The Pap Test : A Cure for the Crisis

<v Announcer>Funding for this program is provided by a grant from the College of American <v Announcer>Pathologists. <v Introducer (Elizabeth Dole)>Hello, I'm Elizabeth Dole. The 1980s have been an exciting and busy time <v Introducer (Elizabeth Dole)>for women. With careers and family, time for one's self is sometimes at <v Introducer (Elizabeth Dole)>a premium. That may mean missed doctors appointments, putting off for <v Introducer (Elizabeth Dole)>another year the gynecological exam that is so crucial to continued good health. <v Introducer (Elizabeth Dole)>In the past year, there've been numerous media reports concerning the Pap smear screening <v Introducer (Elizabeth Dole)>test and its accuracy in detecting cervical cancer. <v Introducer (Elizabeth Dole)>You may have seen or read of these stories and wondered if you could be affected by a <v Introducer (Elizabeth Dole)>mistake, a mistake that has left some women with undiagnosed cancer. <v Introducer (Elizabeth Dole)>There are actions we as women can take to make sure cervical cancer does not <v Introducer (Elizabeth Dole)>challenge our lives. <v Introducer (Elizabeth Dole)>We must take the time to make the Pap screening test a part of a regular cancer <v Introducer (Elizabeth Dole)>prevention program. We must educate ourselves about the test so <v Introducer (Elizabeth Dole)>we can better talk with our physicians and be able to understand our own Pap smear

<v Introducer (Elizabeth Dole)>reports. I urge you to watch the following program, which details <v Introducer (Elizabeth Dole)>the Pap smear scare in this country and then counsels women on the questions <v Introducer (Elizabeth Dole)>they can ask their doctors. Take this half hour for yourself, for your good <v Introducer (Elizabeth Dole)>health. And for those you love. <v W. Bud Wentz, Gynecologist>Somebody finally blew the whistle. <v Gwen Boyd, Gynecologist>Shocking, just disgusting, really. <v Jared Schwartz, Pathologist>A few laboratories were doing almost criminal work, <v Jared Schwartz, Pathologist>but we all would be painted as bad. <v Shirley Greening, Cytotechnologist>OK, this is a great article. <v Shirley Greening, Cytotechnologist>What's going to be done next? <v Host (Eugenia D'Ambrosio)>The response was varied, but all echoed concern over a crisis that would brew following <v Host (Eugenia D'Ambrosio)>the series of articles published in the Wall Street Journal. <v Host (Eugenia D'Ambrosio)>That series blew the lid off of a scandalous situation that some labs <v Host (Eugenia D'Ambrosio)>in this country were doing subpar diagnostic work on Pap smears and women <v Host (Eugenia D'Ambrosio)>were getting cancer. Some are undergoing hysterectomies and others were <v Host (Eugenia D'Ambrosio)>dying needlessly when a correct diagnosis and treatment could have saved

<v Host (Eugenia D'Ambrosio)>them. <v Gwen Boyd, Gynecologist>Just lie back. <v Gwen Boyd, Gynecologist>Come on down. <v Host (Eugenia D'Ambrosio)>The Pap smear is the best cervical cancer control test a woman can have. <v Host (Eugenia D'Ambrosio)>Although it has been a part of a routine gynecological exam for about 20 years, the <v Host (Eugenia D'Ambrosio)>test was actually developed by Dr. George Papanikolaou in the 1940s. <v Host (Eugenia D'Ambrosio)>At that time, Dr. Papanikolaou was developing a test that would study the changes a <v Host (Eugenia D'Ambrosio)>woman's body goes through during the menstrual cycle. <v Host (Eugenia D'Ambrosio)>By chance, he discovered that changes in the cells taken from the cervix coincided <v Host (Eugenia D'Ambrosio)>with the development of cancer. Suddenly, doctors had a safe, painless <v Host (Eugenia D'Ambrosio)>and an economical method to detect the early signs of cervical cancer. <v Host (Eugenia D'Ambrosio)>That test, the Pap smear, has been an overwhelming success. <v Host (Eugenia D'Ambrosio)>Since the time the test was developed. <v Host (Eugenia D'Ambrosio)>Deaths from cervical cancer have dropped by 70 percent.

