Copyright 1999 Federal News Service, Inc.
Federal News Service
JUNE 10, 1999, THURSDAY
SECTION: IN THE NEWS
LENGTH:
1737 words
HEADLINE: PREPARED STATEMENT OF THE
AMERICAN SOCIETY OF CLINICAL PATHOLOGISTS
(ASCP)
BEFORE THE
HOUSE GOVERNMENT REFORM COMMITTEE
SUBJECT - EARLY DETECTION
OF WOMEN'S CANCER
BODY:
The American 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 technicians. 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.
While
ASCP members are involved in the diagnosis of all types of cancer affecting
women, our statement today focuses on cervical cancer detection and prevention.
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. Some of these reasons are explored below.
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 and concern.
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 thecytotechnologist
(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%. Laboratory managers 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.
While the overall vacancy rate for
cytotechnologist (supervisor) has decreased over the past two years, 10% down
from 12.5%, the vacancy rate in smallmedium 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.
Medicare Reimbursement
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, 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.
Liability
With 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.
Socioeconomic Barriers
According to 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 screening.
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 screened.
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.Solutions 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. ASCP 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.
Title VII of the
Public Health Service Act (Health Professions Education Partnerships Act of
1998, P.L. 105-392), includes 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.
Increasing 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 targetted
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 inreaching 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 cancer.
END
LOAD-DATE: June 11, 1999 
