The formation of a society was advocated in 1961 as a consequence of two letters published in the British Medical Journal of August 12th and November 4th. Mary Egerton, Moira Murray, Freda Osmond-Clarke and Erica Wachtel, having attended the first International Congress on Cytology sponsored by the International Academy of Gynaecological Cytology in Vienna in September of that year, considered that Great Britain was lagging far behind America and Europe in the development of this speciality, and that the creation of a society would help to establish and promote the practice of cytology throughout the country. Consequently, a meeting was held at the Royal Society of Medicine on December 1st 1961 to discuss the formation of a society. A working party, under the Chairmanship of C.W. Taylor (Birmingham) was formed to look into the formulation of Statutes with the aim of promoting the growth and development of clinical cytology in the United Kingdom, and the organisation of scientific meetings. Membership would be open to all registered medical practitioners interested in cytology and the title of the society would be "The British Society for Clinical Cytology".
The first scientific meeting was held on July 5th, 1962 at the Hammersmith Hospital with Professor J. Bamforth as President, C.W. Taylor as Chairman, Stanley Way as Treasurer and Erica Wachtel as Secretary, with nine Ordinary members of Council including Sir John Peel. By 1964 there was a need for an Assistant Secretary, the post being first filled by O.A.N. Husain and by 1967 the introduction of the office of Vice-Chairman was considered necessary and Professor K. Hill was its first incumbent.
It has to be remembered, however, that the use of cytology in diagnosis was not new in Great Britain. Before the introduction of histological methods, one of the pioneers of medical microscopy was L.S. Beale of King's College Hospital. 'The Microscope and its Application to Clinical Medicine' appeared in 1854, and this as well as his other methods, was illustrated with drawings of cells seen in smears and spreads rather than sections. The introduction of paraffin embedding, around 1880, made the use of histological sections a practical procedure and there are few reports on the use of cytology in the diagnosis of epithelial cancers until Professor L.S. Dudgeon of St. Thomas's Hospital developed cytodiagnosis from scrapings of tumours. Professor Dudgeon also investigated the possibility of identifying malignant cells in sputum and, with C.H. Wrigley, he published the first systematic and adequately illustrated account of the diagnosis of cancer of the lung from smears of sputum (1935). Most pathologists continued to be sceptical but Dudgeon's method was still used at St. Thomas's even after his death in 1939 and its value was confirmed by F.J. Sambrook Gowar (1942). An application of cytodiagnosis which also came into routine use before the second world war was the wet smear technique of Russell for the diagnosis of brain tumours (1937).
After the war, a number of British workers interested themselves in different aspects of cytodiagnosis. Some of them were influenced by the Dudgeon method or by haematological cytology, others by the new wave of interest from across the Atlantic, following the work of G.N. Papanicolaou. Amongst these were Dudgeon's successor at St. Thomas's Hospital, J. Bamforth (lung etc. 1946,1953), J.G.S. Crabbe (urine, 1952), A.I. Spriggs (serous fluids, 1952; 1957: cerebrospinal fluid, 1954), R.O.K. Schade (stomach, 1956), M.M. Boddington and Truelove (colon, 1956), and D.J. Oakland (colon, 1957). In 1953 G.R. Osborn published his 'Applied Cytology' covering various diagnostic fields, including the vaginal smear.
The Papanicolaou smear was introduced in the United States of America during the 1939-1945 war and only began to arouse interest in this country in the post-war period. In 1951 a discussion was held by the section of Obstetrics and Gynaecology of the Royal Society of Medicine in which J. Bamforth, A.F. Anderson, Erica Wachtel and K.R. Dempster took part. At this time the increasing interest in exfoliative cytology was demonstrated by the number of cytologists who went to the United States to visit Papanicolaou, Ruth Graham, J.E. Ayre and others. These included M.E. Attwood, A.F. Anderson, G. Crabbe, F. Hampson, F.A. Langley, A.I. Spriggs, Erica Wachtel and S. Way. A further conference took place in 1955, this time at the Royal College of Obstetricians and Gynaecologists. Sir William Gilliatt and Dame Hilda Lloyd were instrumental in setting up a committee to look into the matter for the Royal College of Obstetricians and Gynaecologists and evolved links with such American workers as G.N. Papanicolaou and Ruth Graham, and also with Professor Alex Agnew, H. Fidler and D.A. Boyes in Vancouver.
