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Breast Pathology

The Breast Pathology fellowship is a specialized, training program designed to provide a trained pathologist, certified by the Royal College of Physicians and Surgeons of Canada or equivalent, with a unique sub-specialization in breast pathology with an option to also develop a secondary sub-specialization such as molecular pathology, routine surgical pathology, genitourinary pathology, etc. by taking the elective option. 

Training Context: St. Joseph’s Healthcare, Hamilton, Hamilton Regional Laboratory Medicine Program (HRLMP) evaluates around 500 breast biopsies annually, which include needle core biopsies, vacuum-assisted biopsies, and the latest MRI-guided biopsies. These are all subjected to diagnostic and biomarker/therapeutic analysis by the breast pathologists working at St Joseph Hospital. Each patient’s breast biopsy result at St Joseph’s Healthcare is presented and discussed at the breast radiology-pathology correlation rounds to ensure that the findings are concordant or to formulate a plan for the next steps for discordant cases. Subsequently, the majority of the patients undergoing breast resection are also reviewed by the breast pathologists.  

The Juravinski Cancer Centre affiliated with the CIBC breast screening program situated at the Juravinski site provides similar screening and follow-up services for patients with breast cancer including recurrent, metastatic, and post-neoadjuvant therapy cancer cases. Together these two sites cover breast cancer screening and treatment for the entire population of Hamilton. Both the St Joseph’s Hospital and Juravinski Hospital also receive consultation requests from the community for diagnostic and biomarker analysis from communities such as Brantford, Niagara Health System, etc. Together, we offer the full range of studies required to evaluate and guide the treatment of breast cancer including routine histology, in-house immunohistochemistry (IHC), and fluorescent in situ hybridization (FISH) testing for HER2/neu. Our existing pathology program provides a robust training experience to several pathology residents and creates opportunities to collaborate on research projects, including ongoing breast cancer clinical trials with numerous faculty members of various oncology departments of McMaster University as well as pathology faculty in other universities in Ontario. The volume of case material, quality of the faculty, and general educational environment make this a rich and nurturing centre in which to enhance diagnostic skills and carry out research.

Program Information

The Breast Pathology fellowship will provide a specialized training program for individuals who have completed training in Pathology and are preparing to practice in a setting that requires advanced knowledge of breast pathology including biomarker analysis of breast cancers.  Most of the fellow’s time will be allocated to clinical service, during which they will be given time and direction to develop and improve knowledge and skills in breast pathology. Training will be conducted at St. Joseph’s Healthcare and Juravinski Hospital and Cancer Centre pathology laboratories. The fellow will participate in weekly MCC and breast radiology-pathology correlation rounds, interpretation and reporting of breast biopsies, breast cancer resection specimens, troubleshooting of laboratory issues, and critical values, and completing a SOR (Serious Occurrence Report), as required. The fellow will maintain a logbook of cases as they arrive and their status.  

The fellow will be expected to participate in one or more independent research projects suitable for peer-review publication. There will be opportunities and expectations to participate in resident teaching and to present at discipline-specific seminars and rounds. When a resident is rotating through the breast pathology at the same time as the fellow, the fellow will function as a mentor for the resident and provide additional guidance such as a review of cases at the multiheaded microscope and supervision related to the resident’s level or training. Optional elective/s of up to 4 blocks will be available. This may be a research elective, an elective breast pathology rotation at another university, or an elective that covers molecular genetics relevant to breast pathology.  If the fellow chooses to have an in-house genitourinary and /or surgical pathology elective, the option to pursue the same will also be provided at any of the pathology sites under HRLMP. The fellow may also be premised to arrange an elective with similar objectives at an outside institute. During this time, the fellow will acquire advanced knowledge and expertise in the subject of their chosen elective. 

Successful completion of the fellowship will be achieved by the following:  

  1. Completion of an education, quality improvement (QI), quality assurance (QA), or research project that is relevant to the current healthcare scenario with the goal of presentation and/or publication of results.
  2. Preparation of a portfolio/ (anonymized information) to record learning experiences, including large/ resection specimens signed out.
  3. Preparation and presentations at weekly breast radiology pathology biopsy correlation rounds, breast DST MCC rounds, and at least one academic half-day or grand round session per year of fellowship.
  4. ITERS and on-call evaluations reflecting an assessment rating of satisfactory or above. 

The fellowship program will be 12 months in duration and includes experiential and structured educational components.  

Experiential components (80%)  

The weekly schedule will be as follows:  

  • Sign out of breast biopsy, resection, and consultation cases: Review all breast biopsy and resection cases as provided in the weekly rounds list, order immunohistochemistry, ensure specimen handling requirements are met and documented, prepare preliminary reports, and update supervisor on a daily basis. Review of consultation cases as required. 
  • Breast Biomarker Immunohistochemistry sign out. Review and sign out of routine and requested in-house breast biomarkers tests including ER, PR, HER2/neu, Ki67, PDL1 immunohistochemistry tests as required, under the supervision of faculty staff members. 
  • Breast HER2/neu FISH sign out: Complete fluorescent in situ hybridization ( FISH) review with technical staff and participate in sign out of the same with the supervisor on a weekly basis 
  • Optional elective: There will be the option to include some elective time (up to 30% of the fellowship time/ 4 blocks) to gain exposure to other aspects of pathology. This may be a research elective, an elective breast pathology rotation at another university, or an elective that covers molecular genetics relevant to breast pathology or routine surgical pathology. If the fellow chooses to have a genitourinary pathology elective, the option to pursue the same will also be provided. The fellow may also be premised to arrange an elective with similar objectives at an outside institute. During this time, the fellow will acquire advanced knowledge and expertise in the subject of their chosen elective. 

Structured educational components (20%)  

  • Education, quality and research: Lead and work on an education, quality improvement (QI), quality assurance (QA) or research project. Contribute to resident and staff teaching, including leading multi-header case-based slide rounds. Attend selective academic half-days and present at least one academic half-day for pathology residents and or Grand Rounds for staff, residents, and faculty members. 
  • Research Presentation: The research project is to be accomplished with the goal of presenting the work to colleagues at the departmental Annual Research Day, regional, national, and international meetings. The topic of the project should be relevant to patients and healthcare providers.  
  • Participation in rounds: Attend weekly hospital breast biopsy correlation rounds (Thursdays), slide unknown rounds for residents (Thursdays), city-wide breast MCC pathology rounds (Wednesdays), and Pathology Grand rounds. 
  • Conferences/ CME: Attend relevant breast/ genitourinary/ surgical pathology pathology conferences. 

To be eligible applicants should be certified specialists in Pathology and hold/ eligible for a CPSO license. International applicants must also have verified sponsorship support for their fellowship that meets or exceeds the minimum funding requirement of Postgraduate Medical Education at McMaster University, including any educational CME/ travel funding support. Applicants must submit a letter of interest, a detailed CV, written verification of amount and duration of fellowship financial support from their sponsor (which should detail how the financial support will be paid, i.e., directly to the fellow or via transfer of funds to McMaster), in addition to a minimum of two letters of reference that includes one from their Program Director.

We are now accepting all applications for the 2025-26 academic year until September 27th, 2024 for the ideal start date of July 2025. The application form can be found through the PGME Application process.

Information Box Group

Image of Katie Wang smiling

Katie Wang

Senior Education Program Associate

Pathology Fellowships