Serving Patients and Country

The Papanicolaou award is presented annually to a member of the American Society of Cytopathology (ASC) in recognition of meritorious contributions in the field of cytopathology. The 2024 award recognizes ASC past-President and multiple-committee member Barbara Crothers. Following a career as an army pathologist, Crothers continued to focus on gynecologic pathology research and diagnostic consultation in breast, GYN, and cytopathology at the Joint Pathology Center near Washington, DC. Currently, she works part-time at the James H. Quillen VA Medical Center and with AIxMed – a cytology AI software company.

What drew you to pathology as a career?
 

I had initially planned on becoming a psychiatrist and studied psychology as an undergraduate. Noticing that I was interested in research, one of my professors directed me towards medicine, suggesting that psychiatrists tend to access better research grants than psychologists. This advice set me on a path that eventually led to pathology.

As a pre-medical student, I worked with a pathologist on a research project: inducing cancer in mice, treating it with vitamins, and examining the histologic changes. I dissected the diseased tissues, made my own paraffin tissue blocks, prepared stains from scratch, cut the paraffin sections, and stained them by hand. A local pathologist taught me some basics of pathology and helped me diagnose tumors and interpret tissue changes. That work fascinated me.

Then, in medical school, I rotated in cellular pathology at the Armed Forces Institute of Pathology, learned about cytology diagnostics, and had an early introduction to digital pathology. Further rotations in pathology introduced me to the diversity and complexity of the practice.

Pathology is detective work – and it suited my curious nature. I was drawn to the opportunities to work independently, while still having the full support of a team, to balance technical work with laboratory management, and to interact with patients both directly, via procedures, and indirectly through advising clinical tumor boards.

The implementation of technology into pathology practice also interests me, and I have always been at the forefront of introducing these new advances into the laboratory.

What have been your career highlights?
 

Pathologists are often stereotyped as being reclusive introverts – the “odd ducks” of medicine – so it may surprise people to know that my most rewarding work has always involved collaboration with others to move medicine and pathology forward.

As Pathology Consultant to the Army Surgeon General, I collaborated with the gynecology consultant to implement liquid-based Pap testing with reflex HPV testing into the Department of Defense, opening the door to civilian sector reimbursement for this technology. I was also responsible for assigning postings to the pathologists. By anticipating demand, I was able to advise the Surgeon General on the appropriate pathology subspecialties to train and successfully defended the introduction of both molecular pathology and informatics fellowships as critical to army pathology.

During my deployments to both South Korea and Iraq, I served as the Pathology Theater Consultant – advising on and orchestrating laboratory operations for the entire deployed military of that region. I introduced telepathology to expedite diagnostic turn-around time and procured upgraded equipment in both sites.

My most difficult, yet fulfilling, role was as Pathology Program Director at Walter Reed Army Medical Center. That involved rewriting all of the rotation descriptions and objectives, and creating new rotations and new metrics – a huge project. Mostly, though, I enjoyed working with the residents to improve the program and introduce meaningful changes that better prepared them for practice. I feel proud that those residents went on to become highly-sought pathologists, known for their diverse skill sets, competency, and work ethic.

My volunteer activities with the ASC and the College of American Pathologists (CAP) provided me with significant personal development opportunities and a network of wonderful colleagues. As Chair of the CAP’s Cytopathology Committee, my most enduring impact was re-organizing it into working groups that tackled most of the actions during the meeting – hence minimizing the time members needed to spend on committee work at home.

My family, though, is the ASC; I was honored to serve as its Vice President, President-Elect, and President. I’ve also served on and chaired multiple ASC committees, where my focus has always been on supporting our cytologists (formerly cytotechnologists) and promoting the practice of cytology.

How did your time as an army pathologist shape your personal and professional development?
 

On a professional level, I might describe military pathology as a double-edged sword. Though military medicine is very academically-oriented in the medical centers, they don’t have the prestige or research funding of civilian academic centers, so visibility is limited to the military system. Military career progression is based on leadership and rank, rather than research and publication, so very few military physicians pursue a purely academic pathway. The bottom line is, ex-military scientists might find it much harder to gain academic and professional recognition outside of the military system.

That said, I would choose this pathway again – it builds independence and self-esteem. In the army, you are expected to assume leadership positions, whether you feel prepared or not. One quickly learns to adapt and acquire new skills, especially in personnel and laboratory management.

Working with many different components of army hospital systems taught me a lot about regulations, collaboration skills, and problem solving. I’ve been intimately involved in the remodeling, consolidation or moving of every hospital in which I have worked in the military. Because we often lack the resources necessary to complete a job, especially during deployment, the military teaches you to be inventive and creative by default.

