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Right now, in a hospital in Sudan, pathologists could soon be using the same standardized cancer reporting template as their counterparts in Ireland, the United Kingdom, and the United States. No matter where a patient's tissue sample is read, the goal of the International Collaboration on Cancer Reporting (ICCR) is for clinicians to capture the same core information, in the same structure, anywhere in the world. The American Society for Clinical Pathology (ASCP) supports the work of the ICCR to achieve this goal.

The problem ICCR was built to solve

Before 2010, standardized cancer pathology reporting existed, but it existed in silos, built by organizations like the College of American Pathologists, the Royal College of Pathologists in London, and the Royal College of Pathologists of Australasia, according to Professor Kieran Sheahan, president of the ICCR, and a histopathologist at St. Vincent's University Hospital & University College Dublin, Ireland. A pathologist's report might look completely different depending on which country, or even which hospital system, produced it. ICCR was formed to merge those separate efforts into one global standard.

Now, ICCR has “a global reach, particularly to low- and middle- income countries (LMIC), and these standardized cancer reporting protocols are available to around 192 countries,” Dr. Sheahan says. Their website’s traffic gets in the ballpark of 40,000 hits per six months, from Asian, African, and South American countries.

The goal is not to standardize how medicine is practiced everywhere, according to Kenneth Landgraf, Executive Director of the ASCP Center for Global Health. Rather, “it is to identify the minimum essential information that should be reported consistently for every patient, regardless of where that patient receives care.”

Its role is also to ensure that the realities faced by laboratories in resource-limited settings are represented in those discussions, he added.

What's inside a dataset

The standardized datasets that the ICCR is working to include in the template will lay out which data points are "core" (mandatory) versus "non-core" (recommended), according to Marta Cohen, OBE, MD, Chair of ICCR's LMIC Committee.

"The template will include clinical information, gross morphology data, size, metastases, previous treatment or current treatment, the diagnosis... and genetic and immunohistochemical determinants,” she explains.

Dr. Sheahan says they also assess for diagnostic information that not every country has the technology for, such as “mismatch repair proficiency or deficiency, which separates colon cancer into two very different cancers.” To make up for the technology gap, including this information on the ICCR template will help pathologists leverage their governments for the necessary funding, he adds.

The impact of reporting

Standardized reporting enables healthcare professionals, such as surgeons or oncologists, to make better treatment decisions. While Dr. Sheahan is clear that ICCR doesn’t set the standards for tumor staging—that comes from the American Joint Committee on Cancer and the Union for International Cancer Control—they do “translate and update those standards into a standard report that we think pathologists should use," he says.

It also “transforms pathology from narrative text into computable data,” Mr. Landgraf says. “That makes it possible to improve patient care today while building the datasets that will drive tomorrow's research and quality improvement,”

Standardization in the real world

Standardization has a real impact. The ICCR members who’ve adopted the standards for a long time, like the Dutch, have shown “that by standardizing colorectal cancer that you can actually increase survival,” Dr. Sheahan says. Just having the data available helps clinicians “optimize their therapy, whether it be surgical or chemotherapy or radiation therapy,” he adds.

Other pathologists are implementing or looking to do so even in countries with active conflicts, such as Sudan and Ukraine, where Dr. Sheahan says they are hoping to “digitize and make electronic” the datasets.

ASCP's role — Extending the reach

As a member organization of ICCR's council, ASCP has translated the datasets into Spanish, French, and Portuguese, and is “making these internationally recognized standards available to many more pathologists around the world,” Mr. Landgraf says. ASCP has also been represented on the ICCR Council and Dataset Steering Committee, bringing the perspective of laboratories and pathologists working in LMIC countries.

Dr. Cohen “highlights the value” of ASCP’s contribution, saying, “It's a joining of forces to get to higher standards. I think it's so important, that without it [and other pathology societies], it would not be possible to have this.”

Closing the gap for low- and middle-income countries

Much of ICCR's current energy is going toward a new LMIC committee working to identify what's blocking adoption in under-resourced countries where there is a greater burden of cancer. Dr. Cohen points to a limited number of qualified professionals to diagnose as well as lack of standardization.

She shares a story about a pathologist from Kazakhstan, trained in pediatric pathology, who is spending three months with her doing research thanks to a European Society of Pathology scholarship. The woman, Dr. Cohen says, “told me that there was nobody in her country to give an informed opinion on pediatric tumors. So, in the whole of the country, there is no trainer.”

Mr. Landgraf points out that many laboratories in LMICs still rely on narrative reports because their information systems or workflows were not designed around structured reporting. This creates a challenge around “resources, infrastructure, and implementation support,” he says.

He says that successful implementation also depends on:

• training pathologists to use synoptic (structured) reporting
• laboratory information systems that support structured reporting
• cancer registries capable of receiving standardized data
• local adoption by clinicians and institutions
• availability of diagnostic tests referenced in the datasets
• ongoing maintenance as World Health Organization (WHO) classifications, staging systems, and biomarker recommendations evolve.

  A live global survey is currently mapping those gaps, which Dr. Cohen urges people in LMIC countries to fill out as soon as possible. Fill out the form here.

Next steps

The ICCR is leaning on new tools, such as AI-assisted translation, automated SNOMED coding (Systematized Nomenclature of Medicine), and free webinars for LMIC pathologists as well as actively fundraising to expand its reach, Dr. Sheahan says. This infrastructure work is ongoing, and offers an opportunity for young pathologists, and pathologists early in their career, to get involved with organizations like ICCR.