<v Host (Eugenia D'Ambrosio)>But the American Cancer Society estimates that 45,000 women will develop cervical <v Host (Eugenia D'Ambrosio)>cancer this year. Most cases that are found early can be cured. <v Host (Eugenia D'Ambrosio)>However, 7,000 women will die of cancer this year, and every year. <v Host (Eugenia D'Ambrosio)>Many of them fail to have an annual Pap test. <v Host (Eugenia D'Ambrosio)>But a percentage of those women didn't skip their annual exam. <v Host (Eugenia D'Ambrosio)>They were meticulous in having yearly Pap smears. <v Host (Eugenia D'Ambrosio)>What happened in their cases? <v Host (Eugenia D'Ambrosio)>Well, the Pulitzer Prize winning stories published by The Wall Street Journal claim 20 to <v Host (Eugenia D'Ambrosio)>40 percent of Pap smears don't show cell abnormalities, don't show that the cancer <v Host (Eugenia D'Ambrosio)>could be forming. Is it the fault of the Pap screening procedure? <v Host (Eugenia D'Ambrosio)>No, say professionals. It's human error. <v Host (Eugenia D'Ambrosio)>All through the system, from physicians sampling to a misdiagnosis by the lab. <v Doctor 2>Do you feel the speculum? Just relax. <v Doctor 2>You'll feel a little more pressure when I open it up. <v Doctor 2>Try not to touch it. <v Host (Eugenia D'Ambrosio)>Research shows half of the error rate is at the source of the Pap smear. <v Host (Eugenia D'Ambrosio)>Many physicians are simply not taking an adequate sample from the cervix. <v Interviewer>Is that a difficult area to sample?

<v W. Bud Wentz, Gynecologist>Absolutely not. <v Interviewer>Then what's the problem? <v W. Bud Wentz, Gynecologist>Part is education and part is a reluctance to change. <v W. Bud Wentz, Gynecologist>And part is probably not reading the literature too, to see that <v W. Bud Wentz, Gynecologist>when one takes a new cervical preparation and there's a number of <v W. Bud Wentz, Gynecologist>ways one can do this, you will harvest a great many more cells from the area <v W. Bud Wentz, Gynecologist>where the action is, where something is occurring. <v Host (Eugenia D'Ambrosio)>Wentz says that's the biggest area for mistakes. <v Host (Eugenia D'Ambrosio)>Some doctors are only sampling the outside or ecto cervix and not sampling <v Host (Eugenia D'Ambrosio)>the endocervical canal where cancerous changes first occur. <v Host (Eugenia D'Ambrosio)>He demonstrates the correct way to sample. <v W. Bud Wentz, Gynecologist>It will take some sort of an applicator or something like this, and you scrape this <v W. Bud Wentz, Gynecologist>and spread it on a slide. This is the ectocervix or the outer portion of it. <v W. Bud Wentz, Gynecologist>The hole in there is the endocervical canal through which the menstrual products go. <v W. Bud Wentz, Gynecologist>And it's very important to sample up in that area because you can see it and in a number <v W. Bud Wentz, Gynecologist>of ways you can do it. We favor aspirating the mucus, by putting this <v W. Bud Wentz, Gynecologist>in here and sucking it out and putting on a second slide.

<v W. Bud Wentz, Gynecologist>If the woman is older, you can take a little cotton tip applicator. <v W. Bud Wentz, Gynecologist>These are practically no cost at all. <v W. Bud Wentz, Gynecologist>Put it in here. Turn it around and put it on. <v Host (Eugenia D'Ambrosio)>Wentz says an adequate Pap smear contains two slides. <v Host (Eugenia D'Ambrosio)>One of the cells on the ectocervix. The other. <v Host (Eugenia D'Ambrosio)>A sample of the endocervical canal. <v Host (Eugenia D'Ambrosio)>Both have to be immediately fixed to prevent drawing and then sent to the laboratory with <v Host (Eugenia D'Ambrosio)>proper identification and supporting clinical information. <v Host (Eugenia D'Ambrosio)>Once at the lab, the slides are carefully identified and then go through a 22 multi-stage <v Host (Eugenia D'Ambrosio)>screening process. Then they are given to the cyto technologist to screen. <v Host (Eugenia D'Ambrosio)>It's at this point where the other half of the error rate is made. <v Host (Eugenia D'Ambrosio)>The problem in part is overworked personnel. <v Host (Eugenia D'Ambrosio)>Too many slides for too few cyto technologists and a discount system that demands <v Host (Eugenia D'Ambrosio)>too much for too little. <v Host (Eugenia D'Ambrosio)>In the past 15 years, laboratory work has become very competitive. <v Host (Eugenia D'Ambrosio)>Some large laboratories are attracting physician business by offering discounts on <v Host (Eugenia D'Ambrosio)>Pap smears in exchange for the more lucrative lab work a doctor's office generates.

