Anatomical pathology and cancer research
For many people, an anatomical pathologist researching cancer would not be the most obvious link. However, for Dr Rosemary Balleine, one discipline goes hand-in-hand with the other.
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“Anatomical pathology is very much focussed on the diagnosis of cancer and while it has a reputation for being a fairly static form of medical practice, the pathologist is uniquely placed to examine all forms of cancer and the full spectrum of disease from premalignant changes to very advanced lesions,” she says.
“Moreover, the pathologist can put these observations into context with other forms of change in the human body such as inflammation, healing, degenerative change or hormonal effects. So conceptually, it is an easy leap for a pathologist, whose job it is to look at a human tissue specimen and answer the question what is it?’, to become engaged in thinking more deeply about what cancer actually is, how it grows and how you could stop it.
“Working in pathology led me to view cancer as both terrible and fascinating, and this in turn led me to a career in cancer research,” she says.
Rosemary has used her experience in pathology to research improvements in breast cancer diagnosis and treatment, and to ultimately add to the understanding of different stages of breast cancer and the genes that cause the disease.
“Breast cancer pathology is the particular focus of our research group,” she says. “Our overall aim is to refine the routine assessment of breast tissue removed in the course of investigation or treatment for breast cancer, so that as much information as possible is available to guide the patient and her clinicians.
“For example, we recently reported a study using detailed molecular analysis to subdivide a very early form of breast cancer called ductal carcinoma in situ (DCIS) into two categories based on intrinsic aggressiveness (molecular grade) and further described an approach to apply this classification in a routine diagnostic setting.
“In other ongoing work we are systematically examining the pathology of breast cancer in multiple members of families with a high breast cancer incidence to determine whether this can provide information on the underlying genetic basis of disease,” says Rosemary.
The exciting thing about cancer research is that it is working – every year new things are learned, new progress is made and gradually we come to understand aspects of cancer that we could only guess at in the past.
Rosemary sees the major challenge in managing cancer as matching the risk from the disease to the potential risks and benefits of treatment. Something she believes tissue pathology can play a major role in.
“The intrinsic aggressiveness of breast cancer is quite variable and an insightful assessment of each case has potential to quite directly inform management decisions,” she says.
“Rapid progress is being made in this area but there remains an urgent need for further improvements. For example, it is currently fairly straight-forward to identify a form of cancer that has potential to behave aggressively, but it is more difficult to confidently identify a cancer or premalignant change in the breast that poses only a low risk. This is an important area to keep working on.”
Even though this is an issue Rosemary is confident will be solved through research, she is also aware that other factors will become important for prevention, diagnosis and treatment of breast cancer in the future.
“Incremental improvements will come from continuing research in this area and I am sure that some of the particular challenges we currently face, such as identification of low risk lesions, will be solved,” she says. “However, it is also certain that new issues will emerge from changes to practice or population cancer risks that we will need to respond to. For example, the introduction of breast cancer screening and widespread use of hormone replacement therapy have had an impact on breast cancer research priorities in recent years.
“Other issues are likely to arise over time so our approach to cancer research needs to be sufficiently flexible to respond to the big questions of the day.”