Breast cancer: Diagnosis and treatment intertwined

Breast cancer is the most common malignancy in Filipinos, outranking lung cancer even as it primarily affects women (men do develop breast cancer but rarely).

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It is the second leading cause of death from cancer. Fifty-five percent of cases are diagnosed late, due to embarrassment and modesty of having their breasts examined, the expense of seeking medical care or simply lack of access to it.

Once a breast lump is detected, by the patient or her doctor, radiologic imaging via breast ultrasound and/or mammography can stratify the risk of malignancy. But only a tissue biopsy can make the definitive diagnosis, making the pathologist, who examines the biopsy material grossly and microscopically, the final arbiter.

It is not as simple as it seems. Pathologists spend four years to be proficient in making histopathologic diagnoses. Only after one is board-certified can he/she be allowed to practice. Many cases are straightforward and the few more challenging cases may require the expertise of a breast pathologist.

The journey of a tissue biopsy is not that simple either. It requires a series of steps that must be done correctly to optimize the histologic diagnosis of breast cancer, or any type of cancer for that matter.

The single most important step is the proper preservation of the tissue biopsy called fixation. It requires that the tissue be preserved in 10 percent neutral buffered formalin (NBF) in a ratio of at least 10 volumes fixative to one volume tissue (10:1 ratio) within an hour (cold ischemia time) to prevent breakdown (autolysis) of the cellular material.