International Man of Pathology

Sitting Down With… Ian Cree, Head,WHO Classification of Tumors Group, International Agency for Research on Cancer (IARC), Lyon, France

November 2017

Tell us about your new role with the World Health Organization (WHO)…

IARC is an agency of the WHO, but based in Lyon, rather than Geneva. As head of the Classification of Tumors Group, I essentially hold the responsibility of publishing the WHO Blue Books. Part of my role is to think more deeply about cancer classification. At the moment, we classify by “sight” – by considering the organs in which the cancers occur. And we use the physiological appearance of the cancers, some genetic information, and so on. However, we are learning – from genetic information, in particular – that some cancers that look very different to us are actually similar. And others that look similar are actually very different. It seems very likely that there will be some reclassification of cancers in the future – so I will have my plate full.

How has your career prepared you for the new position? And how is the new role different?

I’ve had a pretty varied career. I started training as a histopathologist in Dundee, Scotland, but I did a PhD in immunology at the same time. Next, I moved down to Moorfields Eye Hospital and Institute of Ophthalmology, now part of University College London. I became a very specialized histopathologist, and at the same time continued to do research, mainly into cancer. I then headed down to the coast, and set up and ran a translational oncology research center in Portsmouth; I also took on roles with the UK National Institute for Health Research (NIHR) and the National Institute of Health and Care Excellence (NICE) on the Diagnostics Advisory Committee. Being a research-active pathologist with management experience certainly helps. Additionally, my work at NICE taught me a great deal about assessing evidence – something that’s very important in my current role.

I’m now an international civil servant, which means I get a blue United Nations passport as well as my ordinary one – although it doesn’t seem to help in airport queues! One of the best things about working at the WHO is being able to collaborate with people of many nationalities; gaining such an international perspective is perhaps more difficult when working with a national organization. I think this is very important for pathology, and for cancer.

“As pathologists, we sometimes undersell ourselves.”

What advice do you have for others wanting to move up the ladder?

The most important thing is not to be frightened of the prospect. As a pathologist, you’re taught to accept large amounts of information, synthesize it, and make decisions. I personally find it much easier to make decisions that could carry a financial risk than making decisions about whether someone has cancer or not. Pathologists make life-changing decisions like that every day, so it’s a better fit than some might think. As pathologists, we sometimes undersell ourselves.

I’d also advise getting some experience and training, where possible. Most pathologists in the UK go through some form of training in administration as trainees, but I think very few of us actually get formal management training, and there’s something to be said for learning the tricks of the trade. It’s also helpful to join some committees and get involved, and look for role models and mentors to learn from. Finding mentors is never easy, but it’s so helpful to see someone else succeed. You can get involved through the Royal College of Pathologists in the UK, and similar organizations around the world. You’ll learn a great deal by doing so – I certainly did.

Whatever your career path, remember that the world is a relatively small place – get out and talk to pathologists in other countries, go to meetings, and get a wider perspective on your own practice.

What do you see in pathology’s future?

It’s an incredibly exciting time to be in pathology – and, in particular, cancer pathology. Things are changing more rapidly than I can remember at any other point in my career. We have an enormous amount of information coming from both within and outside of pathology, which needs to be incorporated into how we think about and diagnose disease, and how we collaborate with colleagues in research. Some great challenges lie ahead in that regard. At the same time, there are some real benefits to be gained from diagnoses that are not only correct, but also as full as they can be.

The molecular pathology revolution is already underway, and the computational pathology revolution is just starting – the areas of digital pathology and artificial intelligence (AI) are starting to provide real tools to help us in our work. I think some of the computational science may look a little scary at the moment, as it’s pretty complicated. But the tools themselves don’t need to be: it could be a case of the pathologist selecting an area on the image of their slide and pressing a button, and getting some information that could help them grade or stage a tumor.

Integrated pathology is something we need to embrace, especially integrated reports. We do have some problems, and there will be plenty of debate about what is important and what is not important for particular cancer types. But scientific debate is healthy – and I welcome it.

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