A military career requires one to be flexible and to embrace change. Frequent moves mean that you have to learn to build teams quickly and garner consensus from diverse personalities. The military provides excellent training courses in management, leadership, and quality assurance, as well as in other skill areas. I took advantage of any training that was offered, but it was the positions to which I was assigned that potentiated my growth by exposing me to so many different areas of medicine and management.

What did receiving the ASC’s 2024 Papanicolaou award mean to you?
 

Quite simply, it means that others in my field recognize the love and hard work that I have dedicated to cytopathology during my career. The ASC is replete with high-caliber individuals dedicated to the cause of human health – “one cell at a time” – and it has been such a delight to work with them all on many different committees and working groups, towards various goals. I’m in awe of their accomplishments, and I hope they understand that they share in this award.

This is the highest honor that a cytopathologist can receive and, frankly, I didn’t expect it. I prefer to work on a team, behind the scenes, and, at times, even let others take credit for my work or ideas. I am not the traditional academic pathologist with a lengthy list of publications and significant breakthroughs in medical practice, which personifies most of the other recipients upon whose shoulders I stand. But I think that I do share some common traits with the great Papanicolaou: a curious mind, a thirst for knowledge and truth, a desire to help heal others, and a love of the basic unit of life – the cell.

What advice would you give to other women aspiring towards pathology leadership?
 

I’m an advocate of the Nike philosophy – just do it. Take preparatory steps towards leadership, such as volunteering for unpopular positions, stepping outside your comfort zone, taking on jobs for which you don’t feel qualified, and seeking assistance. Find mentors: there are numerous people willing to help you and they aren’t always the people you’d expect. Embrace responsibility. Assemble a team and support their development. Take small bites out of any large task. Start the journey, and be open to where it may lead you.

I would also recommend considering General Colin Powell’s 13 rules. I had them pinned on my bulletin board for many years, and I still believe that they provide good advice for all leaders.

Is cytopathology sufficiently valued, in your opinion? (If not, what could be done to improve the situation?)
 

Cytopathology is valued as a subspecialty among pathologists by virtue of the number of individuals who choose this subspecialty training. Cytopathology complements surgical pathology and provides additional information critical to a diagnosis.

However, it isn’t sufficiently valued outside of the pathology community. Few physicians have a clear understanding of the scope of practice of pathologists, let alone cytopathologists. Some dislike “gray” areas like cytologic “atypia” and prefer concrete answers to the question, “does this patient have a tumor?”

I believe that cytopathology is the best kept secret in medicine, because it provides an emotionally rewarding, intellectually stimulating, and flexible career path. However, the cytopathology community has long struggled with how to advertise our subspecialty and to recruit cytologists/cytotechnologists. In my opinion, the best way to do this is to expose college and medical students to the practice. Pathology departments should establish a network of shadow programs for interested students and advertise them through social media. Many pre-medical and medical students have to find their own clinical rotations, and this is one way to improve exposure to our subspecialty.

What is your involvement with cytology AI software development, and how did that come about?
 

With an enduring interest in digital cytology, from early in my career, I was an early adopter of digital technologies. As a physician, my duty is always to the patient first and, with the advent of AI, I want to ensure that algorithms are sufficiently robust and accurate before being deployed to the clinical arena.

I now work part-time with a company that has a software solution that identifies abnormal cells in liquid-based samples and analyzes diseased cell characteristics for interpretation by a pathologist. A former colleague recommended me for the position of Chief Scientist, and the position has given me incredible insight into the industry side of cytopathology and a better understanding of regulatory hurdles facing start-ups.

The role involves advising on software development from the end user perspective – designing research projects, creating training materials, advising on regulatory compliance, and participating in software evaluation. I work with a remarkable, dedicated team of creative individuals who seek to bridge the gap in personnel loss in our field through technology, and I find it very enjoyable.

What do you think the lab of the future will look like?
 

For pathologists, specimens will become increasingly digital, and AI assistance will be the norm. These advances will free pathologists to take on other responsibilities in medicine and medical management, both as consultants and direct providers of medical care. The laboratory will become more fragmented as medicine continues to specialize; anatomic pathology and clinical pathology may become divided.

There is a movement afoot in medicine, away from centralized, institutionalized medicine and towards individual physicians administering personalized care and promoting healthy lifestyles. As more people take responsibility for their own healthcare, there is more demand for and access to laboratory results – but patients cannot always interpret them. Laboratories and pathologists can play a part in that by providing guidance on follow up or treatment of laboratory results, although this may also be through the design of algorithms.

Who inspires you?
 

People (humanity), every day, by their goodwill, courage, and persistence. I’ve been motivated by so many role models during my career – both well-known icons, such as other Papanicolaou awardees, and by colleagues and students who probably don’t even realize the effect that they have had on my aspirations and direction. Role models are all around us. Everyone has some lesson to teach us, some wisdom or inspiration to offer. We just have to pay attention.