National Cytotechnology Week 2022: Expert Interviews
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“Cytotechnologists are thinkers and problem-solvers, and play an integral role in a team of diagnosticians. We are the eyes fighting against cancer.”
Kelly Lennen, MS, CT (ASCP), Assistant Professor and Interim Program Director for the Cytotechnology and Cell Sciences Program at Thomas Jefferson University’s College of Health Professions
Cytotechnology might be the most important field you’ve never heard of. Broadly speaking, cytotechnologists are lab professionals who study cells and cellular anomalies. Working closely with a pathologist, they evaluate cell samples and look for the sometimes subtle signs of cancerous or precancerous lesions, infectious agents, and inflammatory processes; this allows them to detect serious diseases when they’re still at a treatable stage.
Cytotechnologists will also perform molecular and immunologic testing that facilitates personalized patient care. For a largely unsung profession, cytotechnology saves an astounding number of lives.
This year’s National Cytology or Cytotechnology Week (NCW) begins on May 8; National Cytotechnology Day (NCD) falls on May 13, the birthday of Dr. George Papanicolaou, who invented the Pap smear, revolutionizing both cytopathology and cytotechnology. But this is a field that’s grown far beyond its origins: it’s now a lucrative, innovative, wide-ranging, and in-demand career that’s as challenging as it is rewarding.
NCW and NCD are an opportunity to put the field of cytotechnology under the microscope, and get a look at where it’s been and where it’s going. To learn more, read on.
The Origins of Cytotechnology
Modern cytotechnology began to take shape with Dr. George Papanicolaou’s invention of the Pap smear in 1928. This non-invasive method of collecting cellular debris from the lining of the vaginal tract for microscopic examination allowed a laboratory professional to clearly see evidence of cervical cancer. The screening was cheap, easy, and effective.
But Dr. Papanicolaou’s findings were initially met with skepticism and not widely accepted until an extensive trial of his techniques took place in the 1950s. Today, they’re a pillar of cancer prevention.
“The Pap smear has been the most successful cancer screening program in history,” says Kelly Lennen, MS, CT (ASCP), assistant professor and interim program director for the cytotechnology and cell sciences program at Thomas Jefferson University’s College of Health Professions. “Not only have countless lives been saved, but it opened the door for a whole new discipline in pathology: the practice of cytopathology.”
“Dr. Papanicolaou was instrumental in providing a low-cost way to sample the cervix and stain the cells for early cervical cancer detection,” says Deborah Krzyzaniak, MS, SCT (ASCP), CT (ASCP), the educational coordinator and program director for the cytotechnology program in the College of Health Sciences Department at Old Dominion University. “We still use the Papanicolaou stain today for the majority of cytologic specimens.”
The Pap smear was a harbinger of much more to come. Originally developed to screen for cervical cancer, it also proved useful in detecting abnormal cells coming from the uterus, prompting further testing for endometrial cancer. It led to advances in understanding the human papillomavirus and the viral causes of cancer. Further innovations in computer-guided screening and digital cytology still have their roots in Pap testing data. This wide expansion of applications resulting from the original Pap smear has been echoed in the rapid evolution of the role of the cytotechnologist.
“After the Pap smear, cytotechnologists became the experts in gynecologic cytology and played a major role in cervical cancer screening,” Lennen says. “This history is why most people tend to associate cytotechnology with the Pap smear, but the discipline of cytology has evolved well beyond that initial scope of practice.”
The Evolution of Cytotechnology
The success of early cervical cancer screenings led to success in detecting other types of cancer and disease in other areas of the body, too. Cells collected by brushing, washing, and needle aspirations now offer a minimally invasive diagnostic alternative to exploratory surgery, and cytotechnologists can examine and interpret cells from almost any form of tissue or bodily fluid.
Today’s cytotechnologists play an important role in specimen collection and analysis, working with pathologists, radiologists, and surgeons.
“Cytotechnologists have gone from a focused specialty of using a microscope to detect signs of cancer in a Pap smear to the broad, very active role of specimen adequacy assessment during diagnostic collection procedures, using technology for telepathology, performing specimen preparation, and performing the initial diagnostic interpretation for the broad range of body sites and fluids in the pathology laboratory,” Lennen says.
