Can Existing Breast Clinics Evolve into Integrated Diagnostic Centers?

I started blogging about Integrated Diagnostic Centers (IDCs) (see: A Call for the Development of Integrated Diagnostic Centers) as an offshoot of my interest in the merger of pathology, lab medicine, and radiology. Radiologists with clinicians have a long history of developing multidisciplinary diagnostic breast clinics. Michael Legg, one of my hosts at the Health Informatics Conference (HIC) just completed in Canberra, called my attention to the Sydney Breast Clinic which has been in operation since 1978. Its multidisciplinary physician team consists of breast surgeons, breast physicians (i.e, internists), and radiologists. Any breast biopsies or fine needle aspirations (FNAs) of breast lesions, of course, are interpreted by pathologists. Clinics of this type are also well established in the U.K. where they are referred to as "one-stop breast clinics" (see: The Value of "One-Stop" Breast Cancer Clinics Confirmed in the U.K.).

Dr. Mark Pool, a pathologist who blogs over at The Daily Sign-Out has suggested to me that Integrated Diagnostic Centers would be ideally suited for the rapid diagnosis of lung lesions in addition to those of the breast. This prompted me to ask myself whether existing multidisciplinary breast clinics could (or should) morph into these broader types of clinics, offering screening and the diagnosis of lesions other than those in the breast. My initial reaction was that this was probably unlikely for a couple of reasons. First of all, breast disease is very common and existing breast clinics offer both screening as well as the diagnosis of identified masses. I suspect that many currently have all of the business that they can handle. Secondly, I think that these clinics have developed a special focus on women's health. The staff might find it difficult, if not undesirable, to shift gears to include male patients in the mix.

If it is unlikely that most multidisciplinary breast clinics would expand to include patients with lung, mediastinal, lymph node, thyroid, liver, and kidney masses, how would the proposed IDCs get a toehold in an area? Note that I am excluding from this list intestinal and prostate lesions, which I am sure would continue to be identified and biopsied by gastroenterologists and urologists. My answer to this question is that I think the greatest demand for such IDCs would emerge in association with large urban hospitals and academic medical centers. Internists in such settings, after initially identifying masses of this type, would welcome a service that could generate a firm diagnosis embedded in an integrated report (radiology + pathology + serum/tissue biomarkers) in several days.

Comments

[Mark Pool]

Regarding intestinal and prostate lesions, in one sense, the [gastroenterologists] and urologists anticipated this integrated diagnostics concept by hiring/contracting their own pathologists (although for reasons different than improving patient care by an integrated report).