CANCER in Any Language

Data and statistics on diagnoses of cancer are paramount to public health, cancer networks, and ministries of health around the world for designing, planning, and implementing cancer control plans. The diagnostic report generated for each patient has direct implications for that particular patient’s care but, in aggregate with all other pathology reports, also forms the epidemiological basis for national cancer planning. Cancer, however, does not follow state or national boundaries and trends; risk factors and interventions for cancer need to be studied by population centers with aggregate data that is reliable across groups.

Figure 1

Figure 2

In the last two decades of the last century, histology and immunohistochemistry (IHC) formed the basis of most pathology reports and often included long interpretive narratives. These stories wove together the beautiful peculiarities of a given cancer with its immunophenotype of stains to create a prose as unique as the patient from which it was derived.

In the first decade of this century, standardization of reporting for cancer through synoptic reports or templates moved from a practical individual laboratory solution to a series of vetted standardized datasets available from several sources such as the College of American Pathologists and the International Consortium on Cancer Reporting (ICCR).

In the last decade, prognostic IHC, gene-specific polymerase chain reaction, sequencing in various forms, gene amplification status, and a host of other markers of tumor biology have exploded on the landscape—each with very specific importance to a given patient and to public health. The time has come for data from cancer of individual patients to be reported in a standardized way, potentially to centralized data registries regardless of the geographic location of the patient. To date, datasets for the generation of synoptic reporting templates have been available only in English. However, the value of a template, once standardized, is that each element of the template can be reduced to a numerical value, which can be generated in any language but analyzed collectively. For example, assume we have four pathology reports (in four different languages), all of which describe a 1.0-cm invasive ductal carcinoma with negative margins and negative lymph nodes that is found to be estrogen receptor positive and Her2 negative. If each of the four pathologists reporting those cases uses a template in his or her own language, the data elements (as seen in Figure 1) can be mapped to the same format so the tumor is reduced to the same code in a common database. An example of a template for cervical cancer (Figure 2) shows how complicated such forms can appear, but, when coded and standardized, the data can be extracted and analyzed mathematically.

The American Society for Clinical Pathology (ASCP), in collaboration with the ICCR, is piloting translations of existing templates from the ICCR datasets into Spanish, French, and Portuguese, which are being posted and freely available publicly in October 2018. These languages were selected in order to allow access to this type of standardized reporting to large parts of Africa and South America, which are focus areas for the ASCP Center for Global Health.

“In an effort to improve cancer care and cancer control globally, the International Collaboration on Cancer Reporting (ICCR) is committed to producing evidence informed datasets based on the latest WHO IARC tumour classifications, TNM staging and clinically important biomarkers,” says John R. Srigley, MD, FRCPC, FRCPath, FASCP, FRCPA(Hon.). “The ICCR is delighted to work with the ASCP in the translation of the datasets into Spanish, French and Portuguese. This effort will greatly assist pathologists including those practicing in low and middle income countries to effectively communicate complete cancer pathology results to clinicians, cancer registrars and other secondary users.”

By using vetted, standardized translation services to make these datasets available, pathologists and laboratory professionals in these target locations can more easily report their cases, submit data for cancer registries, and contribute data directly to international data collections for public health, planning, and research. Through collaborations with the Union for International Cancer Control and other partners, promotion of the use of the templates and training on their implementation will improve cancer diagnostics around the world.