August 2008
PAP/NGC Programs Review

Ann T. Moriarty, MD*

The University of Tennessee in Memphis received word in June that its cytotechnology program was not going to educate the five students accepted for the 2008-2009 school year and that the school would be placed in inactive status once its current class graduates. The school in Memphis was established in 1951 to provide cytotechnologists for the Memphis Mass Cervical Screening Project sponsored by the National Cancer Institute and funded by the U.S. Public Health Service. The potential loss of this school highlights the approaching demise of cytotechnology training in this country.

Barbara Benstein, PhD, SCT (ASCP), recently completed the conversion of the program from a one-year baccalaureate to a two-year master’s curriculum, incorporating training in molecular methods. Just as she and her co-authors finished writing what could be a roadmap for the future and before it could even be published in CAP TODAY (see “For Cytotechnologists, Molecular Training a Must”), Dr. Benstein and her faculty learned of the possible demise of the 57-year-old cytotechnology training program, which is the only one in Tennessee.

A crisis for women’s health care is in the making, and it must be addressed before it is too late.

Molecular training is essential for cytotechnologists as the practice of pathology evolves. Cytotechnologists are uniquely qualified for the melding of morphologic and molecular analyses. This combination represents a unique skill set among clinical laboratory scientists, incorporating subjective assessments and judgment. Appropriately trained cytotechnologists and the pathologist are the ideal team in the rapidly changing “futurepath.”

Dr. Benstein, et al., in the editorial above clearly identify a path for cytotechnologists who may want to arm themselves with this molecular skill set. The CAP has masterfully addressed the future with its Futurescape conference. The American Society of Cytopathology has its eye to the future of cytopathology with the launch of its Web-based forum as outlined by Barbara Crothers, DO, in “For All of Us, a Place to Ponder Cytopathology’s Future”.

How can we fail when we have such wonderful opportunities to sculpt our future and lay the foundation for a smooth transition into the molecular era of pathology? We are not ostriches with our heads buried in the sand; we seem to be aware of the future and are taking steps to get there.

How do we train for the future? We must school our young pathologists and cytotechnologists in new technologies and re-tool our veteran pathologists and cytotechnologists to deal with changing patterns of practice. Where does this training take place? Schools. Residency training programs, cytotechnology schools, and organized continuing education facilities and programs.

For cytotechnologists, training is rigorous and unique. Cytotechnologists first have to learn the new language of medicine and then are thrust into intense microscopic study. Cytotechnologists not only learn to interpret the subtle changes in cellular morphology on Pap tests but also are taken through a whirlwind of medical conditions, subcellular pathology, and molecular testing. Cytotechnology schools are intimate programs; the median class size in 2007–2008 was eight students. There are not many schools of cytotechnology remaining in this country. As of this year there were 38 active schools of cytotechnology in the United States. Seven schools have closed since 2007. More are in danger of closing. As a community we need to address the educational and financial needs of our training programs to ensure well-educated cytotechnologists are entering the field, ready to fill the impending vacancies left by the retirement of a professional workforce. About 50 percent of the cytotechnologists have worked in the field for more than 20 years, according to a 2007 ASCT workforce survey.

Some believe that the HPV vaccine will eliminate the need for Pap tests and therefore cytotechnologists. We believe the Pap test is not going away anytime soon. It will take more than a generation for the HPV vaccine to have an impact. Individuals already exposed to HPV and those with established cervicovaginal intraepithelial lesions will not achieve complete prophylaxis. The use of HPV and other ancillary testing modalities as screening or triage tests is not yet established. It will take years before we see a sustained decline in the Pap test volume based on new testing schemes (Wilbur D. Perilous Times for the Pap Test. CAP TODAY, February 2008). Even if primary HPV screening becomes established, there will still be Pap tests for those identified as having high-risk HPV, and thus a need for cytotechnologists. Most important, Pap test screening is not the only professional activity for cytotechnologists. Nongynecologic cytology and fine-needle aspiration volumes are growing and will continue to do so in the era of smaller specimens and personalized therapies. Closing programs based on the misconception that Pap test volume is the only predictor of workforce needs is shortsighted and dangerous.

Pathologists will need skilled cytotechnologists to assist them through the molecular “future­path” of morphologic interpretation. With continued closures of cytotechnology schools, there will be a profound shortage of cytotechnologists, a health care professional whose training is in evolution now to meet the unique visual and molecular needs of the pathology laboratory. We will be stuck with our heads in the sand.