<v Tom White, Gynecologist-Obstetrician>I think most of these large labs do give you discounts if <v Tom White, Gynecologist-Obstetrician>you put all your business with them. <v Beverly Kraemer, Pathologist>There is definitely a Paps for profit cycle going <v Beverly Kraemer, Pathologist>on out in the country and usually is, <v Beverly Kraemer, Pathologist>in regards to your question about the larger laboratories, it usually is <v Beverly Kraemer, Pathologist>centrally focused around the larger independent laboratories. <v Host (Eugenia D'Ambrosio)>The deal was not only attractive for some laboratories, the Pap smear became a big profit <v Host (Eugenia D'Ambrosio)>center for doctors. For example, some labs were charging a $1.50 to $3 <v Host (Eugenia D'Ambrosio)>To process a Pap test. The attending doctor charges the patient anywhere from $10 to $20 <v Host (Eugenia D'Ambrosio)>for that test. Simple arithmetic shows the huge profit that is made from this system. <v Host (Eugenia D'Ambrosio)>Instead of taking advantage of the savings, professionals say that discounted price <v Host (Eugenia D'Ambrosio)>should have been viewed suspiciously by physicians. <v Jared Schwartz, Pathologist>What can you actually get today for 3 dollars? <v Jared Schwartz, Pathologist>And when you're talking about a test trying to screen for malignancy.

<v Jared Schwartz, Pathologist>Performing the test. Issuing a report. <v Jared Schwartz, Pathologist>Mailing it. 3 dollars is pretty low. <v Shirley Greening, Cytotechnologist>Well, I remember doing a study about 10 years ago in Florida <v Shirley Greening, Cytotechnologist>where we determined that taking all the variables that supplies <v Shirley Greening, Cytotechnologist>equipment, the technology, salary and so on. <v Shirley Greening, Cytotechnologist>It cost almost 6 dollars to do a Pap smear 10 years ago for one <v Shirley Greening, Cytotechnologist>slide. So if we're charging half of that right now, <v Shirley Greening, Cytotechnologist>I can't see how these businesses are keeping in <v Shirley Greening, Cytotechnologist>business. <v Host (Eugenia D'Ambrosio)>The labs are staying in business by requiring their cytotechs to do more than is safely <v Host (Eugenia D'Ambrosio)>possible. <v Patricia Ashton, Cytotechnologist>The laboratories were discounting their their specimens, practically giving away their <v Patricia Ashton, Cytotechnologist>cytologists And therefore, the only way to make a profit was to have the <v Patricia Ashton, Cytotechnologist>cytotechnologists screen more and more slides. <v Host (Eugenia D'Ambrosio)>And because cyto technologists have traditionally made low salaries, many have chosen <v Host (Eugenia D'Ambrosio)>to work 2 jobs or are paid by the number of slides read each day. <v Host (Eugenia D'Ambrosio)>The workload can reach 150 to 200 slides per day.

<v Host (Eugenia D'Ambrosio)>That averages to 2 minutes or less, the amount of time a cytotech has to view a slide. <v Beverly Kraemer, Pathologist>A Pap smear may have anywhere from 5000 to 50000 cells <v Beverly Kraemer, Pathologist>smeared all over the surface of the slide. <v Beverly Kraemer, Pathologist>So the cytotechnologist must keep a constant level of concentration <v Beverly Kraemer, Pathologist>throughout the entire screening process and not let her concentration waver. <v Host (Eugenia D'Ambrosio)>This is what the cytotechnologist must concentrate on. <v Host (Eugenia D'Ambrosio)>Hundreds of thousands of cells on one slide. <v Host (Eugenia D'Ambrosio)>To read 150 or 200 slides per day, she would have to screen at this rate. <v Host (Eugenia D'Ambrosio)>Almost impossible for even the most experienced eye to see abnormal cells and <v Host (Eugenia D'Ambrosio)>impossible for the most conscientious cytotechnologists to keep up the pace. <v Patricia Ashton, Cytotechnologist>But to go lickety split through a slide. <v Patricia Ashton, Cytotechnologist>No, you just you just can't do it. <v Patricia Ashton, Cytotechnologist>You're going to miss important cells. <v Shirley Greening, Cytotechnologist>Have eye fatigue, backaches, neck aches, and <v Shirley Greening, Cytotechnologist>it disturbs concentration. <v Host (Eugenia D'Ambrosio)>Under those conditions, cyto technologists have missed abnormal cells, a mistake called

