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Olubukola Ayodele: No Օncology without Pathology

Olubukola Ayodele/LinkedIn

Aug 14, 2025, 19:24

Olubukola Ayodele: No Օncology without Pathology

Olubukola Ayodele, Breast Cancer Lead at the University Hospitals of Leicester NHS Trust, shared a post on LinkedIn:

“As oncologists, we often speak about breakthrough drugs, clinical trials or surgical techniques. But none of it matters without the quiet power of pathology.

Behind every diagnosis of cancer is a pathologist examining slides, decoding cell behaviour, identifying biomarkers, guiding treatment.

I spoke about the importance of knowing the subtype of breast cancer in another post, that information won’t be possible without the pathologist.

In breast cancer, a pathologist doesn’t just tell us whether there are cancer cells in that biopsy or surgical specimen. They tell us:

What type of breast cancer it is (ductal or lobular- which in turn tells me the origin)
Whether it expresses ER, PR, or HER2 receptors
How fast it’s growing (grade)
Whether margins are clear after surgery
Whether there’s lymph node involvement
What the pathogical response is after neoadjuvant treatment
And increasingly, whether there are genetic mutations that matter for targeted therapies

Every treatment decision I make: endocrine therapy, chemotherapy, HER2 blockade, immunotherapy, is anchored in what the pathologist sees and reports.

Pathology is the blueprint.

And yet, it’s often invisible to patients because it’s not the face they see at the clinic. It’s not the voice delivering the diagnosis. But it is the foundation of everything that follows.

That one line on a report, ‘HER2 Positive (3+)’ changes the entire course of treatment.

That ER score? Guides my decision-making.

That sentence notes ‘insufficient sample for full receptor status’? Means I may need to re-biopsy before offering systemic therapy.

In a world of personalised medicine, pathology is no longer just about naming the disease, it’s about understanding it.

It’s about:

Predicting how a tumour will behave
Knowing which drugs will work (and which won’t)
Identifying patients whom we can de-escalate their treatment or who need more

As a breast oncologist, I rely on my pathology colleagues every single day. The quality, clarity, and depth of their work directly impact patient outcomes.

We must advocate for:

Investment in digital pathology and AI tools
Access to quality pathology services globally because in many low-resource settings, cancer is often misdiagnosed and leads to some of the poor outcomes we often see
Closer communication between pathologists and oncologists because nuance matters, hence the need for MDTs (tumour boards)

So here’s to the pathologists who are the unseen, unsung heroes of oncology.

Without you, there is no precision. No personalisation.