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.
"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
𔄀what 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."
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