<v Host (Eugenia D'Ambrosio)>a false negative report. Some labs don't tell the doctor his sample was inadequate, <v Host (Eugenia D'Ambrosio)>didn't have enough cells or was destroyed by lack of proper processing, also considered <v Host (Eugenia D'Ambrosio)>a false negative. <v Jared Schwartz, Pathologist>The reason some of them don't is because they're afraid that the physician, if they tell <v Jared Schwartz, Pathologist>the physician the material you're sending me is not adequate, the physician is gonna say, <v Jared Schwartz, Pathologist>okay, I'm to go to another laboratory. <v Host (Eugenia D'Ambrosio)>But in the end, isn't that woman getting short changed? <v Jared Schwartz, Pathologist>Absolutely. She's getting short changed. And, of course, so is the physician, because <v Jared Schwartz, Pathologist>he's not going to be getting the information he needs to adequately care for her. <v Host (Eugenia D'Ambrosio)>Schwartz says most labs do let the physicians know their sample was inadequate. <v Host (Eugenia D'Ambrosio)>And under most circumstances, doctors will repeat the Pap screen, <v Host (Eugenia D'Ambrosio)>but some don't. <v Jared Schwartz, Pathologist>There's no question there are those out there who don't want to know. <v Jared Schwartz, Pathologist>And it's important for the patient to understand and just to to emphasize to their <v Jared Schwartz, Pathologist>physician. I want to know is my Pap smear adequate. <v Jared Schwartz, Pathologist>I want to see it on the report. <v Host (Eugenia D'Ambrosio)>It isn't necessarily a case of the doctor misleading their patients, but rather their <v Host (Eugenia D'Ambrosio)>knowledge that cervical cancer takes 5 to 7 years to get to a dangerous point.

<v Host (Eugenia D'Ambrosio)>Some doctors and cytotechs feel an adequate Pap smear will be compensated by <v Host (Eugenia D'Ambrosio)>Pap tests taken during the woman's next annual exam. <v Host (Eugenia D'Ambrosio)>But that doesn't take into consideration the small percentage of women who develop a rare <v Host (Eugenia D'Ambrosio)>type of cancer that grows quickly. <v Host (Eugenia D'Ambrosio)>Or the high risk group, those women with many sexual partners or <v Host (Eugenia D'Ambrosio)>whose companion is promiscuous. <v Host (Eugenia D'Ambrosio)>Research is now showing that certain sexually transmitted diseases diseases like herpes, <v Host (Eugenia D'Ambrosio)>chlamydia and human papillomavirus may be precursors to cervical cancer. <v Gwen Boyd, Gynecologist>It's epidemic. It truly is epidemic. <v Gwen Boyd, Gynecologist>And once a person has that virus, that person has that virus for life. <v Host (Eugenia D'Ambrosio)>Not only is the disease for a life, but it could end a life if the cancer develops and <v Host (Eugenia D'Ambrosio)>is left unchecked. That one simple test, the Pap smear, can <v Host (Eugenia D'Ambrosio)>alert a doctor and his patient of trouble brewing. <v W. Bud Wentz, Gynecologist>Herpes, the herpes simplex virus, C MV cytomegalovirus, <v W. Bud Wentz, Gynecologist>the chlamydia organism and the papilloma virus.

<v W. Bud Wentz, Gynecologist>The presence of all of these virus infections can be identified on Pap smears, <v W. Bud Wentz, Gynecologist>if the cytology laboratory will do it. <v Host (Eugenia D'Ambrosio)>Unfortunately, some labs won't do it. <v Host (Eugenia D'Ambrosio)>Won't list the diseases present under doctor's orders. <v Jared Schwartz, Pathologist>Yes, I have had physicians come and say I'm not really sure that I want <v Jared Schwartz, Pathologist>that information because they feel that if that information is put down, even <v Jared Schwartz, Pathologist>though it's only suggestive, it's not an absolute that will force them to bring the <v Jared Schwartz, Pathologist>patient back and discuss such things as sexually transmitted diseases. <v Jared Schwartz, Pathologist>Some physicians are uncomfortable with that. <v W. Bud Wentz, Gynecologist>I'm appalled. <v W. Bud Wentz, Gynecologist>I'm appalled that the Cytology. <v W. Bud Wentz, Gynecologist>The cytopathologist would not continue to report what he saw <v W. Bud Wentz, Gynecologist>because that's his obligation and doubly appalled that <v W. Bud Wentz, Gynecologist>a clinician who took a Pap smear would not want every facet of information <v W. Bud Wentz, Gynecologist>that could be obtained to that for the benefit of this patient. <v Cytotechnologist>This woman has an infection. <v Cytotechnologist>And I think she's having some surface reaction, an inflammatory-.

