20 Jul 2021

Breast Pathology Update

Prof Sarah Pinder has provided an update on breast pathology services in July 2021

Breast Pathology Update

I have been asked by the National Co-ordinating Committee for Breast Pathology to remind our surgical colleagues to please be mindful of the difficulties and pressure on histopathology laboratories across the country at present. There is both an increase in workload, partly as a result of the post-COVID recovery and partly a longer term inexorable increase in complexity of breast specimens and of histology reporting. Additional elements include extra technical and medical work being asked of histopathology laboratories as part of the network of genomic laboratory hubs for the national test directory, new biomarkers to be adopted and validated, and all whilst maintaining quality standards and protocols.

This increased workload is in conjunction with a shortfall in trained consultant pathologists; a workforce survey by the RCPath as long ago as 2017 found that only 3% of histopathology departments said they had enough staff to meet demand and almost 1 in 6 posts were covered by locums, or were vacant. More particularly (and one suspects aggravated over the last 18 months) it was clear in 2017 that there was an approaching retirement crisis, as a quarter of all histopathologists were aged 55 or over and there were insufficient trainee doctors in post to fill the gaps. A repeat survey by the RCPath is in progress, but one suspects the situation will be even worse. In addition to the recognised deficit in medial pathology staffing it has become, more recently, increasingly apparent that there are insufficient laboratory staff to fill vacancies and many, if not most, histopathology laboratories are suffering shortages; trained biomedical scientists are like gold dust. Common to all hospital departments there is a shortage of administrative staff in the pathology offices. Staff at all levels may also be self-isolating as their children have been sent home from school, or are themselves off ill.

As one example, one large centre reports 120% breast case volume at present compared to pre-covid levels, with 60% staffing levels in the laboratory, despite some locum cover (when locums can be found) and a backlog of 3800 blocks to cut, whilst being down by one Breast Pathology Consultant. The lead breast pathologist described the situation as being at “breaking point”. From feedback at the national pathology committee meeting it is clear that the situation in this centre is duplicated across many histopathology departments across the UK.

So, thank you for your patience with your pathology services, please give your breast pathology colleagues and the laboratory staff a little love, appreciation and any practical support you can; at the moment they particularly need it.

Prof Sarah E Pinder (on behalf of the National Co-ordinating Committee for Breast Pathology)