Breast cancer screening pathology: an assessment of the practise and needsin Belgium and Luxembourg

Education and quality assurance (QA) in breast screening pathology have bee n encouraged by the Europe Against Cancer programme. As a prerequisite for the set-up of a QA programme in Belgium and in the Grand Duchy of Luxembour g, an inquiry was initiated to evaluate the daily practise in breast pathol ogy, the modalities in handling and analysing breast specimens and the will ingness of the pathologists to participate in a QA scheme. Of the 278 maile d questionnaires, 109 confidential and valid questionnaires were returned, meaning a participation rate of 40%. All 109 respondents indicated their wi llingness to voluntarily participate in the further QA programme. Segmental resections for conservative surgery and excision biopsies ranked first and second, respectively, in examination requests. Of the respondents, 50% com plained about the lack of clinical information on the pathology request for m. A multidisciplinary team approach for the diagnosis of screen-detected l esions was deemed desirable by 87% of the respondents, but only 16% of them actually participate in such pre-operative meetings. Even more puzzling is that 75% of the respondents report regular unavailability of the control r adiogram of the surgical specimen removed for non-palpable lesions. One-qua rter to one-third of the pathologists still regularly perform frozen sectio ns on microcalcifications or tumours smaller than 1 cm. However, 81% of the respondents estimate that pre-operative diagnosis is not appropriate for t his type of lesion. The results of this inquiry show that the guidelines fo r the diagnosis of screen-detected breast lesions are not yet fully applied in daily practise. The development of local comprehensive breast teams inv olving a pathologist should improve the co-ordination between the medical d isciplines, represent an important way of disseminating the guidelines on b reast screening pathology and stimulate the relay unit to conduct QA progra mmes.