<v Speaker>Pathologists and cytotechnologists working in the majority of labs in this country. <v Speaker>Labs that are doing quality work, say the media attention to the Pap smear crisis <v Speaker>verified certain rumors that shoddy work was going on in a few Pap <v Speaker>mills. When the cost of a discount Pap smear is compared to that for a diagnosis <v Speaker>done by a competent lab, the price difference is so little, professional say <v Speaker>all labs should be doing quality work instead of cutting corners. <v Patricia Ashton, Cytotechnologist>The difference in cost is not significant. <v Patricia Ashton, Cytotechnologist>And I would think that that women, if given the option of having <v Patricia Ashton, Cytotechnologist>their smear, interpreted at a laboratory that had cytotechnologists <v Patricia Ashton, Cytotechnologist>who were handling a reasonable workload and had the time to devote to each individual <v Patricia Ashton, Cytotechnologist>case, would be willing to pay that extra amount. <v Patricia Ashton, Cytotechnologist>But they have no idea what a Pap smear costs. <v Patricia Ashton, Cytotechnologist>It's it's a hidden component in in their in their fee to their <v Patricia Ashton, Cytotechnologist>gynecologist. <v Host (Eugenia D'Ambrosio)>In fact, proposed legislation would require labs to build a patient, bypassing the <v Host (Eugenia D'Ambrosio)>doctor that would end the discount profit system.

<v Host (Eugenia D'Ambrosio)>There are physicians who have searched for low cost Pap smears in order to pass the <v Host (Eugenia D'Ambrosio)>savings onto their clients. For example, Planned Parenthood Federation of America, <v Host (Eugenia D'Ambrosio)>which serves lower and middle income women, it annually screens the laboratories used <v Host (Eugenia D'Ambrosio)>by hundreds of clinics nationwide. <v Host (Eugenia D'Ambrosio)>Despite the cost, which is a major factor, laboratories that consistently produce <v Host (Eugenia D'Ambrosio)>false negatives have been dropped from their program. <v Gwen Boyd, Gynecologist>The cervical biopsy a lot of times was much worse than the Pap smear reading. <v Gwen Boyd, Gynecologist>The Pap smear would have a reading of mild dysplasia or mild changes in the cells, <v Gwen Boyd, Gynecologist>and the biopsy would show either moderate or severe changes in the cells. <v Gwen Boyd, Gynecologist>So at least the abnormal Pap smear was being followed up. <v Gwen Boyd, Gynecologist>But I would have expected the Pap smear to read a little worse than it did. <v Host (Eugenia D'Ambrosio)>In changing labs Dr. Boyd knows the patient cost of a Pap smear will probably have to <v Host (Eugenia D'Ambrosio)>increase, but the assurance of quality is worth a few extra dollars. <v Host (Eugenia D'Ambrosio)>Overworked personnel isn't the only problem facing labs.

<v Host (Eugenia D'Ambrosio)>There simply aren't enough cytotechnologists to diagnose the millions of Pap smears <v Host (Eugenia D'Ambrosio)>and other specimens generated each year. <v Beverly Kraemer, Pathologist>The problem that they now face is, of course, the impending crisis of the <v Beverly Kraemer, Pathologist>cytotechnologists in terms of manpower. <v Beverly Kraemer, Pathologist>There are fewer and fewer cytotechnologists to go around. <v Beverly Kraemer, Pathologist>And so the laboratories are in somewhat of a catch 22 <v Beverly Kraemer, Pathologist>to try and reduce the workload. <v Beverly Kraemer, Pathologist>And yet at the same time, they don't have the personnel to to identify, to <v Beverly Kraemer, Pathologist>carry out that goal. <v Host (Eugenia D'Ambrosio)>The fact is, the number of registered cytotechnologists working in the field is dwindling <v Host (Eugenia D'Ambrosio)>and fewer women are choosing cytology as a career. <v Host (Eugenia D'Ambrosio)>Traditionally, a woman's job, the salaries are low and the work is not as attractive as <v Host (Eugenia D'Ambrosio)>other fields of medicine and science that are opening for women. <v Host (Eugenia D'Ambrosio)>The number of active training programs has fallen to about a third of what was available <v Host (Eugenia D'Ambrosio)>10 years ago, and it's estimated three quarters of the jobs available this year <v Host (Eugenia D'Ambrosio)>will go unfilled. Professional societies feel if better salaries are offered <v Host (Eugenia D'Ambrosio)>and more reasonable workloads are enforced, women and men will become interested

<v Host (Eugenia D'Ambrosio)>in the field. They recommend the following qualifications for a competent lab <v Host (Eugenia D'Ambrosio)>and effort to improve the working environment and the quality of product. <v Host (Eugenia D'Ambrosio)>The most important of these is a reasonable workload for cyto technologists. <v Host (Eugenia D'Ambrosio)>Another professional group, the College of American Pathologists, requires labs have <v Host (Eugenia D'Ambrosio)>documented quality control and quality assurance programs. <v Robert Rickert, Pathologist>Well, I think the laboratory as a whole is responsible for both its quality <v Robert Rickert, Pathologist>control and its quality assurance activities. <v Robert Rickert, Pathologist>And the high quality laboratory should be committed <v Robert Rickert, Pathologist>to a comprehensive program of quality assurance, which includes <v Robert Rickert, Pathologist>those technical and proper process related elements of quality control. <v Host (Eugenia D'Ambrosio)>The College of American Pathologists accredits 4000 out of the 10000 labs <v Host (Eugenia D'Ambrosio)>operating in this country. The CAP inspects each lab every other year <v Host (Eugenia D'Ambrosio)>with a team of professionals with a mandatory staff inspection by that lab during <v Host (Eugenia D'Ambrosio)>the intervening year. The program is stringent.

