Abstract
Surgical pathology is the medical specialty in charge of cancer diagnosis. Although very important since oncology development, its link with overdiagnosis and overtreatment remains understudied. Despite big mediatisation, molecular biology has not brought much progress to tumour classifications. On the contrary, the silent apparition of immunohistochemistry at the end of the 1980's improved much of tumour classifications so significantly that it could cast doubts in some trials’ results of that period. This article discusses how the booming and abuse of immunohistochemistry might have led to overdiagnosis. It also highlights that the ISO 15189 standardization, as well as the tumour classification complexity, might function to induce overtreatment. In summary, critical reading and understanding of pathology reports by general practitioners are essential. Therefore, family doctors should not hesitate to discuss the cancer diagnosis with the pathologist, and in some cases also question the oncologist decision. This approach can be considered a quaternary prevention action which can prevent overtreatment.
Highlights
Surgical pathology is the medical specialty in charge of cancer diagnosis
New review studies could be performed, since slides or paraffin blocks are stored for long time, which makes possible to review the 1970-1990 cases. This context is highlighted on the British Pathology Association website ‘conversation with pathologists’, where it is possible to listen to pathologist David A
The same slide image can be of a melanoma, if the patient is an adult, or a congenital naevus in the case of a newborn! the industrialization of pathology might induce overdiagnosis, backed by pharmaceutical industry concerned with a positive association of immunohistochemical test to treat patients
Summary
Gatter et al have demonstrated that immunohistochemistry helps the pathologists to classify tumours and that without the advent of immunohistochemistry, big mistakes have been made. Ventana invented and sold around the year 2000 the first automate which could perform the whole immunohistochemistry technique by itself It was a huge success and Ventana took the first rank in the world immunohistochemistry market: in 2011, in the US, it had more than 50% of the immunohistochemistry $650 million market.[13] In 1998, the US Food & Drug Administration approved Roche’s Herceptin (trastuzumab) as a chemotherapy drug for breast cancer. In order to prescribe Roche’s Herceptin, oncologists must have a positive HER-2 test It is made on the breast cancer slides by pathologists by means of immunohistochemistry. In 2014, one of the most important pathology review study noticed that ‘Certain recommendations, those related to repeating the test and pathological concordance, have lower levels of supportive evidence than existing key recommendations”.16 This recent HER-2 test cut-off change may increase Herceptin prescription for the years to come. ISO 15189 states that the integrated systems should be preferred and most laboratories, which own Ventana automates, will be pushed to buy Ventana antibodies, in case of ISO 15189 being strictly applied
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