Breast pathology guideline implementation in low- and middle-income countries


  • Shahla Masood MD,

    Corresponding author
    1. Department of Pathology, College of Medicine– Jacksonville, University of Florida, Jacksonville, Florida
    • Department of Pathology, University of Florida, 655 West Eighth St., First Floor Clinical Center, Jacksonville, FL 32209
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    • Fax: (904) 244-4060

  • László Vass MD, PhD,

    1. Department of Pathology-Cytopathology, Flor F. University Hospital of Pest County, Budapest, Hungary
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  • Julio A. Ibarra Jr MD,

    1. Department of Pathology, Orange Coast Memorial Medical Center, Fountain Valley, California
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  • Britt-Marie Ljung MD,

    1. Department of Pathology, Division of Cytology, University of California at San Francisco, San Francisco, California
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  • Helge Stalsberg MD,

    1. Department of Pathology, University Hospital of North Norway, Tromsø, Norway
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  • Alexandru Eniu MD, PhD,

    1. Department of Breast Tumors, Cancer Institute “Ion Chiricuta,” Cluj-Napoca, Romania
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  • Robert W. Carlson MD,

    1. Department of Internal Medicine, Division of Medical Oncology, Stanford University, Stanford, California
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  • Benjamin O. Anderson MD,

    1. Department of Surgery, University of Washington, Seattle, Washington
    2. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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  • on behalf of the Breast Health Global Initiative Pathology Focus Group

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    • The BHGI Pathology Focus Group members included Shahla Masood (Leader), László Vass, Julio A. Ibarra, Jr, Britt-Marie Ljung, Helge Stalsberg, and R.F. Chinoy (Alexandru Eniu and Robert W. Carlson as invited observers).

  • Complete financial disclosures are presented at the end of this article.


The quality of breast healthcare delivery and the ultimate clinical outcome for patients with breast cancer are directly related to the quality of breast pathology practices within the healthcare system. The Breast Health Global Initiative (BHGI) held its third Global Summit in Budapest, Hungary from October 1 to 4, 2007, bringing together internationally recognized experts to address the implementation of breast healthcare guidelines for the early detection, diagnosis, and treatment in low-income and middle-income countries (LMCs). From this group, a subgroup of experts met to address the specific needs and concerns related to breast pathology program implementation in LMCs. Specific recommendations were made by the group and process indicators identified in the areas of personnel and training, cytology and histopathology interpretation, accuracy of pathology interpretation, pathology reporting, tumor staging, causes of diagnostic errors, use of immunohistochemical markers, and special requirements to facilitate breast conservation therapy. The group agreed that the financial burden of establishing and maintaining breast pathology services is counterbalanced by the cost savings from decreased adverse effects and excessive use of treatment resources that result from incorrect or incomplete pathologic diagnosis. Proper training in breast pathology for pathologists and laboratory technicians is critical and provides the underpinnings of programmatic success for any country at any level of economic wealth. Cancer 2008;113(8 suppl):2297–304. © 2008 American Cancer Society.