August 2008
PAP/NGC Programs Review

The following letter was sent earlier this year to all cytotechnology program administrators and directors:

We the undersigned professional societies wish to inform educators and laboratory administrators of a coming crisis in healthcare. Many schools of laboratory allied health, and cytotechnology in particular, are under threat. We are very concerned that precipitous action may reverse hard won gains in public health.

A system that has saved many lives is at risk of being destroyed. The Pap test achieved a 70 percent decrease in cervical cancer and a 90 percent decrease in the death rate since screening programs began in the late 1940s. Dr. Papanicolaou created a partnership between pathologists and a laboratory specialty, the cytotechnologist, to defeat a scourge that claimed tens of thousands of lives annually. The terminal cervical cancer ward in every hospital was largely eradicated. Dismantling cytotechnology programs is, at the very least, premature and will endanger patient health.

Sensational media sources have wrongly touted the end of the Pap test due to the advent of the human papillomavirus vaccine. Administrators have noted this information and acted. Funding for schools has been redirected and facilities have closed or been told they will be terminated at the end of the academic year. In reality, local HPV vaccination programs have hardly begun and currently no national vaccination program exists. Vaccinations will be directed toward a naive population that has not had exposure to HPV. We know that older individuals will not receive equal protection even if it is deemed reasonable to vaccinate them. Once a national program begins, it will be at least half a generation before the vaccinated individuals arrive at the normal ages for cervical cancer surveillance. Additionally, vaccines do not cover the entire spectrum of high-risk HPV types.

These scientific facts indicate that we still need the capacity to perform Pap tests and will need capacity as we go into the foreseeable future. Recent publications have estimated that there may be a 50 percent decrease in the number of Pap tests in a decade due to HPV vaccines, HPV testing, and altered testing protocols, but this is only a 50 percent decrease. In the United States alone we perform over 60 million Pap tests annually. Even at a 50 percent reduction, 30 million tests is still a considerable volume. Simply due to the aging of our laboratory staff, we will easily lose more than half our current testing capacity unless we maintain the cytotechnologist pool through our established excellent training programs.

It is an enormous effort to maintain an accredited program, but an even more daunting task is to re-open a closed program or to create a program de novo. Our average cytotechnologist is now approximately 50 years old.

Retirements and an ever-decreasing number of schools are setting the stage for a crisis. It would truly be a paradox if all the recent advances caused an increase in cervical cancer or an escalating Pap test cost because of lack of cytotechnology professionals. Furthermore, our aging population is going to need additional cytologic services for the diagnosis and monitoring of cancer at sites other than the uterine cervix, and there may be no one to help deliver those services.

We know that budgets are always under siege and administrators are under constant pressure to improve their bottom line; however, we may find ourselves in a worse situation if we succumb to short-term fiscal remedies. We are imploring administrators and public officials capable of acting to pay attention to this looming crisis for the sake of the public and themselves.

American Society of Cytopathology

American Society
for Clinical Pathology

College of American Pathologists

United States and Canadian
Academy of Pathology

American Society for Cytotechnologists

American College
of Obstetricians and Gynecologists

Papanicolaou Society of Cytopathology

Texas Society of Pathologists

American Society
for Reproductive Medicine

Clinical Laboratory
Management Association

Association of Public
Health Laboratories

American College of Nurse-Midwives