College of American Pathologists
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  In Cusco, Peru, Pap tests for 1,200 women


CAP Today




August 2009
Cytopathology Programs Review

Rosemary H. Tambouret, MD
Barbara A. Winkler, MD

The number of outreach efforts by the pathology community to laboratories and pathologists in underfunded, underserved communities around the world is rising. Cytopathologists, cytotechnologists, and preparatory technicians play significant roles in this work, as described in the following examples.

Cervical cytology screening in the mountains of Peru is sorely needed in a country where cervical cancer is the leading cause of death in women and where screening rates are less than 30 percent, even in advantaged urban areas. In fact, Peru has one of the highest rates of cervical cancer in the world. The Inter­national Cervical Cancer Foundation, or INCCA, was founded in 2005 by Daron Ferris, MD, of the Medical College of Georgia, with the goal of reducing mortality from cervical cancer through a combination of clinical care and education. In Peru, the INCCA operates through a nongovernmental agency known as CerviCusco, which in May 2008 opened a freestanding regional clinic in Cusco, Peru. A volunteer team of three pathologists, seven cytotechnologists, and one cytopreparatory technician traveled from the United States to work with the volunteer clinicians to provide Pap smear screening for the first time. With donated supplies and equipment, they screened more than 1,000 Peruvian women. And they did it the old-fashioned way: with conventional smears, monochromatic stain, and baby oil as mounting medium. Despite the technical challenges, the efforts of the cytopathology volunteers were a resounding success.

The 2009 INCCA mission took place from May 25 through June 5. Two volunteer cytology teams from all over the United States attended, with one pathologist, four cytotechnologists, and one preparatory technician for the first week and one pathologist, five cytotechnologists, and one preparatory technician for the second week. As in 2008, friends and relatives of the professional staff supported the laboratory by performing clerical and administrative duties. Donated supplies allowed for traditional Pap staining of conventional smears and for histology and biopsy processing in the CerviCusco laboratory. The volunteers provided screening services to more than 1,200 women in the Cusco area, most of whom were having Pap tests for the first time.

The volunteer “vacation” was again a rewarding and inspirational experience for all who attended. The American Society of Cytopathology list-serv and the CAP Cytopathology Committee were helpful in recruiting volunteers. CAP Cytopathology Committee members Barbara Winkler, MD, and Andrew Fischer, MD, served as the lead pathologists for the 2009 mission. More information about the INCCA, including a documentary from the 2008 mission, can be viewed at Plans are underway for the 2010 mission as well as for educational programs in Peru for health care providers and patients in the coming year.

On the education front, the International Academy of Pathology seeks to establish new divisions in all parts of the world. One of the most recent additions is the East African Division of the IAP which was inaugurated by Fred Silva, MD, in October 2008 during the 9th International Conference of the Association of Pathologists of East Central and Southern Africa, or APECSA. One of the authors (RT) was privileged to have been invited to the APECSA meeting by James Kitinya, MD, who gave a keynote address on the history of pathology training in East Africa. Several speakers lectured on cytology topics or described their research in the field of cytology. Andrew Field, MBBS, of Australia, known for his mobile, hands-on fine-needle aspiration tutorial given around the world, also gave a keynote address on FNA biopsy in health care. Lucy Muchiri, MBChB, MMed (Path), of Kenya reported on the initial results of her research to determine the prevalence of HIV infection and cervical neoplasia in a Kenyan semi-urban population. Shabin Nanji, MBChB, of Toronto, who is working with Dr. Muchiri, gave a talk on glandular lesions of the cervix. Meetings such as this are important for fostering international cooperation and collaboration. The time and cost necessary to attend the meetings are well worth it because of the lasting professional bonds that are formed.

As for her outreach efforts, Dr. Nanji continues to work on bringing cervical cytology screening to women of Nairobi thanks to the CAP humanitarian grant she received in 2007. She returned recently from Kenya where she collaborates with Dr. Muchiri and a second Kenyan pathologist, Shahin Sayed, MD, as well as a gynecologist, an epidemiologist, and a registered nurse. So far 940 women have been screened, 70 percent for the first time in their lives. The project had been slow to get off the ground because of political instability, especially in regions of screening sites, and more recently because of lack of reasonably priced cytology screening services. Despite this, Dr. Nanji is determined to expand the cytology service from conventional smears to liquid-based cytology with HPV testing as needed. She especially hopes to keep the work local to ensure the development and sustainability of laboratory expertise in Kenya.

Finally, the ASC will establish a bulletin board on its Website ( where cytology volunteers and organizations in need of cytologists can find each other.

Dr. Tambouret, of Massachusetts General Hospital, and Dr. Winkler, of Quest Diagnostics in Teterboro, NJ, are members of the CAP Cytopathology Committee.