Copyright 1999 Federal News Service, Inc.
Federal News Service
MARCH 16, 1999, TUESDAY
SECTION: IN THE NEWS
HEADLINE: PREPARED STATEMENT OF
AMERICAN SOCIETY OF CLINICAL PATHOLOGISTS
HOUSE COMMERCE COMMITTEE
SUBCOMMITTEE ON HEALTH AND THE
SUBJECT - WOMEN'S HEALTH:
RAISING AWARENESS OF CERVICAL
Chairman Bilirakis, members of the
subcommittee, my name is Rose Marie Gatscha, SCT(ASCP). I am Cytology Manager at
Memorial Sloan-Kettering Cancer Center in New York City. I am here today
representing the American Society of Clinical Pathologists.
Society of Clinical Pathologists (ASCP) is a nonprofit medical specialty society
organized for educational and scientific purposes. Its 75,000 members include
board certified pathologists, other physicians, clinical scientists, and
certified technologists and technicans. These professionals recognize the
Society as the principal source of continuing education in pathology and as the
leading organization for the certification of laboratory personnel. ASCP's
certifying board registers more than 150,000 laboratory professionals annually.
The Pap Smear Facts
The Pap smear is a proven screening method of detecting
and preventing cervical cancer. It is the most effective cancer screening test
in medical history as it is largely responsible for the 70% to 80% decline in
death due to cervical cancer over the last 50 years in the United States.
Approximately 4,900 women die from cervical cancer annually in this country,
making it the tenth leading cause of death from cancer in women. Approximately
14,000 new cases of cervical cancer are diagnosed each year.
The Pap smear
is a safe, noninvasive, cost-effective medical procedure. Cells collected from a
woman's uterine cervix are sent to a cytopathology laboratory where the cells
are evaluated. The cytotechnologist prepares the slide and evaluates the
specimen, which is composed of thousands of cells - usually between 30,000 to
200,000 cells in a single specimen. If the specimen is within normal limits, a
report is sent to the woman's health care provider. If an abnormality is
detected, then a pathologist examines the slide and issues a final diagnosis.
Barriers to Pap Smear Testing
While it is difficult to believe, more
women (80%) die of cervical cancer because they have never had a Pap smear or
they have not had a Pap smear in the last five years than those that die of a
false negative Pap smear. We believe this is unconscionable.
There are many
reasons why some women do not have Pap smears, or why Pap smears may be less
available to women. I'd like to devote the rest of my comments to exploring
Trained Cytotechnologists Are Needed
The American Society
of Clinical Pathologists' Board of Registry, in conjunction with MORPACE
International, Detroit, conducts a biennial wage and vacancy survey of 2,500
medical laboratory managers. The survey measures the vacancy rates for 10
medical laboratory positions, and compares and contrasts these data with that
from 1988, 1990, 1992, 1994, and 1996 studies. The 1998 data has just been made
available, and the information regarding cytotechnologists, the professionals
who interpret cellular material such as Pap smears, is of particular interest
The current vacancy rate for cytotechnologists (staff level) is
10.5%, an increase over the 1996 rate, which was 7.1%. This is the first
increase in the cytotechnologist (staff level) vacancy rate in eight years. It
is also important to note that for rural areas, the cytotechnologist (staff
level) vacancy rate is 17.6%, and totals 9.7% for small-medium size cities and
12.1% in large cities. Also, while the vacancy rate for cytotechnologist (staff
level) in large hospitals is 8.3%, the vacancy rate nearly doubles for hospitals
with a 100-299 bed size - up to 15.8%. Hospitals with bed size of 300-499
reported vacancy rates for these professionals at 14.3%.
were questioned about the difficulty they have in filling work shifts. 21%
reported problems recruiting cytotechnologist (staff level) for day shifts,
three times higher than the 8% reporting such difficulties in 1996.
the overall vacancy rate for cytotechnologist (supervisor) has decreased over
the past two years, 10% down from 12.5%, the vacancy rate in small-medium size
cities for cytotechnologist (supervisor) is 20.0%. Vacancy rates for
cytotechnologist (supervisor), while virtually non-existent in the east north
central, west south central, and far west regions of the country, are explosive
in the northeast (16.7%), south central atlantic (18.2%), and west north central
(12.5%) parts of the nation.
These data show some cause for concern.
Cytotechnologists are highly skilled and trained individuals, who must have at
least a baccalaureate degree followed by a year of specialized training in
cytology. Cytotechnologists must then take a rigorous national certifying
examination, administered by the ASCP, in order to become certified.
