conditions.

There are several organizations related to breast pathology, including the International Society of Breast Pathology (ISBP), the San Antonio Breast Cancer Symposium (SABCS), and the Lynn Sage Breast Cancer Society. Additionally, there is the North American Breast Pathology Conference (NABPC), along with other subspecialty organizations focused on both pathology and clinical aspects of breast health like the Association of Breast Pathology (ABP) in the UK and the International Society of Gynecological Pathologists (ISGyP).

It pairs well with several other subspecialties, facilitating a multidisciplinary approach to patient care. These include gynecologic, gastrointestinal (GI), pediatrics, general surgical, and cytopathology. This collaborative approach ensures comprehensive evaluation and management of patients with breast-related conditions, covering a wide range of diagnostic and treatment considerations.

While direct patient interaction is not routine, there are instances where pathologists in this field may engage with patients. This interaction is often facilitated when a breast pathologist is also trained in cytopathology, allowing them to perform fine-needle aspirations (FNAs) of breast masses, recurrences, and lymph nodes. Although patient interaction may be limited, there are opportunities for pathologists—particularly during fellowship training—to gain valuable experience by contributing directly to patient care and diagnosis in breast-related conditions.