Breast Pathology Fellowship

The breast pathology service at Brigham and Women's Hospital (BWH) is a unique service that provides the following:

1. Clinical diagnostic services to BWH and Dana-Farber Cancer Institute (DFCI), the leading breast cancer program in the country, to guide treatment of patients seen by medical, surgical and radiation oncologists and to guide management of patients who undergo breast core needle biopsies performed by BWH radiologists.
2. Educational training in breast pathology to residents and fellows, with the goal of producing experts in breast pathology who can advance the field and promote the health of women with breast disease. This also includes teaching research skills to fellows with research projects designed to develop organizational skills and a rigorous scientific method utilizing all of the resources and technology of BWH, DFCI and Harvard Medical School.
3. Personal consultation service for pathologists, clinicians and patients around the United States and internationally, providing diagnoses for the most intriguing and challenging breast pathology cases, including Dr. Stuart Schnitt's Personal Consultation Service (>600 personal consultation cases annually).
4. Research support to DFCI and BWH medical, surgical and radiation oncologists involved in breast clinical trials.

Our educational activities are focused on training fellows with the following objectives in mind for them:

1. Develop clinical expertise in the interpretation of breast pathology and ancillary studies to develop a clear understanding of diagnostic pitfalls and to be able to recognize and minimize diagnostic errors.
2. Develop the ability to craft comprehensive pathology reports that encompass and acknowledge clinical challenges related to the pathologic findings, and that impact patient treatment decisions.
3. Develop communication skills with clinicians.
4. Develop graduated responsibilities to be able to perform independently in practice.
5. Develop teaching skills and experience to mentor junior colleagues.
6. Develop the skills to organize and complete clinical and translational research projects.

Fellows on the breast service preview and work up in-house and consultation cases including institutional consults and personal diagnostic consults. Fellows learn to craft detailed, consistently high standard pathology reports, incorporating relevant clinical information available from the medical record and imaging reports where appropriate, and they write succinct salient notes to clinical colleagues at the end of more complex pathology reviews.

A specific feature of more complex breast pathology consultation is the need to coordinate multiple types of data, multiple pathology reports, imaging findings, immunohistochemistry, ISH and multiple gene assays, into one consolidated report. We teach trainees to identify inconsistencies and to resolve them. These are often critical for optimal patient care and a proactive approach from fellows to take responsibility for this as their skills develop is encouraged.

Clinical correlation and communication skills are developed by discussion of case details over the microscope one-on-one at sign out, involvement in e-mail communications with clinical colleagues, by attendance and presentation at the weekly DFCI Breast Oncology Tumor board, attended by a multidisciplinary team of breast cancer specialists including medical, surgical and radiation oncologists, radiologists, and pathologists, and at the bi-weekly pathology-radiology correlation conferences.

A monthly Longwood Breast Interesting Case Conference held jointly with Beth Israel Deaconess Medical Center (BIDMC) breast pathology faculty and fellows is an opportunity to share and review interesting and unusual breast cases seen by the BIDMC and BWH breast pathology services. Teaching and mentoring skills are developed throughout the training, with fellows expected to provide tutorials to medical students in basic breast pathology, present at weekly Breast Oncology Tumor boards, and present a breast 'long' and 'short' case at the Dana-Farber Cancer Institute Oncology Pathology conference.

Case volumes available for fellows to review are ample. In 2019, over 6700 cases were reviewed on the breast service comprising more than 4400 consults of which >960 were personal consults (i.e. very challenging diagnostic cases). More than 300 in-house excisions and over 2000 in-house biopsies were reviewed. Separately evaluated ancillary study reports were issued on over 500 cases.