HEALTH PSYCHOLOGY

Health Psychology and Concordance to Treatment

Health Psychology and Concordance to Treatment

Proper medical and surgical treatment of cancer requires a clear understanding of the extent of disease at the time of initial presentation. Although initial physical examination and radiographic findings provide information for clinical staging, most treatment decisions are based on pathologic staging with information derived from the pathology report. Breast cancer treatment decisions require accurate and complete information on specimen and tumor description, orientation and analysis of surgical margins, and full reporting of histologic features. Unfortunately, not all pathology reports contain the information needed for clinical decision-making.

Over the past few decades, breast-conserving therapy (BCT) has emerged as the preferred treatment for stage I and II breast cancer. In addition, regardless if the lesion is IDC, ILC, ductal carcinoma in situ (DCIS), or a combination, achieving negative margins at the initial surgery will decrease the chance of tumor recurrence.3 Breast imaging plays a crucial role in determining which patients are eligible for BCT. Magnetic resonance imaging (MRI) has been shown to be more accurate than ultrasound and mammography in estimating the local extent of invasive breast cancer and DCIS. (Rodenko and Pruneda 2006 1415-1419) However, controversy still exists surrounding the proper use of MRI in newly diagnosed breast cancer. The most common indications for MRI in newly diagnosed breast cancer patients are women with occult breast cancer, difficult/complex conventional breast imaging, and in monitoring response to neoadjuvant therapy.2 Even though MRI offers the advantage of high sensitivity, the disadvantages include low specificity, which can lead to more imaging, biopsies, and more aggressive surgery.

Few studies have examined the accuracy with which MRI estimates the pathologic size of invasive breast cancer and DCIS. The studies that have been performed have reported a wide range of correlations. In addition, most of these studies had relatively low sample sizes ranging from 33 to 115 patients. (Mumtaz and Davidson 2007 417-424) Finally, few studies have examined which factors correlate with overestimation and underestimation of invasive tumor size on MRI. The goal of this study was to analyze the concordance between MRI and invasive breast cancer pathologic size and to examine which factors are associated with discordance.

To improve the quality of pathology reporting, the College of American Pathologists (CAP) developed and published guidelines designed to standardize the reporting of surgical specimens for all malignancies. The guidelines provide templates by organ site and by type of surgical specimen. The guidelines were published in September 2008 and widely distributed throughout the pathology community in America, but there was no requirement for their mandatory use. (Kepple and Klimberg 2005 623-627) To date, there has been no evaluation of the extent to which these guidelines have been implemented in practice. The purpose of this study was to determine the degree to which breast cancer pathology reporting adheres to the CAP practice guideline recommendations in western New York.

The choice of treatment for solid tumors depends in large part on the pathologic features of the primary tumor, surrounding tissues, and regional lymph ...