August 2008
PAP/NGC Programs Review

Barbara A. Crothers, DO

As of July 1, the American Society of Cytopathology offers individuals the opportunity to creatively contemplate the future of laboratory medicine and cytopathology and begin taking steps in the direction most benefiting patients, via its Future of Cytopathology Forum.

Directly on the heels of the CAP’s foray into the future of pathology with the launch of the Futurescape conference, the American Society of Cytopathology, too, is putting up the peri­scope with an eye to the future. The two organizations have been allies in the past to achieve common goals, and this effort is no different.

For the past several years, the ASC has monitored the impact of cytotechnological changes and molecular testing on the practice of cytopathology. On the positive side, new technologies and molecular testing for HPV DNA have resulted in huge improvements in cervical cancer screening for cytology practitioners and patients. In addition, fine-needle aspiration services have increased in number as more specialists become proficient in ultrasound-guided techniques. There is growing demand for diagnostic, prognostic, and therapeutic information from small biopsies that are often taken in conjunction with cytology specimens such as fine-needle aspirates. Molecular studies and cytology specimens make a promising marriage, one that may capitalize on the strengths of each partner.

On the other side, the gains in cytotechnology processing in conjunction with imaging instruments have raised the productivity of cytotechnologists and reduced the number of personnel required for Pap test screening. At the same time, changes to the algorithms in cervical cancer screening have lengthened the interval between Pap tests and added HPV DNA testing in lieu of Pap tests in special circumstances. The sum effect has been a decline in the number of Pap tests performed. As a result, some administrators have questioned the value of Pap testing and cytology education, a position that is woefully shortsighted. Women outside of the recommended ages for HPV testing in conjunction with Pap tests (those under age 21) still require screening and followup. Women with low-grade squamous intraepithelial lesions are screened with Pap testing at more frequent intervals without obliteration of their lesions, potentially offsetting the initial reduction in screening Pap test volume.

The future holds much promise for cytopathology. As the population ages and the number of physicians continues to decrease, new opportunities, novel partnerships, and networks of alliances will be created.

The ASC is exploring these partnerships and alliances through a Web-based bulletin board forum that opened last month, and it invites those interested in the future of laboratory medicine and cytopathology to contribute their ideas, observations, and solutions to future health care deficits that might affect pathology. Nine forum discussion groups have been structured around major forces affecting the future of medicine. Each forum is co-hosted by two chairs and facilitated by members of the forum working group. The forums are composed of multidisciplinary members with expertise or interest in the forum topic. One forum specifically addresses the roles of cytotechnology and cytopathology in the shifting medical field. The posted forums are as follows:

• Current gaps in heath care and management
• Boutique medicine and the patient consumer
• Fusion of medical specialties
• Global medicine
• Telemedicine
• Molecular technologies
• Expanding roles of cytopathology
• The business of medicine

The ASC will use these discussions as the basis of a Futures Summit to be held before the ASC’s annual scientific meeting in 2009. The summit will explore feasible health care scenarios based on existing forces to align ASC strategies with future perceived medical needs.

The face of medicine is changing rapidly. It is no surprise that many national medical organizations are investigating the impact of technological and population changes on their professions. There is clear evidence that emerging technologies will be transformational, meaning they will change what medical pro­viders do and not just how they do it. Although these technologies have advanced the capabilities of medical and laboratory professionals over the years, only recently have we seen the start of trends that change the fundamental relationships between providers and between providers and patients. These changes will have a profound effect on all health care workers. Growing populations, greater longevity, diminishing resources, and prolonged chronic medical conditions will confront health care professionals with challenges that must be resolved. Contribute to the future of cytopathology, and your future, by participating in the new ASC forum at www.cytopathology.org.