A Conversation with Dr. Laura Collins, Vice Chair of Oncologic Pathology and Breast Cancer Research Lead
Dr. Laura Collins is Vice Chair of Oncologic Pathology, Chief of Breast Pathology, Breast Cancer Research Lead at the Meyer Cancer Center, and a Professor of Pathology and Laboratory Medicine (pending appointment at rank). Her work has helped define the natural history of breast lesions and improve diagnostic accuracy worldwide. We spoke with Dr. Collins about her career, her research on precursor lesions, and what women should know about breast cancer risk.
Laura C Collins, MBBS
Professor of Pathology and Laboratory Medicine (Pending Appointment at Rank)
Q: Could you briefly introduce yourself and your current roles?
A: I’m Laura Collins. I’m Vice Chair of Oncologic Pathology, Chief of Breast Pathology, Breast Cancer Research Lead for the Meyer Cancer Center, and a Professor of Pathology and Laboratory Medicine (pending appointment at rank).
Q: Your research has focused on breast cancer and especially early precursor lesions. How did you become interested in this field?
A: My involvement began with the Nurses’ Health Study. I evaluated breast specimens from enrolled nurses, which led to several projects on breast cancer risk in women with benign breast disease, atypical hyperplasia and ductal carcinoma in situ (DCIS).
Q: One of your landmark studies helped define the natural history of DCIS. How did that collaboration come about, and what did you find?
A: Through my mentor Stuart Schnitt, who had long worked with the Nurses’ Health Study. We examined women with previously unrecognized DCIS treated by biopsy alone and followed their outcomes. Together with Nurses’ Health Study investigators, we showed that some lesions progressed to invasive carcinoma—low-grade lesions over a more protracted time-period, high-grade lesions more quickly. Those insights would likely not be possible today because there is much better recognition of DCIS, and ready access to ancillary testing or consultation for difficult cases.
Q: You were also the lead author on the first inter-observer agreement study of breast core needle biopsies. Why was this important?
A: It was early in the use of core needle biopsy as an alternative to surgical incisional or excisional biopsies for women with radiologically detected breast lesions. We found that pathologists agreed strongly on clearly benign and clearly invasive lesions, but agreement decreased for borderline lesions such as atypical ductal hyperplasia versus low-grade DCIS, which is more a reflection of the subjectivity of applying the diagnostic criteria for these borderline lesions, not a function of the biopsy method itself. The key takeaway: the vast majority of breast lesions detected on imaging studies can be accurately classified on core needle biopsy.
Q: You’ve also studied the impact of family history and atypical hyperplasia. What surprised you?
A: Prior studies suggested family history magnified risk in women with atypical hyperplasia. We showed there was no added effect of family history beyond the effect of the atypical lesion itself. And, although atypical hyperplasia confers a bilateral increase in risk, there’s a slight preponderance of cancers on the ipsilateral side in the first few years of follow up, supporting its role as a non-obligate precursor lesion.
Q: Many women with a family history fear they’re at much higher risk. What do you wish more women understood?
A: Family history is definitely important, but it’s not the only factor. Women should discuss genetic testing with their physician, especially if a relative has tested positive for a BRCA mutation. Self-exams are helpful but imaging studies and starting to screen at the appropriate time—typically a few years before the youngest family member’s diagnosis—are far more effective.
Q: Are we missing an opportunity to reach younger women with this information?
A: Awareness campaigns like Breast Cancer Awareness Month help, but access to screening remains uneven. We also need to ensure family physicians take young women’s breast symptoms seriously. Most masses in young women are benign, but cancer must be ruled out.
Q: The incidence of breast cancer is rising among younger women. Is that better detection or something else?
A: Younger women aren’t in the screened population, so the increase isn’t simply detection; more is at play here. Environmental exposures or other factors are possible, but not yet proven.
Q: What are your current research priorities and future directions?
A: Continuing to work with the Nurses’ Health Study as well as on a cohort of young women with breast cancer with collaborators at Dana-Farber Cancer Institute and here at WCM. I think being able to better predict which atypias and DCIS lesions will progress would be a major contribution. And also, being here at WCM, I think there will be greater opportunity to contribute to the study of breast cancer in underrepresented minorities and to improve outcomes in underserved populations.
Q: You’re known as a dedicated educator. Why is teaching important to you?
A: I love sharing knowledge and helping pathologists resolve diagnostic challenges. Accurate pathology is critical for patient care—especially in the era of personalized medicine where treatment decisions are much more nuanced and depend heavily on our findings.
Q: Did you always plan to become a pathologist?
A: No, I went into medicine wanting to be a pediatrician. But in London, the pathology training in my medical school was several months long, so I had extensive exposure to the specialty. When I moved to the U.S., a pathology residency felt like the right path. I am very happy with the choice I made; I love the beauty of what we see down the microscope and the intellectual challenge of putting all the pieces of the diagnostic puzzle together.
Q: How would you characterize breast cancer care and research in the U.S. today?
A: Much improved. We have more targeted therapies and an emphasis on de-escalating treatment which provides patients with treatments geared to their specific type of cancer and avoids overtreatment for patients with low-risk disease. Molecular assays can guide decisions about chemotherapy. But disparities remain, and we must improve care for less-served populations.
Q: You trained in the U.K. Are there elements of the British system worth adopting here?
A: I’m a big fan of national healthcare—access for all is fundamental. It’s not perfect in the U.K., but ensuring every individual can get care is invaluable. The key is resourcing the system adequately, which I acknowledge is a monumental challenge.
Q: You moved to New York in July after years in Boston. How has the transition been?
A: Wonderful. Everyone has been welcoming. I am settling into a rhythm at work, as I get to know more about the people with whom I will be working most closely. Also, my daughter lives in Brooklyn, and we’ve started a weekly cooking project working through an Ottolenghi cookbook—ambitious, delicious, and healthy!
Q: What do you love about New York?
A: Its vibrancy. Having lived in London, I love being back in a bustling city. Central Park, tiny restaurants with amazing food, and Shakespeare in the Park—it’s all been fantastic.
Q: What do you do in your free time, and what might surprise your colleagues?
A: I cook, read, swim and cycle, and, perhaps surprisingly, have competed in sprint triathlons. I’d love to complete one in New York City.
Q: Where were you born and raised?
A: I was born in Texas but raised in Nigeria, in Ikeja outside Lagos, and in England. My father, English, ran a company manufacturing office furniture. My mother, American, a homemaker and quilter, returned to Texas to have me and my younger sister. After elementary school, I went to boarding school in the Midlands of England (Think Harry Potter, without the wizardry!).
Q: Have you been back to West Africa?
A: Not since my teens. My father lived there for 35 years, but we moved back to England during a period of instability in the country. I have begun collaborating with Dr. Lisa Newman on the International Center of Study of Breast Cancer Subtypes in Africa, which has partnerships in Nigeria, so in some small way, I feel like I am reconnecting with the country of my childhood.
Q: Any final thoughts?
A: No, just that I’ve really enjoyed this conversation. Thank you.