Laboratories rely on certified cytotechnologists to evaluate all Pap smears.
With high vacancy rates, there is concern that some laboratories will not have
the appropriate personnel available to evaluate Pap smears.
Cytopathology smears are
currently priced at $7.15 on the Medicare laboratory fee
schedule. The actual cost of the conventional Pap smear
(excluding new technology and the professional component for physicians) is in
the range of $13 to $17. The cost of new liquid- based Pap testing is $28-$32.
This price includes cytotechnologist salaries, overhead costs, CLlA-mandated
quality control, laboratory supplies, and supplies given to healthcare providers
who obtain the smear. The Medicare payment rate for
Pap smears should increase significantly.
ASCP and other
organizations are working with the Health Care Financing Administration to
increase the Medicare payment rate for Pap
smears. In addition, Representative Neil Abercrombie and Representative Mary
Bono have recently sponsored legislation, HR 976, to increase the Medicare
payment rate to $14.60. ASCP supports this effort to bring attention to the need
for the Pap test and a more appropriate payment rate.
annual screening, the chance of a woman developing cervical cancer can be
reduced to less than 1%. Pap smears have an irreducible false negative rate
(10%40%) due to sampling errors on the part of health care providers and
screening errors occurring in laboratories.
According to a March 1997 report
in the Archives of Pathology and Laboratory Medicine, the continued availability
of Pap cancer screening test is threatened by lawsuits because the legal system
demands a zero error rate which is mathematically unachievable even in the most
competent professional hands.
Healthy People 2000, the National Health Promotion and Disease Prevention
Objectives, there are several key assumptions that may be used to help overcome
barriers to cervical cancer screening. The objectives state, "low income, low
education and advancing age are all associated with a decreased likelihood of
receiving Pap tests." The report continues that "age influences both cervical
cancer incidence and survival. While younger women are more frequently diagnosed
with cervical cancer, older women are more often diagnosed at later stages of
the disease and are more likely to die from it than younger women." We are also
aware that certain populations of women - African American, Hispanic, Asian, and
low-income rural women - often face cultural and economic barriers to Pap
For example, it is not uncommon for low-income women of Hispanic
descent to refuse Pap testing. Even if the Pap smear is free or of little cost,
these women, whose families may rely on them for income and support, refuse the
test because they do not want to know if they have cancer. A cancer diagnosis,
in this instance, would mean extensive, and often prohibitive, medical costs to
treat the cancer, and would tear the women away from their families for extended
periods of time. Many women in this situation prefer not to know their potential
cancer status. In addition, a lack of culturally appropriate materials or
information communicated in Spanish is a barrier to Hispanic women being
In a study compiled by the Centers for Disease and Prevention, it
was determined that transportation and its costs were barriers to Pap testing
for Native American women.
In speaking with public health officials, we are
also aware of examples in certain Asian-American communities where it is
considered shameful for women to have a Pap smear. In this culture, husbands may
not want their wives to be examined "in that way" by a male physician.
The Pap smear, named for its creator Dr. George N.
Papanicolaou, is one of the most effective cancer screening tools available to
women today. There are ways to lessen the barriers that exist to Pap testing, so
that cervical cancer becomes a less formidable disease to women.
continues to work with the cytology community to provide continuing education
and certification for these laboratory professionals. ASCP has also established
a scholarship program for medical technology students, including
cytotechnologists. The Society awards 100 student scholarships each year to
assist with educational finances.
Last year, your Committee reauthorized
Title VII of the Public Health Service Act (Health Professions Education
Partnerships Act of 1998, P.L. 105-392), which included a program for Allied
Health Project Grants. This program has been effective in addressing the
training and educational needs of allied health personnel, including
cytotechnologists. However, further strides in funding are still needed to
increase the number of cytotechnologists to an adequate level.
the Medicare reimbursement for Pap testing to
an amount more in line with current costs would also help to attract and retain
professionals in the field.
ASCP, along with many other organizations, are
working to educate the general public and the priority populations mentioned
above about the importance and effectiveness of the Pap smear. We are
particularly proud of the efforts we have undertaken to help educate other
health care providers about the Pap smear.
ASCP believes it is important to
develop and disseminate educational materials to targeted populations and to the
health care providers that serve them, and develop relationships with community
organizations, such as schools, retailers, employers, social facilities, and
churches, to assist in reaching women that are not participating in cervical
cancer screening programs.
We aim to continue these educational efforts, and
look forward to working with you and others in the prevention of cervical
I would be pleased to answer any questions you may have.
LOAD-DATE: March 17, 1999