Preface by the QUATE Chair of the EFCS

Since its introduction as a detection method for cervical cancer about 50 years ago, microscopic examination of cells from the cervix, the Pap smear, has proved to be the most effective screening test for cervical cancer to date. Nevertheless, its accuracy is perpetually disputed, with sampling and screening errors indicted as sources of errors in diagnoses. Recently, with generally improved training of cytology personnel in interpretative skills, sampling errors are the predominant reason for false negative test results.

During the recent development of cell suspension-based thin-layer processing techniques, failure to transfer abnormal cells from the sampling device to the glass slide was discovered to be an important reason for so-called sampling errors. An advantage of liquid-based samples is the improved representativeness of cytologic preparations.
However, the quality of the cell sample remains dependent mainly on the skill of the individual practitioner. Therefore, the importance for instruction of clinicians in proper sampling techniques and improved collection devices cannot be underestimated. The use of ineffective samplers, such as dry cotton swabs or a single wooden spatula, must be declared obsolete. Pathologists should not hesitate to convey to the practitioner when the sample is suboptimal or inadequate for interpretation.

To ensure that the quality of cytodiagnosis is universally optimal, effective training programs followed by contemporary, high-quality continuing education courses are essential. Monitoring individual and laboratory performance with carefully constructed and maintained quality assurance procedures is critical to ensure that diagnostic accuracy and timely reporting of results are offered to women regardless of geographic location or financial resources. Such parameters as workload limits and screening intervals must be based on scientific data, based on well-designed and controlled studies, and not be emotionally or politically determined.

In countries where screening programs exist, the incidence of invasive cervical cancer has been dramatically reduced. Even if the practice of cytopathology is universally optimized, eradication of cervical cancer will not be realized unless and until complete participation of sexually active women is achieved. The greatest gain in reducing cervical cancer will be accomplished by screening every "never-screened" woman.


Where do we stand with automation of primary and secondary screening? Although currently restricted to affluent societies because of the cost, automation of primary screening and automated quality control will play an important role in the future. As an intermediate measure, interactive systems will provide a selection of specimens that are, with high likelihood, not abnormal versus those which should be visually reviewed by experienced personnel. In any case, automation of primary screening should not be seen as a threat to professional career opportunities in the field. On the contrary, it will create a need for professionals with higher levels of diagnostic expertise.

G. Peter Vooijs, M.D., Ph.D., F.I.A.C.
Chair, QUATE Committee, European Federation of Cytology Societies
President, 14th International Congress of Cytology (Amsterdam 2001)
Co-chair, IAC-UICC Liaison Committee
Professor and Dean, Medical Sciences, Nijmegen University
Nijmegen, The Netherlands

 

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