Breast cancer pathologist: Getting the right diagnosis is crucial
Lavinia Middleton, M.D.
When I first went to medical school, I thought I’d be a cardiologist. My dad was very sick with heart disease while I was growing up, so I spent a lot of time in the hospital. I saw how the cardiologists treated him and other patients, and I wanted to heal people in the same way.
But once I actually got to medical school, I found that I was more interested in following pathology specimens to the lab to find out what my patients actually had, rather than in caring for them at their bedsides. I also loved the mental challenge of making a diagnosis, especially in very unusual or difficult cases.
Precise treatments based on precise diagnoses
All patients who come to MD Anderson will have their diagnoses confirmed by one of our pathologists. We do this first to make sure that their staging is correct, their tumor size is correct and their margin assessment is correct — because all of these factors can affect which treatment options they’re offered.
About 25% of our patients will see a change in their diagnosis. That means one out of every four times, a second opinion can be a game-changer. That’s why I believe everyone should get a second opinion, whether they’ve been diagnosed with cancer or not.
It doesn’t happen very often that we change someone’s diagnosis from benign to malignant or from malignant to benign, but when we do, it is very significant. Because we offer precise treatments based on precise diagnoses. So, even a slight adjustment can affect, for instance, what treatment options patients are offered first, such as chemotherapy or surgery.
My family’s experience with a misdiagnosis
I know how important it is to get an accurate diagnosis, because my family was directly affected by an inaccurate one. My uncle was incorrectly diagnosed with lung cancer while I was doing my residency training at the National Institutes of Health. I had him send me his pathology slides to review, and I discovered that he didn’t have lung cancer after all.
What my uncle actually had was a very rare type of infectious disease in his lungs. He’d gotten it by inhaling soil particles on farms, as he was a dairy equipment salesman and installer in Wisconsin. We were able to recommend the appropriate treatment and he made a complete recovery. But if my uncle had accepted his first diagnosis, he might have undergone all kinds of unnecessary treatment for something he didn’t even have.
Subspecialists make the difference
MD Anderson is unique because we have subspecialists to treat each disease. That means each pathologist looks at that particular type of tissue all day, every day, and has seen hundreds of thousands of slides during the course of his or her career.
MD Anderson has 12 pathologists dedicated to breast cancer alone. I am one of them. And I love that I get to use my gifts to help our patients. It’s what gets me up in the morning.
I grew up watching Quincy on TV and reading Nancy Drew and Hardy Boys books, and I think of what I do as a kind of detective work. I love studying slides and consulting books to make sure my patients are getting the right diagnosis. Because the right diagnosis leads to right treatment and better patient outcomes.
Lavina Middleton, M.D., is a professor in Pathology, Deputy Chief Medical Officer, and the Medical Director of Quality Assurance, Surgical Pathology.