I am a very lucky President. I am surrounded by excellent mentors, prior Presidents, future Presidents, and co-workers. This organization has withstood the test of time, and has greatly benefited from the many excellent people who have volunteered their time and efforts to make this the organization that it is. This organization has an effective set of bylaws, a stable National Office Staff and executive Vice President, and a stable membership. Cytology continues to be a field that benefits the patients it serves every single day, one cell at a time, and the ASC continues to benefit its members.
In many ways, the goals of the ASC for my presidency have already been set by the actions of the leadership that has come before me. No President can do it alone, and very few initiatives can be successfully achieved in a single year. Nevertheless, during this year I would like to focus on three areas where other leaders have already paved the way:
- Improve the quality of cytology through evidence based practice;
- Make the ASC part of a big tent of pathology and cytology organizations;
- Help cytotechnologists adapt and evolve.
The ASC already has had several initiatives to improve the quality of the practice of cytology. However, the effectiveness of these efforts has been uneven. There are many reasons for this. Importantly, quality means different things to different people, and in fact, it has proved surprisingly difficult to measure quality in pathology in general and in cytology specifically. In addition, measuring quality, as opposed to sexy molecular studies, is a very hard way to pursue an academic career. There is simply more money to pursue new tests that look at the molecular structure of cancer than to measure something as hum drum as workload.
Nevertheless, without quality, cytology cannot survive; other tests will simply replace it. The writing is already on the wall. While HPV testing is a great advance and, I believe, should be used more than it currently is, interpreting the studies that compare HPV to cytology is difficult because the quality of the cytology arm is not clear. If the sensitivity for CIN2 on biopsy of cytology is truly less than 40%, which is what at least one center achieved in large randomized trials, then we should immediately switch to HPV testing instead. Fortunately, I do not believe this to be true – but only studies that address the issue of quality can answer this question. Urovysion is another excellent test, one that I also love to use, but similar questions about the quality of the cytology arm of studies of Urovysion have also been raised. At the end of the day and for better or worse, if we do not actively seek to define standards for quality in cytology, cytology will be replaced by these molecular tests for no other reason that the quality of these tests can be more clearly defined and controlled.
But quality will not ensure the future of cytology alone. The world of medicine is becoming increasingly competitive and the field of cytology is at risk of being lost in the sea of other specialties, which are also actively seeking to expand their own influence. In such a setting, it is imperative for the ASC to work with other organizations to pool our resources and influence for the benefit of all. Certainly the ASC should continue to preserve its independence and its own unique approach to supporting the interests of its members. Nevertheless, this does not mean that every other organization that does cytology is a competitor. More and more the ASC will need to seek alliances to successfully navigate the issues that will arise in the future. If done right, these alliances can be a win-win proposition for all the organizations involved.
And one group that really deserves a win is our cytotechnology membership. Previous Presidents and many members at all levels of this organization have already pointed out that the future of cytotechnology is evolving. This trend cannot be stopped. What can be changed is where it ends up. In one scenario, cytotechnology may be a field that no longer exists. In another, cytotechnologists may end up as competitors to pathologists. Neither of these scenarios is a win-win, but neither of these scenarios is written in stone. It is in all of our best interests to actively work to make sure that cytotechnologists remain an indispensable part of the cytology team that works to provide the best quality of care to our patients.
Finally, as all of you know, there is great uncertainty about the financial future of medicine in general. Regardless of which way things go, it seems very unlikely that there will be more money available to work with in the future than we have now. Certainly funds for education are likely to decrease, and since the ASC is primarily an educational organization, this is a very important challenge. As a field, we must be creative in figuring out how to support our future efforts, and also we must be creative in figuring out more cost effective ways to carry out those efforts.
Fortunately, the ASC has a nest egg of investments and a strong Foundation. Working together, we have the time and the resources to come out of this difficult period stronger and better placed than we entered it. However, this will be a difficult process. No amount of creativity will allow the ASC to continue to be all things to all people all the time. Some difficult decisions and priorities will likely have to be made. I would hope that when those decisions are made, people will focus on objectives that benefit everyone associated with the ASC – patients, members, and cytology as a whole, and that they recognize they do not have to make these decisions alone, and that the important resource that is our cytotechnology membership will be given the support and resources they have certainly earned.
Andrew A. Renshaw, MD