A number of well known gynaecologists made important contributions to the establishment of exfoliative cytology of the female genital tract. Professor J. Chassar Moir with A.H.T. Robb-Smith (one of the first histopathologists to support cytology), helped to establish A.I. Spriggs and M.M. Boddington in the Oxford laboratory. Professor H.C. McLaren in Birmingham supported the work of M.E. Attwood, while Stanley Way in Newcastle and A.F. Anderson in Edinburgh each produced centres of excellence. Other enthusiasts were Professor W. Nixon at University College Hospital, and Miss Gladys Hill who after a Marsden travelling professorship in 1952 encouraged Mary Egerton, as the Annie McCall Research Fellow, to develop gynaecological cytology at the Royal Free Hospital. In 1958 G. Lawson and subsequently R. Yule developed cytology in Aberdeen under Sir Dugald Baird who in 1960 initiated the first screening programme to cover all the women at risk of developing cervical cancer in the region. J. Elizabeth Macgregor was appointed to this task. The fall in the incidence of cervical cancer in the region illustrated the success of the programme. Peter M.M. Bishop endocrinologist at the Chelsea Hospital, invited Freda Osmond-Clarke and Moira Murray to study natural hormonal changes and those of various steroid hormones. Important contributions in this field were also made by Mary Egerton and Erica Wachtel. Erica Wachtel, who worked with Professor McClure Browne at the Hammersmith Hospital dedicated her career to cytopathology and in 1964 produced a widely used text book. Sadly in June 1980 Professor Erica Wachtel died suddenly at her home in London. She trained many from overseas and her very personal interests in each of her trainees was sustained throughout her career. Erica probably contributed more then anyone to the early days of cytopathology. A memorial fund was established in 1980 and the first Dr. Erica Wachtel Lecture was given by Dr. Nils Stormby (Sweden) at the ASM in Guildford in September 1982.
The first Consultant in Cytology in the Health Service, O.A.N. Husain, was appointed to St. Stephen's Hospital, London, in 1961.
Following the reports of J.M.G. Wilson of the DHSS 1961 and against the general inertia and even advice of senior histopathologists, the National Cervical Cytology Screening Service began officially in 1967, although some enthusiasts had been providing a routine diagnostic service to clinics and general practitioners for several years before that. In 1964, in preparation for this service, five training schools were set up to teach the skills of cytodiagnosis - at the Hammersmith Hospital (Erica Wachtel), the Royal Free Hospital (G. Crabbe, Mary Egerton and Chandra Grubb), Birmingham (Professor H.C. McLaren and M.E. Attwood), Manchester (Professor F.A. Langley and P. Smith) and Newcastle (Stanley Way). The National request/report form was also introduced in 1967 and half a million smear tests were performed. Expansion was rapid and by 1970 nearly 2.5 million tests per year were being recorded, increasing to 3.9 million in 1986. Most of the increase in the number of smears had been from general practitioners - 27% of all smears in 1973 to 43% in 1980. The recall of women after a five year interval from the centre at Southport was abandoned on 1st April 1983. The DHSS made District Health Authorities responsible for the Cervical Screening Programme. On July 26th 1985, Officers of the BSCC met Mr. Kenneth Clarke, Minister for Health, to discuss pressure on laboratories resulting from the increased workload. The following year a health circular, HC(86)2 directed Health Authorities to give priority to screening for prevention of cervical cancer. Call and Recall was to be implemented from lists of women held on Family Practitioner Committee computers starting not later than April 1st 1988.
