More time permitted to bring cancer protocols onboard
At the request of the CAP, the American College of
Surgeons Commission on Cancer has delayed for a year its plan to require
the cancer programs it accredits to use the CAP’s protocols as part
of their reporting.
The Commission on Cancer originally had intended to make scientifically
validated portions of the cancer protocol checklists mandatory for
cancer programs starting Jan. 1, 2003. That requirement will now
be delayed until Jan. 1, 2004.
"We received a letter from the CAP which told us they would not
be able to meet their November  deadline for republishing
the protocols and asking us to delay implementation," says M. Asa
Carter, manager of the accreditation and standards section of the
ACS’ cancer programs. "The CoC executive committee felt it was reasonable
to grant the request. We did not want to implement a requirement
using material in revision."
Carolyn Compton, MD, PhD, chair of the CAP Cancer Committee and
chair of the Department of Pathology, McGill University, Montreal,
says the protocols had to be updated because a new edition of the
AJCC Cancer Staging Manual was published recently. Members
of the committee also wanted to clarify which portions of the protocol
checklists were scientifically proven and which were optional. And
they wanted to incorporate information that was released after the
protocols were finished, such as new WHO classifications of tumors.
"I am pleased with the delay" by the ACS’ Commission on Cancer,
Dr. Compton says. The delay affords the CAP Cancer Committee time
to update the material and gives pathology departments at cancer
centers time to modify their software to accommodate the checklists.
The Cancer Committee members who worked on the protocols "have
made a huge effort to update them, and we are done with that portion,"
Dr. Compton says. Some of the protocols were dramatically edited,
she adds. "We have now defined what elements of the checklist are
essential and which are not." In all cases, she says, they made
the protocols "consistent with those that have been devised by other
Once the CAP Board of Governors approves the rewritten protocols,
they will be posted on the College’s Web site (www.cap.org)
so cancer centers can begin incorporating them into their reporting.
"We’ll be considering them in batches and approving them as swiftly
as possible," says M. Elizabeth Hammond, MD, a member of the Board
of Governors and former chair of the Cancer Committee. Dr. Hammond
is chair of the Department of Pathology, Urban Central Regional
Hospitals of Intermountain Healthcare, Salt Lake City.
At its meeting in mid-November, the Board of Governors committed
to a Dec. 31 deadline to approve the 23 checklists updated by the
Cancer Committee. "These will be available on the CAP Web site starting
in 2003," Dr. Hammond says. "They represent the vast majority of
cancer specimens." Cancer Committee members are refining the other
15 protocols and will soon send them to the Board.
The Board of Governors, at its November meeting, approved the
new checklists for the first batch of eight protocols. Those eight
encompass the most important cancer sites: breast, colon and rectum,
skin melanoma, endometrium, kidney, lung, prostate, and uterine
Those portions of the checklist that are not scientifically proven
will be marked with an asterisk and won’t have to be included in
the reporting, Dr. Hammond says.
The critical elements will be those that are scientifically validated
and that must appear in every report pathologists issue to clinicians.
For example, the critical elements for a breast biopsy are specimen
type, laterality, tumor site, tumor size, histologic type, and histologic
grade. "You have to provide these elements, but we don’t specify
the format," Dr. Hammond says. "You can use narrative or synoptic."
The ACS Commission on Cancer has approved more than 1,430 cancer
programs at hospitals and freestanding cancer centers, Carter says.
The accreditation surveys are performed every three years, "but
we will expect our approved programs to be in compliance with the
protocols as of Jan. 1, 2004," she adds. If found deficient in a
subsequent survey, a cancer program will have 12 months to resolve
Carter advises cancer programs to watch the CAP Web site for protocol
updates. "As the information becomes available, share it with pathologists
and get ready for implementation," she says.
Using the protocols "is a high-priority item for us," Carter adds.
The College’s standardized checklists will make it easier for cancer
registrars to locate needed information in medical records. Cancer
registry data are shared with state cancer registries and the ACS’
National Cancer Data Base.
"The CoC made the decision in the first place to make it mandatory
because we recognized the value of these protocols back in 2000,"
Carter says. "We recognized that the original deadline for implementation
was unrealistic, but once we have the complete set of guidelines,
we want to move forward."
Because pathologists formulated the guidelines themselves, she
says, pathology departments and laboratories should accept them
more readily than if another group had created them.
Karen Southwick is a writer in San Francisco.