The proof of the profession’s growth is in the data: the number of Pap smears performed is lower than a decade ago, but the number of other diagnostic cytology procedures is booming. The widening of a cytotechnologist’s range of procedures and expertise has led to a recent retitling for those certified in this profession, from cytotechnologist, which may give a sense of a practitioner limited to a small suite of technical skills, to cytologist, which better conveys a broad scope of practice that studies all cellular specimens.
“The utility of cytology for all body sites and the expertise of the cytotechnologist is valued more than ever,” Lennen says. “Lung cancer, thyroid cancer, bladder cancer, breast cancer, liver cancer, pancreatic cancer, and more are often first diagnosed with cytology. Demand for the skill set of certified cytotechnologists is still increasing, and the increase in starting salaries is a testament to that.”
The Future of Cytotechnology
The pace of cytotechnology’s evolution isn’t slowing down. Digital cytology enables imaging and analysis of cell slides without the actual specimen being in the room. Telepathology empowers a cytotechnologist to be the eyes and hands of a pathologist during a procedure to assess a specimen’s adequacy. Digital cytology and telepathology not only make the healthcare system more efficient, but they also open up the possibilities of greater collaboration between medical professionals and expanded access to healthcare services in underserved communities.
“High-throughput digital scanning of glass microscope slides can allow a cytotechnologist or cytopathologist to evaluate and interpret cells and provide a diagnostic interpretation from anywhere the computer connection can be set up,” Lennen says. “The day will come soon when a high-quality monitor will replace a high-quality microscope as the tool of cytology.”
“The emergence of digital cytopathology is very exciting,” Krzyzaniak says. “The idea that we can transmit images to another pathologist across the world for consultation is not only timesaving but lifesaving. In addition, cytotechnology training programs teach students to diagnose digitized images on a computer (without a microscope). This is an important skill that every cytotechnologist needs to assist with fine needle aspiration cytology adequacy procedures.”
Cytology reports will continue to grow in detail, too. These reports were limited to the visual interpretation of a specimen for signs of cancer just over ten years ago. Today, with the addition of new technology, these reports can also include findings that give greater insight into the origin of a cancerous lesion, along with prognostic findings of immunochemistry or molecular studies that pinpoint protein expressions or mutations present in the cancer cells that are markers for targeted therapies.
“I am curious how the tools of our trade will evolve with time and technology and what will be the next standard of cancer prevention and care, but I am confident cytology services will play a role as long as cancer is a human condition,” Lennen says.
“In the future, cytotechnologists will take on even more responsibility in helping the pathologist make the final diagnosis,” Krzyzaniak says. “Cytotechnologists may be expected to go on all fine needle aspiration procedures alone and take on the role of an assistant to the pathologist rather than a technologist.”
The biggest challenge facing cytotechnology is simply this: the world needs more cytotechnologists. As the population lives longer, the instances of cancer increase. And as people increasingly survive cancer diagnoses thanks to early detection and treatment, there is a greater need for cytotechnologists to monitor cancer survivors for recurrent disease. A large wave of cytotechnologists who entered their careers in the 1970s and 1980s are on the cusp of retirement; to keep winning the fight against cancer will require a new crop of cytotechnologists eager to make a difference.
“Cytotechnologists are thinkers and problem-solvers and play an integral role in a team of diagnosticians,” Lennen says. “We are the eyes fighting against cancer. My hope is that new cytologists embrace their role as life-long learners. What we know about cancer, how to detect it, and how to best fight it is ever-evolving. I want cytologists to be on the front of that drive.”
Resources for National Cytotechnology Week
To learn more about cytotechnology’s work, advocacy, and future, check out some of the resources below.
- American Society for Cytopathology (ASC): Founded in 1951, ASC is a unique society that provides a forum for physicians and cytotechnologists to network with each other personally and professionally.
- American Society for Cytotechnology (ASCT): Founded in 1979, ASCT is committed to defining and promoting the profession of cytotechnology.
- American Society of Clinical Pathology (ASCP): ASCP unites more than 100,000 anatomic and clinical pathologists, medical laboratory professionals, residents, and students to advance laboratory science and improve patient care.
- Journal of the American Society for Cytopathology (JASC): This cross-disciplinary journal publishes work for all readers involved in the practice of cytopathology and its related basic sciences, epidemiology, and clinical oncologic disciplines.