After the early years of consolidation the Society became active in the expansion and improvement of diagnostic cytology, the most significant advance being in Aspiration Cytology. With the development of Ultrasound and computerised tomography techniques, non-palpable as well as palpable tumours are now aspirated from many anatomical sites. Following a rapidly increasing demand for fine needle aspiration cytology in the pre-operative diagnosis of breast cancer, the BSCC became actively involved in the development and teaching of this technique for the national breast screening programme introduced in 1988.
From its inception, the Society, mindful of the valuable part played by some non-medical cytologists, created a category of 'Extra-Ordinary Members' for those who had made a significant contribution to cytology. At first there was a maximum allocation of 10 percent of the Society's medical membership but, following a referendum, this was increased to 20 percent in September 1974. When the decision to implement the Extra-Ordinary Membership was made in 1971, it was necessary to set up a Credentials Committee to examine the credentials of applicants for membership. Since the revision of the Statutes in 1974, all applications for membership have been evaluated by this Committee. In 1967 a Newsletter was introduced and there are now three issues per year. It provides a valuable vehicle for the transmission of information to members of the BSCC and its Affiliated Societies and includes a calender of forthcoming meetings, tutorials and workshops at regional, national and international levels.
In 1981 in an effort to improve the standard of smear-taking the Society published a small booklet on the taking of cervical smears written by Elizabeth Macgregor. This was well received and the first edition of 15,000 copies was sold followed by a second edition of 10,000 copies. Further demand for the booklet and recognition of the importance of smear taking technique for successful cervical screening led Council in 1988 to ask Margaret Wolfendale to make a video film and update the booklet. The Video and Booklet were launched in 1989 the booklet being further revised in 1995.
The idea of a Journal in Cytopathology was first discussed at the Council meeting in May 1988 following an approach by a publishing company. After a year of discussions, consultation and research into the advantages, disadvantages and likely success of such a venture, Council decided that there was a need for a European specialist journal of cytopathology which would benefit the Society if it was accepted as its official Journal. In May 1989 Council agreed to recommend this to the membership for ratification at the next A.G.M. Blackwell Scientific Publications Limited were nominated as publishers with Dulcie Coleman and Peter Trott as Editors. The Journal was to be named 'Cytopathology' and would have the same format as Histopathology, which was published by Blackwells as the official journal of the International Academy of Pathology. Using the arrangement for Histopathology a contract was drawn up whereby, providing all the members of the BSCC agreed, the Journal would be included in the Annual Subscription at half the commercial price. The proposals were accepted overwhelmingly by the membership at the 1989 A.G.M. and it was decided to proceed with publication of the first volume in 1990, to consist of 6 issues per year. 70 original articles had been received by the end of 1990, most from the United Kingdom but also from elsewhere in Europe, Australia, South Africa and North America.
The BSCC is indebted to Dr. Gordon Canti, who has given royalties from his successful colour atlas of Sputum Cytology to the Society. The Society has recently received substantial financial support through the generosity of Mr. Tony Clegg. His interest in the BSCC began in 1988 when discussing fund raising for the ASM in York, with his friend Dr.John Hopkinson. Mr. Clegg was at the time Chairman and Chief Executive of the Mountleigh Group and until his death in June 1995, lived in Yorkshire. He had made ample donations and persuaded other philanthropic industrialists to do likewise. This money enabled the BSCC to extend its activities and supported a new training school in Leeds, intercalated BSc awards for medical students to study cytology related topics and research projects. Tony Clegg, keen to promote the aims of the Society further, launched a fundraising appeal in 1990. The Cansearch Appeal, continues to support numerous projects under its new president, Dr. A.J.F. O'Reilly.
