Since the most recent data on facilities for evaluating vaginal cytology areabout three and one-half years old, anew survey of such facilities was conducted by the American Cancer Societyto bring these figures up to date.

A brief questionnaire was designedand approved by the Board of Governors of the College of American Pathologists and by the joint committee oncytology of the College and of theAmerican Society of Clinical Pathologists headed by Dr. John R. McDonald.Out of 3,535 pathologists queried bymail, 2,931 (83%) replied. The following report, based on these 2,931 replies,was accomplished after two mailings onDec.16,1960and Jan.11,1961.

The following estimates include anallowance for the few pathologists whodo vaginal cytology but did not answerthe questionnaire. It is unlikely thatfinal figures based on complete returnswould vary more than 3 or 4 per centfrom the ones given here.

Female genital cytologic smears wereanalyzed for approximately 5,100,000women in the United States in 1960, inabout 1,700 different laboratories. According to present plans, pathologistsexpect to be able to handle 6,100,000cases in 1961, an increase of 1,000,000,or about 20%. In answer to the question of the potential expansion in 1961,“¿�Shouldthere be a sharp increase inpublic demand for this test,― they indicated that capacity could be aboutdoubled —¿�to 11,000,000 —¿�with aboutone half of the pathologists indicating

From the Program Evalueation Section, AmericanCancer Society, inc., New York, N. Y.

willingness to expand their facilitiessubstantially under these conditions.This doubling, however, is predicatedon demand and would require additional personnel in most cases —¿�a totalacross the country of about 200 additional pathologists'8 and about 1,100 additional cytotechnicians.

At the present time there are over1,300 cytotechnicians employed in over800 laboratories. There are presentlyabout 350 openings for additional cytotechnicians, and pathologists would liketo absorb an additional 310 by July 1,1961, and another 520 by the end of theyear, if demand warrants.

According to our best estimates fromtwo studies made in 1956 and 1957 bythe College of American Pathologists,the rate of growth of female genitalcytology has been as follows: 1.0 million cases in 1955; 1.6 million cases in1956; 2.2 million cases in 1957; and 5.1million cases in 1960.

Current plans of pathologists allowfor an additional growth of 20%, or 1.0million cases in 1961. Therefore, looking at the nation as a whole, facilitiesare not readily available for increasingcytological usage very much beyondwhat is taking place already. However,a willingness to expand is expressed byenough pathologists to allow for a veryrapid increase in facilities, providedthe logistics of the problem can beworked out to permit the necessary balance between demand and the trainingand hiring of personnel needed for this

*Mm.e than 350 pathologists are cuerrently beingcertified each year and all of thiese han-c met certain minicnnem requirements in cytodiagnosis.

97

National Surveyof CytologicFacilitiesA SpecialReport

Daniel Horn, Ph.D. and Annabelle Siegel, BLA.

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expansion. The most encouraging as- of the country. Fortunately, the numpect of this part of the problem is the ber of returns of questionnaires was solarge number of pathologists who are very high that similar statistics haveapparently not only willing, but eager been prepared for each American Canto expand when it becomes desirable cer Society Division; these returns inand practicable to do so. dicate the potential for expansion and

This summary portrays the cytology the number of cytotechnicians neededsituation nationally. As might be ex- for expansion in the various states.pected, there are variations in the p0- They are summarized in Table 1 ontential for expansion in different parts pages 98 and 99.

Uterine Cancer and Cytology: a StatementJohn R. McDonald, M.D.,* and Frank C. Coleman,M.D.**

Many authorities agree that, if cervical smears were performed regularly onalladultwomen, cancerofthecervixuteriasa causeofdeathcouldbeeliminated.Thus,itbecomesimperativethatthetechniqueoftakingcervicalsmearsbelearnedby allphysicians.Ithasbeenstatedthat20 percentofwomen who visita doctoraskingtohavea Papanicolaousmear arediscouragedfrom havingitdone.

Why this apathy? It is probable that some physicians have not familiarizedthemselves with the technique of the procedure, even though it is quite simple.The procedure is best performed by a physician in the office or the hospital. It ismost important that he examine the uterus for gross abnormalities at the sametime.Smears are made even ifno abnormalitiesarenoted.The smear itselfisvery simply collected and there is no necessity for referring a patient to a cancercenter to have this procedure done.

The cervix should be visualized without the use of a lubricant. The specimenfrom the cervix, particularly in the region of the internal os, may be collected bymeans of a swab, wooden spatula or tongue blade. The material is spread in athin film on a glass slide and before drying is immediately immersed in an alcoholethersolution.A brochuredescribingthe procedurefor takingand handlingcervicalsmears may be obtainedfrom your Divisionof the American CancerSociety. Its title is “¿�Cytologyand Cancer of the Cervix.―A medical film entitled“¿�PelvicExamination and the Cytologic Method― is also available.The interpretationofcervicalsmears isa laboratoryprocedurewhich isbest

done by a localpathologist.The pathologististhen availableforconsultationregardingtheinterpretationofthefindings,thepossibledesirabilityforrepeatsmears, the method of biopsy, and further treatment if the smear is positive.This consultation is not available with “¿�mailorder― cytology.

In a survey recently conducted by the College of American Pathologists andthe American Cancer Society, cervical smears of 5.8 million women in the UnitedStates were examined by pathologists in 1960. This represents about 10 per centof the women in the country in the age group that should be examined. Facilitiesfor examination of Pap smears by pathologists are generally available now andareexpanding.

*Chai@an, Exfoliative Cytology Committee, College of American Pathologists.**president, College of American Pathologists.

100