A new era for breast pathology

Breast pathology is undergoing rapid change, with digitalisation, AI, and new biomarkers transforming both working methods and treatments. To mark Pink October, we spoke to Unilabs’ senior physician, Dr Eugenia Colón, about how scientific and technological developments in breast cancer are enhancing diagnostics and allowing pathologists to play an increasingly central role in precision oncology.

Innovation for impact

“The most rewarding aspect of my work is that our diagnoses directly influence treatment. Assessments of tumour type, margin status, lymph nodes and biomarkers such as ER, PR and HER2, guide decisions about surgery, systemic treatment, and targeted therapies, and directly influence a patient’s prognosis,” says Dr Colón. She also describes how scientific developments in breast cancer are making the profession feel even more exciting to work in. “New biomarkers, molecular subtypes, and so-called companion diagnostics, for example, HER2-low (low occurrence of the HER2 protein), is now clinically relevant. This means that pathologists are playing an increasingly central role in precision oncology.”

Augmented pathology

Technological developments in breast cancer care are advancing rapidly, with digital pathology and AI algorithms increasing diagnostic precision and efficiency.

Dr Colón says whole-breast scanning (a standardised, complete analysis of breast samples performed by a pathologist) and AI can reduce variation between assessors and free up time for more difficult cases, allowing for a form of augmented pathology. “AI can take care of routine tasks, while we focus on the overall assessment and clinical interpretation. It’s about enhancing, not replacing, the role of the pathologist. For the technology to work in practice, it requires validation, regulatory approval, and smooth integration into our systems,” she explains.

She says, in the future, she hopes to see fully-integrated digital pathology with validated AI that is approved and smoothly integrated into workflows, ensuring that, above all, human expertise is enhanced and empowered by technology.

More markers, greater responsibility

Dr Colón says developments in breast cancer treatment are placing new demands on pathology. “New therapies, such as antibody-drug conjugates for patients with HER2-low, are blurring the boundaries between diagnostic categories. This requires standardisation and continuous training to maintain high quality.”

Molecular profiling is also becoming increasingly important. She believes that future pathology reports will combine classical histology with molecular and spatial biomarkers. “Instead of just describing the appearance of the tumour, we will be able to provide an integrated risk profile and guidance for treatment. But development must also be equitable. It is important that new technologies and therapies are not only available to certain patient groups or in certain regions. Fairness in diagnostics and care is crucial.”