College of American Pathologists
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  President’s Desk Column


cap today

Finding our way-and having fun

November 2003
Mary E. Kass, MD

Some people need to know every step they’ll be taking to get where they’re going, and often that works, though not always. Sometimes the journey itself reveals a fortuitous detour, and sometimes there is more than one destination. I have found that if the company I keep is well intentioned and honest, our path together will probably come to a good end. The important things are the simple ones: to have worthy goals, to get in the game, and to make good use of my time.

Our recent experience in community outreach to promote cervical cancer screening is a case in point. In the late 1990s, the members of the CAP Council on Public Affairs spent a lot of time talking about Pap tests. Reimbursement was so low and liability costs so high that many laboratories didn’t know how long they could continue to do them. Women’s confidence in the test was at an all-time low. The Pap test had fallen victim to its own success and the high-profile distractions of a medical liability climate run amok.

We decided to reach out to like-minded colleagues—women’s groups, the American College of Obstetricians and Gynecologists, the Centers for Disease Control and Prevention, the National Institutes of Health. We agreed to create a working coalition with one initial goal: to encourage women in the United States to get an annual Pap test. Our message: “Annual Pap Smears Save Lives.”

In time, much good came of this. Policymakers agreed to increase reimbursement. The College launched See, Test, and Treat, a pilot program to bring single-visit breast and cervical cancer screening and followup to women in remote areas. And the CAP created a program (available at www. MyHealth TestReminder. com) that enabled patients to sign up for e-mail notices when they’re due for routine screening.

See, Test, and Treat was a fortuitous detour. We had reviewed the most recent data from the National Cancer Registry to learn where cervical cancer remained most prevalent, and we found that the highest U.S. death rates were among Native American women in Iowa, North Dakota, South Dakota, and Nebraska. Women there were dying of cervical cancer at much higher rates than those of other ethnic groups in the United States. This population also had the third highest rate of death from breast cancer in the United States. In McLaughlin, SD, only 21 percent of Native American women had a Pap test in 1999 and 2000, and 80 percent of those who needed followup did not receive it.

At the outset, we had planned to find the eye of the storm and produce educational brochures. The detour was the discovery that the barriers to care were not just about education. They were also about transportation where many had no car and communication where few had a telephone. After many conference calls and meetings with tribal leaders, local health care professionals, and Indian Health Service personnel, we decided to bring breast and cervical cancer screening with immediate feedback and on-site followup to two underserved Native American communities in South Dakota. Community support grew slowly, but with time we built trust, and on trust we built a partnership.

When the College put out a call for volunteers, the response from pathologists, cytotechnologists, gynecologists, and radiologists was overwhelming. Four See, Test, and Treat events have provided 301 Pap tests since 2001. Between 11 percent and 19 percent of those tests have been abnormal (compared with four percent to seven percent in the average cytology laboratory). In total, 45 colposcopies and 10 LEEP procedures have been done on site. There have been 167 mammograms and 12 fine-needle aspirations. One fibroadenoma and one metastatic carcinoma from the lung have been diagnosed.

See, Test, and Treat was a side trip that took us where we were meant to go. The pathologists who volunteered relished the opportunity to work side-by-side with gynecologists, radiologists, and primary care professionals, and they liked being able to meet some of the patients. It was rewarding to do, and it was wonderful to know we were the ones who had created it. Volunteers for future clinics are wait-listed, in part because nearly everyone who goes asks to return.
Pathologists have a natural affinity for systems; we know how to get things done. We are also respectful of and collaborate well with peers. These qualities are precisely those needed to move away from diagnostic tasks and toward more prescriptive responsibilities, ones that help define future directions in clinical care.

I believe that our future will call for a more prominent role in the hospital environment. This might not have been an original destination, but we need to move outside our comfort zones. A solid track record on the hospital medical staff is the best employment insurance around, and it will cost us only our insecurities.

If public speaking is a barrier, you’re in good company, and the College has a fine program to help with that. We offer a two-day speaker training workshop every November in Chicago. To check out the results, log on to the Patient/ Public Resources section of the CAP Web site and watch a couple of your colleagues’ video news releases. They’re genuine, solid public service and superb.

One of the best ways to learn how to lead, advocate, and negotiate is to volunteer to serve on a CAP committee. Some of the brightest lights in our specialty will sit beside you at the table. They will teach you things you didn’t know you needed, and you will discover skills you didn’t know you had. Committee appointments are for one year, with a maximum tenure of six years. To volunteer, please send a copy of your curriculum vitae, with a letter about your skills and interests, to Shannon Peterson at the CAP, 325 Waukegan Road, Northfield, IL 60093.

For some years, I enjoyed the enormous benefit of guidance from Pierre Keitges, MD, a wonderful pathologist. Pierre personified carpe diem. He once advised me that the quickest way to earn the respect of my peers on the medical staff was to volunteer for something nobody wanted to do, and to do it well. I took his advice; it altered my path a bit and ultimately took me to unexpected places. But I arrived in good company, with the best of intentions, and I plan to continue to walk the walk.

Dr. Kass welcomes communication from members. Send your letters to her at