<v Host (Eugenia D'Ambrosio)>A checklist of over 3000 items covers all personnel and laboratory functions. <v Robert Rickert, Pathologist>Concerns itself, for example, with the physical facility, <v Robert Rickert, Pathologist>with the qualifications of the personnel, with the technical <v Robert Rickert, Pathologist>procedures in place, with the technical manuals <v Robert Rickert, Pathologist>which define those procedures, the adherence <v Robert Rickert, Pathologist>to safety standards, participation in stringent <v Robert Rickert, Pathologist>quality control and quality assurance activities. <v Robert Rickert, Pathologist>And all of those elements are reviewed and evaluated <v Robert Rickert, Pathologist>as part of this accreditation program. <v Host (Eugenia D'Ambrosio)>This program is known to be the best in the field, but laboratory compliance is <v Host (Eugenia D'Ambrosio)>voluntary. Laboratories doing business in this country do not have to be accredited <v Host (Eugenia D'Ambrosio)>by the CAP. The federal government and some of the states do have rules <v Host (Eugenia D'Ambrosio)>covering lab operations, but none are tough enough to close down or even clean <v Host (Eugenia D'Ambrosio)>up substandard labs.

<v Host (Eugenia D'Ambrosio)>In fact, some federal inspections can be easily passed. <v Patricia Ashton, Cytotechnologist>One of the problems with the federal government's oversight <v Patricia Ashton, Cytotechnologist>has been that the people who are doing the surveys of these laboratories <v Patricia Ashton, Cytotechnologist>are not trained in cytology and they <v Patricia Ashton, Cytotechnologist>don't know what to look for. <v Host (Eugenia D'Ambrosio)>Ashton was one of many professionals asked to testify at 2 Congressional health <v Host (Eugenia D'Ambrosio)>subcommittee hearings. As a result of her testimony and others, stricter legislation <v Host (Eugenia D'Ambrosio)>is pending. <v Beverly Kraemer, Pathologist>I had the opportunity to glance at the Federal Register, which is the <v Beverly Kraemer, Pathologist>latest in terms of recommendations coming from the Department of Health and Human <v Beverly Kraemer, Pathologist>Services. And they remain open at this time, but are inviting <v Beverly Kraemer, Pathologist>comments as to what would be considered as the best workload <v Beverly Kraemer, Pathologist>guideline for cytotechnologists. <v Beverly Kraemer, Pathologist>So at this point, there is room for negotiation <v Beverly Kraemer, Pathologist>and it remains to be seen whether there will be federally mandated legislation on this <v Beverly Kraemer, Pathologist>point or not. Between you and me, I have a feeling that that's what's coming.

<v Shirley Greening, Cytotechnologist>I think at this point, the federal and state governments have to step <v Shirley Greening, Cytotechnologist>in and say we can no longer condone <v Shirley Greening, Cytotechnologist>practices that continue to be substandard. <v Shirley Greening, Cytotechnologist>I think that the government agencies <v Shirley Greening, Cytotechnologist>have to set the standards, presumably on the advice <v Shirley Greening, Cytotechnologist>of the professional societies that are involved and put some teeth in <v Shirley Greening, Cytotechnologist>the in the standards that already exist. <v Host (Eugenia D'Ambrosio)>Another government agency, the Centers for Disease Control, held a meeting for <v Host (Eugenia D'Ambrosio)>professionals to come up with recommendations for the suggested regulations. <v Host (Eugenia D'Ambrosio)>Among the topics discussed was adoption of uniform language that would be used by <v Host (Eugenia D'Ambrosio)>the laboratory and the physicians. <v Host (Eugenia D'Ambrosio)>Under the current system, doctors are sometimes baffled by the diagnostic reports. <v Diane Solomon, Pathologist>Because of the confusion as to what different diagnostic terms mean, clinicians <v Diane Solomon, Pathologist>are often unsure of exactly what the implications are of a certain diagnosis, <v Diane Solomon, Pathologist>and therefore they may not know how to appropriately treat the patient.

