• Michael Misialek, MD

Inside Breast Tumor Board: What You Need to Know

October is breast cancer awareness month. This year an expected 231,840 cases of invasive breast cancer will be diagnosed in women, along with 62,290 cases of non-invasive, or in-situ, breast cancer. About 1 in 8 women will develop invasive breast cancer. More than 40,000 women will die from breast cancer this year. Not only is early detection important, but prompt treatment by an expert team of specialists is crucial. An effective tool used by many care teams is the tumor board.

What is a tumor board?

Tumor board can be themed around a particular organ, i.e. breast, lung, GI, gyn, etc. This is a team of physicians and other health care professionals that meets regularly to discuss diagnosis and management of patients with newly diagnosed disease, guaranteeing more consultation about the best approach for your care.

Who is present?

The team typically includes oncology, radiology, surgery, pathology, radiation oncology, nursing, patient navigators, social workers and a genetic counselor.

How are cases selected?

Depending on time, volume and local institution practice, the cases reviewed could be all new malignant diagnoses or cases that are specifically requested. They may also include follow up cases, cases in treatment where a decision must be made.

The presentation

Tumor board typically begins with the patient’s oncologist or surgeon giving a short history. Next, a radiologist will show pertinent imaging (mammogram, MRI, ultrasound). The entire meeting room sees the films. Then a pathologist will present the biopsy results. These are either projected directly from a microscope or prepared beforehand. The pathologist explains the diagnosis and the important prognostic features. An open discussion then ensues regarding management and next steps, i.e. surgery, chemotherapy, radiation, etc…

The value of a team approach to patient care assures the best care possible. Each member of the team is important. As a pathologist, I know all treatment begins with a diagnosis. A pathologist is there at the beginning and throughout a patient’s journey.

What can patients do?

Ask if your institution has a tumor board and if so, request your case be presented. Then speak with your physician about the group’s recommendations.

Inquire about the pathology laboratory that will examine your tissue sample. Is the laboratory accredited? The College of American Pathologists (CAP) accredits more than 7,600 laboratories worldwide and provides an online directory for patients.

Make sure the pathologists who are examining your tissue samples are board-certified.

If your hospital doesn’t have a multidisciplinary breast conference, consider getting a second opinion. Second opinions are always welcome. Have your doctor send the biopsy slides to another laboratory and request they be read by a pathologist who specializes in breast pathology. Insurance typically covers second opinions.

Seek out accurate and credible resources to help you understand your pathology report and diagnosis, such as the CAP's resource, “How to Read Your Pathology Report.” Understand the details behind your biopsy and pathology report to help make informed decisions about your health.

Most accredited surgical pathology laboratories include second opinion slide review as part of their quality management program. Ask about this.

To learn more about the vital role of the pathologist, visit Get the facts about your health. Get a copy of your pathology report. Understand it and ask questions. Discover the other member of your care team, the pathologist.

Stay tuned to Path Report during the month of October for continuing stories on breast cancer. What you need to know and how pathologists are working to make patients healthy.

#breastcancer #patholog #tumorboard

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