Medscape recently posted an article that discusses the need for standards for acquiring, preserving and storing cancer tissue, citing a recent Viewpoint article in JAMA by Drs. Laura Goetz, Kelly Bethel, and Eric Topol. If you have the chance, I highly recommend you pathologists read the full article as there is a valuable discussion of the need for appropriate specimens for next-generation cancer genomic testing. Basically, we need to move beyond the idea that "diagnosis" just means having enough tissue or cells to make a morphological diagnosis (including immunohistochemical stains) to one where the "diagnosis" is extended to include molecular testing, even whole-genome sequencing.
I do admire Dr. Topol's principled stand to get patients to drive demand for obtaining appropriate tissue for genomic testing (a refreshing free market approach!). However, I must take exception to comments made by Dr. Topol in the Medscape article where he states (bold is my emphasis):
Dr. Topol notes that there is much resistance from pathologists, in that it would be expensive to have fresh frozen specimens because it requires increased space, monitoring, and electricity for storage in freezers, there would be problems with reimbursement, and so on. "Basically, every excuse under the sun," he said. "But if it was one of them having a new diagnosis of cancer, they would probably like to have as much information as possible."
After having read the JAMA article, I have no idea why Dr. Topol takes such a gratuitous--and unnecessary swipe at pathologists. His remarks and imputations are as ignorant as they are offensive. While Dr. Topol correctly assesses the factors that are contributing to the slow development of processes, standards, and facilities to obtain, preserve, and maintain tumor specimens appropriate and optimal for molecular and genomic testing, resistance from pathologists is absolutely not one of the factors. In fact, the College of American Pathologists, our leading voice, has taken a lead role in developing such standards and educating pathologists in molecular and genomic oncology. See the CAP's resource page for molecular oncology.
Dr. Topol's assessment of the factors that are hindering the development of more widespread tissue procurement for genetic testing is solid--viz., trend of less tissue obtained for diagnosis, logistical issues with fresh frozen specimens, reimbursement--but his conclusion blaming pathologists is absolutely wrong. The resistance that pathologists are putting forth has nothing to do with the concept of acquiring fresh frozen tissue (which we agree wholeheartedly with!) but with the facts that 1) we are responsible for establishing and maintaining an accredited facility for providing this service and 2) we are largely responsible for paying for this service which is neither reimbursed professionally or technically or adds to the "bottom line" of the institutions that we serve. Since about 75% of cancer care is delivered at the community hospital level, perhaps Dr. Topol has some solutions for how these hospitals specifically are going to manage and pay for this--regardless if one of the pathologists (or even one of the administrators) has a new diagnosis of cancer.
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