<v Host (Eugenia D'Ambrosio)>Once regulations clearing up terminology and setting laboratory standards are adopted, <v Host (Eugenia D'Ambrosio)>how can they be enforced on all labs? <v Paul Weisner, CDC>2 ways. Most laboratories, clinicians and most patients want <v Paul Weisner, CDC>to do things correctly. So one way to have people conform <v Paul Weisner, CDC>to standards is to provide them with the appropriate education, the appropriate training, <v Paul Weisner, CDC>appropriate tools to do their jobs well. <v Paul Weisner, CDC>Another way is to provide standards for regulations that say unless you do <v Paul Weisner, CDC>so and so, you will not be able to be reimbursed for Medicare or you will <v Paul Weisner, CDC>not be able to have a license to do interstate commerce in clinical laboratories. <v Host (Eugenia D'Ambrosio)>But in the meantime, many doctors are still using the suspected labs. <v Host (Eugenia D'Ambrosio)>Labs that have been named in news reports as substandard. <v Jared Schwartz, Pathologist>Many of these physicians continue to use these laboratories despite multiple <v Jared Schwartz, Pathologist>episodes of errors occurring. <v Jared Schwartz, Pathologist>I can't answer why. I don't know why. <v Host (Eugenia D'Ambrosio)>At least one physician doesn't understand either.

<v Host (Eugenia D'Ambrosio)>Dr. Tom White says insurance companies should warn doctors that injury claims won't be <v Host (Eugenia D'Ambrosio)>covered if the physician knew the lab was doing subpar work. <v Tom White, Gynecologist-Obstetrician>When you start talking about liability in the doctor's pocketbook and making him liable, <v Tom White, Gynecologist-Obstetrician>then I think you're going to probably make some progress. <v Host (Eugenia D'Ambrosio)>Dr. White knows how preventable mistakes can end in tragedy. <v Host (Eugenia D'Ambrosio)>He treated a woman who unknowingly had cervical cancer because the lab used by <v Host (Eugenia D'Ambrosio)>her former doctor missed the abnormal cells on her Pap smear. <v Tom White, Gynecologist-Obstetrician>Well, I'll be honest with you, this was a patient that was seen by another physician who <v Tom White, Gynecologist-Obstetrician>had a negative Pap smear, who came to see me a year later and had an obvious lesion <v Tom White, Gynecologist-Obstetrician>on her cervix, went back and looked at the Pap smear from the year before, <v Tom White, Gynecologist-Obstetrician>and it showed cancer of the cervix. <v Tom White, Gynecologist-Obstetrician>It was missed. <v Interviewer>And it was done by a large. <v Tom White, Gynecologist-Obstetrician>Done by a large lab. And the Pap smear was reviewed and did show changes that should've <v Tom White, Gynecologist-Obstetrician>been taken care of a year previously. <v Host (Eugenia D'Ambrosio)>The error isn't always made in the lab. <v Host (Eugenia D'Ambrosio)>In Sandra Rosing's case, lab reports repeatedly suggested further testing <v Host (Eugenia D'Ambrosio)>for cancer. A recommendation never followed up by her doctor.

<v Sandra Rosing>The doctor that I had been going to since I was 18 retired. <v Sandra Rosing>10 months later, I had an appointment with my new gynecologist <v Sandra Rosing>and he spotted it immediately. <v Host (Eugenia D'Ambrosio)>The Ohio woman who had to undergo a radical hysterectomy almost immediately. <v Host (Eugenia D'Ambrosio)>She suffered complications from the surgery, which required more medical treatment. <v Host (Eugenia D'Ambrosio)>Her bills are in excess of 50,000 dollars. <v Host (Eugenia D'Ambrosio)>She still undergoes periodic hospital care. <v Host (Eugenia D'Ambrosio)>Surprisingly, Rosing is not angry despite her ordeal. <v Host (Eugenia D'Ambrosio)>She's just happy to be alive. <v Sandra Rosing>I'm just grateful that he retired when he did. <v Sandra Rosing>Had he not, I wouldn't be here. <v Sandra Rosing>It had gone that far. <v Host (Eugenia D'Ambrosio)>Rosing says she would have had the cancer tests done if she had known the pathologist <v Host (Eugenia D'Ambrosio)>recommendations. Her advice to other women, get an annual Pap <v Host (Eugenia D'Ambrosio)>test and read your own Pap smear report. <v Host (Eugenia D'Ambrosio)>That advice is backed by professionals.

