Cytologists Diagnose on the Front Lines
Monday, April 29, 2013
Tamika Felder was an ambitious, young freelance journalist whose career in Washington, D.C., was just taking off. Then her doctor delivered the news that seemed like a death sentence. She had cervical cancer.
“It was surreal,” she recalls, of that fateful day in 2001. “I was diagnosed at age 25 with cervical cancer. I had not gone in for my Pap test for a couple of years. I had thought I was invincible.”
“It all started with the lab test. I still think about the laboratory professional—the cytotechnologist—who conducted the test that saved my life. I tell people that there is a real person behind every single test you perform.”
— Ms. Tamika Felder
Ms. Felder was treated at Johns Hopkins Medical Center in Baltimore, where doctors performed a radical hysterectomy. Chemotherapy and radiation treatment followed. Remarkably, today she is cancer free.
“It all started with the lab test,” says Ms. Felder, founder of Tamika and Friends, a nonprofit support group for women with cervical cancer. “I still think about the laboratory professional—the cytotechnologist—who conducted the test that saved my life. I tell people that there is a real person behind every single test you perform.”
May 13 is National Cytotechnology Day, honoring cytotechnologists for their contributions to health care and commemorating the birthday of George N. Papanicolaou, MD, who developed the Pap test. The number of deaths from cervical cancer is rare in the United States now because so many women have regular Pap tests. Early detection increases the chances of successful treatment. Cytotechnologists and cytopathologists are on the front lines of diagnosing disease at its earliest stages so patients can receive appropriate treatment.
Cytotechnologists are seen as partners with cytopathologists, according to Mary K. Sidawy, MD, FASCP, a cytopathologist at Medstar Georgetown University Medical Center, in Washington, D.C. “That is what makes this specialty strong,” she says.
“Cytotechnologists are the one laboratory professional that report patient samples without having any input other than oversight from the pathologist because they report negative specimens in the gynecology lab,” adds David Wilbur, MD, FASCP, a cytopathologist at Massachusetts General Hospital, Boston. “That responsibility requires that they have a close, interactive relationship with the pathologist who oversees that.”
For decades, cytotechnologists have also performed nongynecologic testing, including cancers from the lungs, breast, gastrointestinal tract, and urinary tract, as well as fine needle biopsies of virtually every body site. Cytotechnologists historically have had a very active role in educating pathology residents, Dr. Wilbur says.
Yet cytotechnologists’ role is evolving. As molecular diagnostics takes a front seat in laboratories, cytotechnologists are now using the techniques of hybrid capture, in-situ hybridization (chromogenic and fluorescent) and polymerase chain reaction, according to Dr. Sidawy, a past president of the American Society of Cytopathology.
Additionally, guidelines announced in 2012 recommend that healthy women do not need a Pap test every year. Laboratories are seeing a reduced volume of Pap tests while the Human Papillomavirus (HPV) test gains momentum.
“We cross-train and cytotechnologists have been very successful performing the HPV test,” explains Barbara Frain, SCT(ASCP)CM, who teaches laboratory medicine at the Indiana University Medical Center, Indianapolis. She believes cytopathology is still a strong career path, even though there are changes on the horizon.