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<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
Program
The Pap Test : A Cure for the Crisis
Producing Organization
WTVI (Television station : Charlotte, N.C.)
Contributing Organization
The Walter J. Brown Media Archives & Peabody Awards Collection at the University of Georgia (Athens, Georgia)
AAPB ID
cpb-aacip-526-j09w08xk0x
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Description
Program Description
"Developed in the 1940s by Dr. George Papanicolaou, the Pap exam has become a sage, painless and economical method of detecting the early signs of cervical cancer. Forty-five thousand women develop cervical cancer every year, and approximately 7,000 of these women die of the disease. However, thousands of lives can be saved if the cancer is detected early with a Pap exam, provided that samples are taken, prepared and interpreted correctly. Unfortunately, according to a recent series of Pulitzer Prize-winning articles published by The Wall Street Journal , 20 to 40 percent of the Pap exams administered each year do not detect the cell abnormalities that reveal cervical cancer."The Pap Test: A Cure for the Crisis takes an in-depth look at why such failures occur; provides advice to women to ensure that their Pap smear is performed and diagnosed properly; encourages women to have a regular Pap examination; and lists questions women might ask their doctors about their Pap exam, including test sampling techniques and laboratory testing procedures. "Featured in the half-hour documentary are pathologists, OB-GYN physicians, cytotechnologists and government representatives who discuss current concerns and issues about Pap testing. Sandra Rosing, a patient from Ohio, talks about how a series of her Pap smears, misinterpreted by her physician, failed to detect cervical cancer that resulted in a radical hysterectomy, a procedure that may have been avoided had the Pap test been diagnosed correctly. Further complications from the hysterectomy have resulted in Rosing incurring more than $50,000 in medical bills since 1985."--1988 Peabody Awards entry form.
Broadcast Date
1988
Created Date
1988
Asset type
Program
Media type
Moving Image
Duration
00:28:49.728
Embed Code
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Credits
Producing Organization: WTVI (Television station : Charlotte, N.C.)
AAPB Contributor Holdings
The Walter J. Brown Media Archives & Peabody Awards Collection at the University of Georgia
Identifier: cpb-aacip-ca4215a7d53 (Filename)
Format: U-matic
Duration: 0:30:00
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Citations
Chicago: “The Pap Test : A Cure for the Crisis,” 1988, The Walter J. Brown Media Archives & Peabody Awards Collection at the University of Georgia, American Archive of Public Broadcasting (GBH and the Library of Congress), Boston, MA and Washington, DC, accessed June 26, 2022, http://americanarchive.org/catalog/cpb-aacip-526-j09w08xk0x.
MLA: “The Pap Test : A Cure for the Crisis.” 1988. The Walter J. Brown Media Archives & Peabody Awards Collection at the University of Georgia, American Archive of Public Broadcasting (GBH and the Library of Congress), Boston, MA and Washington, DC. Web. June 26, 2022. <http://americanarchive.org/catalog/cpb-aacip-526-j09w08xk0x>.
APA: The Pap Test : A Cure for the Crisis. Boston, MA: The Walter J. Brown Media Archives & Peabody Awards Collection at the University of Georgia, American Archive of Public Broadcasting (GBH and the Library of Congress), Boston, MA and Washington, DC. Retrieved from http://americanarchive.org/catalog/cpb-aacip-526-j09w08xk0x