<v Paul Weisner, CDC>Well there's 2, 2 important things that a woman can do to prevent cancer from invading <v Paul Weisner, CDC>from the mouth of her womb into her body.One is to detect it early, and that means <v Paul Weisner, CDC>getting her regular Pap smear tests done. <v Paul Weisner, CDC>But the other part of it is get the report back. <v Paul Weisner, CDC>Understand it. Know what it means. <v Paul Weisner, CDC>Know what it means in terms of having follow up, being sure that there's a follow up <v Paul Weisner, CDC>test, if need be, or if it's only a matter of getting one next year, get it next year. <v Host (Eugenia D'Ambrosio)>In addition to a yearly Pap test, Dr. Wentz lists what a woman should expect <v Host (Eugenia D'Ambrosio)>from a complete exam. <v W. Bud Wentz, Gynecologist>She should expect to have a breast exam. <v W. Bud Wentz, Gynecologist>She should expect an abdominal exam, a pelvic exam and a <v W. Bud Wentz, Gynecologist>rectal exam. Also, a lot of questions that have to do also with the urinary <v W. Bud Wentz, Gynecologist>tract and the G.R. gastrointestinal tract. <v W. Bud Wentz, Gynecologist>And when you do the examination, takes the Pap smear. <v W. Bud Wentz, Gynecologist>It's not just looking at the cervix and taking the scraping we talked about. <v W. Bud Wentz, Gynecologist>One looks at the vulva, the vagina, the cervix, the size, the uterus and the ovaries. <v W. Bud Wentz, Gynecologist>If you don't do all those tests, you're going to miss a lot of problems. <v W. Bud Wentz, Gynecologist>So coming in for the Pap smear affords the woman a much more comprehensive

<v W. Bud Wentz, Gynecologist>evaluation than just a simple Pap smear. <v Host (Eugenia D'Ambrosio)>To prevent cervical cancer, women should have an annual Pap test. <v Host (Eugenia D'Ambrosio)>The test should be between menstrual periods and 24 hours before or after <v Host (Eugenia D'Ambrosio)>intercourse or douching. All 3 can alter the diagnostic results. <v Host (Eugenia D'Ambrosio)>The College of American Pathologists recommends that women question their physicians <v Host (Eugenia D'Ambrosio)>about the lab used. Is it licensed, accredited and inspected? <v Host (Eugenia D'Ambrosio)>Does it have documented quality control and quality assurance programs? <v Host (Eugenia D'Ambrosio)>Is there good communication between the attending doctor and the cytology <v Host (Eugenia D'Ambrosio)>lab, or is it a mail order facility that is far away and is hard to reach? <v Host (Eugenia D'Ambrosio)>Does it report in adequate samples? <v Host (Eugenia D'Ambrosio)>Is the lab staffed with professionals who have reasonable workloads? <v Host (Eugenia D'Ambrosio)>Ask the doctor his Pap test technique. <v Host (Eugenia D'Ambrosio)>Does he obtain sufficient samples to ensure the ectocervix and the endocervical <v Host (Eugenia D'Ambrosio)>canal have been scraped?

<v Beverly Kraemer, Pathologist>I think that many women are subject to the gynecologist's <v Beverly Kraemer, Pathologist>control, if you will. And there are many techniques <v Beverly Kraemer, Pathologist>in Pap smear retrieval that can be more effective than others. <v Beverly Kraemer, Pathologist>And so I think it's it's good for the woman to be able to have that information at her <v Beverly Kraemer, Pathologist>fingertips. <v Host (Eugenia D'Ambrosio)>And most importantly, tell your doctor you want to see your Pap smear report from the <v Host (Eugenia D'Ambrosio)>previous visit. It should say if the smear was inadequate, if further <v Host (Eugenia D'Ambrosio)>testing is needed and if any other diseases were found. <v Robert Rickert, Pathologist>Well, we certainly feel that it is entirely appropriate. <v Robert Rickert, Pathologist>And we encourage women to ask these kinds of questions of her doctor <v Robert Rickert, Pathologist>about the laboratory performing the psychology services. <v Host (Eugenia D'Ambrosio)>The College of American Pathologists is concerned about good health care and advises <v Host (Eugenia D'Ambrosio)>women to be their own health advocates. <v Host (Eugenia D'Ambrosio)>They want you to have this free brochure which highlights the information discussed in <v Host (Eugenia D'Ambrosio)>this program and lists the questions you should be asking your doctor. <v Host (Eugenia D'Ambrosio)>Cervical cancer does not have to maim or kill.

<v Host (Eugenia D'Ambrosio)>A quality Pap test taken annually and processed by a competent lab is your <v Host (Eugenia D'Ambrosio)>best insurance and the cure to the Pap smear crisis. <v On-Screen Text>On Screen Text: For a Free Brochure Call 1-800-Lab-5678 <v Announcer>For information on purchasing a video cassette of this program, send a stamped

<v Announcer>self-addressed envelope and write to Pap Test WTVI Video 42 <v Announcer>Coliseum Drive, Charlotte, North Carolina, 28205. <v Announcer>Funding <v Announcer>for this program is provided by a grant from the College of American Pathologists.