‘A lot of patients just hear breast cancer’
Dr Marie Staunton wants patients to know there are multiple diseases under the umbrella term ‘breast cancer’ and for most the prognosis is excellent
Dr Marie Staunton: “When they [patients] are given their prognostic information and when the surgeon indicates to them the type of breast cancer they have and that they’re likely to have an excellent outcome, they actually should believe it.”
Pathologist Dr Marie Staunton has seen a dramatic improvement in the field of symptomatic breast cancer since she completed her training in 1999.
“When they [patients] are given their prognostic information and when the surgeon indicates to them the type of breast cancer they have and that they’re likely to have an excellent outcome, they actually should believe it. A lot of patients just hear breast cancer, and they just think of the most awful outcome.”
According to Staunton, this transformation is due in part to the rationalisation of the cancer services under the ministership of Mary Harney with Prof Tom Keane, who was then director of the national cancer control programme. “Before that, there wasn’t as much standardisation. And that has really dramatically improved the service, at least from my perspective” she says.
Staunton describes the treatment of patients in Ireland as “very much a team-driven process”, as complete collaboration is necessary to ensure the best possible treatment is provided. “There has to be concordance between the surgical findings, the radiology findings, the pathology findings. We work in complete harmony – there is great trust between each other,” she says.
She neatly summarises this point with reference to the “no-blame safety culture” of the airline industry.
“The patient sees the surgeon, and, in a way, the surgeon is the most important person. The pilot can fly the plane, but it is not much good if the maintenance crew have not put any wheels on the plane or there is no fuel. It is a collaboration between everybody involved – you need all parts of it to work seamlessly and with trust. We often use analogies to the airline industry because in the airline industry, air travel is so safe. If incidents occur in the airline industry, it’s not a culture of blame, it is a culture of explaining what happened so that people can learn from it in the future so within our system when something occurs, we like to learn from each other in an open, non-threatening environment.”
Not one disease
Staunton wishes more people understood that breast cancer is not just one disease. “It’s an umbrella term. And, within it, there are multiple diseases which have very different outlooks – although from the patient’s perspective, breast cancer is considered a single disease process, it’s like a family of diseases, and within it, there are different types of breast cancer. Some of which are highly unlikely to kill a person and then others are aggressive and need absolutely every possible available treatment to maximise the chances of the person having a good survival, but it’s not one disease – within it there’s a range of likely outcomes depending on the subtype. And that will be primarily dictated by your pathologist.”
As part of raising awareness (and funds) around the issue, Breast Cancer Ireland’s Avonmore Slimline Milk-backed Great Pink Run takes place on Saturday, October 13th, in the Phoenix Park, Dublin, and on Sunday, October 14th, in Kilkenny Castle Park.
As a pathologist, Staunton can spend hours a day looking down a microscope and so by working with the multidisciplinary team she is privy to “all of the real-life elements” of her work. “I actually enjoy the interactions with the multi-disciplinary team. I enjoy finding out about how people have done after their diagnosis. We will hear the implications, we kind of feel involved in the patient’s care and in the patient’s journey. We hear about whether they have children, what age they are, we’re very connected with the implications of a diagnosis of breast cancer on patients because we hear the story surrounding them.”
Sense of trust
Although the cancer service has come under intense scrutiny of late, Staunton feels it is crucial that a sense of trust in those delivering the service is maintained. However, she adds they need to be “correctly trained in the beginning” and supported in their professional development.
“We must have trust that we are trained properly and that we are continuing to do things which are evidence-based and protocol-based. Because of the monitoring of our data year-in year-out, if there are any adverse trends, they will be spotted and we can intervene. That we can learn from what we’re doing well and the things we are not doing well, that we can improve the service from the information we glean from our audits and our monitoring of data, that we can use that to continue to improve the service.
“I think the public needs to realise that it is not possible to deliver a blanket guarantee that everything will be perfect, but by making your system as safe as possible, while you cannot guarantee a perfect outcome, you can give the best possible outcome at that particular point in time.”
This culture of accountability is particularly important in her line of work. “In pathology and radiology, it is possible years or decades later for our microscope slides to be taken and reviewed by an external person in another establishment and the same for the radiology images, so there is a permanent record kept of our work. We have no ego about getting a second opinion. After all, I’d rather get a second opinion here and now rather than finding an error five or 10 years’ later.
“We monitor within our department the number of time a pathologist uses second opinions. So if a person never gets second opinions, you would think they’re too sure of themselves. A certain degree of humility is important,” she says.
“If you weren’t willing to be open about the things you do well and the things you do less well I don’t think you could survive in pathology in the current climate. Because it is so monitored for the patient’s benefit.”