Canada's pathology association will unveil national standards at a major conference this weekend that will, for the first time, tell hospital laboratories across the country the best way to determine whether a person has breast cancer and what the treatment should be.
It's a landmark development designed to prevent patients from being misdiagnosed and dying unnecessarily and comes as serious questions are being raised over the adequacy of medical tests performed in Canada.
Pathologists from across the country are gathering in Ottawa to reflect on problems that have exposed serious weaknesses in hospital laboratories and to chart a new course to regain public trust.
At least 300 pathologists and pathology assistants are expected to attend the annual conference, hosted by the Canadian Association of Pathologists.
This year's conference takes place under a grim shadow of missed cancer diagnoses, two major public inquiries and allegations of professional incompetence stemming from serious incidents in four provinces that have raised questions about the quality of medical tests.
“A lot of pathologists are feeling insecure,” said Sylvia Asa, pathologist-in-chief at Toronto's University Health Network, one of the most prestigious cancer research centres in North America. “The whole system has to be rebuilt.”
The association hopes to start the rebuilding process by releasing several reports that will, for the first time, establish workload limits and quantify Canada's critical shortage of pathologists.
But the most significant element of the conference will be the unveiling of new national standards for complex breast cancer tests – the kind at the centre of a major public inquiry into botched tests in Newfoundland.
One of the major challenges will be enforcing the new standards. That's because no province, with the exception of Ontario and B.C., has a regulatory body with the mandate and authority to enforce quality control measures in hospital laboratories. It's just one of the many challenges facing a profession struggling with increasing workloads, a critical shortage of pathologists and a lack of resources.
In addition to providing valuable information hospital laboratories can use to improve quality control and better gauge their performance on a cross-country scale, the association hopes the reports will provide leverage to secure government funding to improve quality assurance systems and professional development.
“I think it's pretty significant,” said president Jagdish Butany. “This way, you can say [to government], ‘This is the accepted standard across the country and we're low on that.'”
But many pathologists, who are responsible for making decisions that determine most of the treatment patients receive, fear that testing standards, improved technology and workload limits won't make much difference.
“I think people are feeling very concerned about the future of pathology given what's gone on,” Dr. Asa said. “The present doesn't look very good, and it's always more disconcerting for some of us to think of the future.”
The problems plaguing hospital laboratories run much deeper than the quality of methods used in the lab, and speak to a systemic lack of resources that have taken a serious toll the quality of cancer and other medical testing.
“I think pathology has been an area that has not received adequate attention on an ongoing basis in recent years,” said Andrew Padmos, chief executive officer of the Royal College of Physicians and Surgeons of Canada. “I think sometimes it takes the appearance of concerns or questions in the public's eye in order to focus the attention of all the stakeholders on those issues.”
Serious questions over the state of cancer testing in hospital labs have been brewing in recent months after revelations of significant problems in four provinces.
An inquiry is continuing in St. John's to determine how nearly 400 breast cancer patients received inaccurate results from hormone receptor tests, which can be used to determine treatment over an eight-year period.
A separate inquiry was launched in Miramichi, N.B., after an audit of pathologist Rajgopal Menon's work found a high number of cases were incomplete or inaccurate.
Health officials in Winnipeg and Owen Sound, Ont., announced separate investigations earlier this year into errors made by two pathologists in those communities.
One of the weekend's highlights will be a presentation by the president and senior representatives of the College of American Pathologists, which oversees quality control in U.S. hospital labs. Although Canada has a national pathology association, it is a voluntary group that doesn't have the authority or funding to establish binding rules and monitor the state of pathology. Dr. Butany hopes that bringing representatives here will result in closer ties with the U.S. organization, which has a multimillion-dollar budget and is considered to have established high standards for laboratory quality assurance.
“I'm extremely positive about [the conference],” Dr. Butany said. “Yes, we've had a few rocks thrown at us but a majority of us do a darn good job.
“Though for many of us the laboratories may not be [as] state of the art we would like them to be, nevertheless we try to do our best. The future, I think, for pathology is tremendous.”