The BSCC has strong links with the Royal College of Pathologists. In 1966 an approach was made by the Society to the Royal College of Pathologists to establish a Joint Committee with the College and the Association of Clinical Pathologists. An invitation to be represented on the Standing Advisory Committee on Histopathology (which included cytology) was rejected as there would have been little freedom to pursue the great need to establish cytology as an important sub-speciality in pathology. The Joint Committee was therefore set up with three representatives from each parent body and its first meeting was held in 1968, since when the integration of cytology with histopathology has steadily increased. The Joint Committee received working papers from the Society and valuable discussions took place on a number of points relating to training. On two further occasions the College suggested representation through the Standing Advisory Committee on Histopathology, in 1976 when it was resisted, and again in 1978 when the College proposed that the joint Committee should become a Sub-Committee of the Standing Advisory Committee on Histopathology with two members each from the BSCC, the College and the Association of Clinical Pathologists, one of the Society representatives being selected to sit on the Standing Advisory Committee. This proposal was accepted in 1982. The name was changed to the Cytopathology Sub-Committee. In 1972 the Royal College of Pathologists included cytopathology in the Final part of the MRCPath. examination in histopathology and a candidate could fail the examination if an adequate knowledge of cytopathology was not demonstrated.
In 1987 the Council of the Royal College of Pathologists decided that posts recognized for higher specialist training in histopathology should include a minimum period of three months training in cytopathology. From January 1988 entrants for the final examination needed certification by their sponsor that they had received this training. This was a welcome response to recommendations made by the Cytopathology Sub-Committee of the College. The College also recommended that senior registrars intending to make cytopathology a major part of their careers should undergo at least one year of training in the subject. Trainees in histopathology became more aware of the role of cytopathology and the necessity for training and experience. Many demonstrated their interest by joining the BSCC. In the new membership examinations the Royal College of Pathologists have introduced a specialist cytopathology Part II Examination and have established a Diploma in Cytopathology.
The Society has also played a leading role in the training of non-medical scientists in cytology establishing with the IBMS guidelines for introductory courses in cervical cytopathology and administrating a recognised examination for those wishing to become cytology screeners. The BSCC had had a Certificate of Competence Examination for cytology screeners since November 1974 and with suitable revision and modification this examination was recognised by the Department of Health in 1989.
The Silver Jubilee of the Society had been celebrated in 1986 at the ASM in Durham. Past Presidents of the Society were present as well as the President of the Royal College of Pathologists, Professor Barbara Clayton and the President of the International Academy of Cytology, Dr. Nils Stormby. In 1987, the Jubilee year of the Royal College of Pathologists had been distinguished by a visit to the College by Her Majesty the Queen. Posters on cervical and breast cancer screening were presented by Elizabeth MacGregor and Peter Trott. The College took the opportunity of its Jubilee year to educate the public about pathology which attracted attention from the media in which clinical cytology and the BSCC were included. Cytology has now become firmly established in the field of cellular pathology with the Society in the forefront of developments in the United Kingdom.
The National Association of Cytologists (NAC) was formed in 1990 to fulfill the need for a pragmatic all-embracing organisation to reflect and represent the views of all members of the cytology fraternity. The NAC was founded by Dennis Williams and Jan Gauntlett (who is sadly no longer with us). The basis for the NAC was developed after a meeting with the DHSS as the DHSS was about to launch a ‘proper’ national cervical screening programme in the late 80’s. The cytoscreener at that time was an ‘ad hoc’ grade and the then Chief Medical Officer thought that cytoscreeners could be trained in a couple of days. Despite the protestations from Dennis and Jan that there should be a minimum of four weeks training at a recognized training school with minimum qualifications of four ‘O’ levels and the fact that they were not getting a lot of support from some of their medical colleagues, Dennis and Jan decided a national group was required and began to form the NAC. Education and the recognition of cytoscreeners were and still are at the forefront of the NAC aims and objectives.
The first Executive comprised of Jan Gauntlett (President), Dennis Williams (Chairman), Steve Maleham (Treasurer), Colin Smith (Publicity), Rosemary Bartlett, Russell Smith and Brian Nation (Newsletter Editor). The NAC was formed approximately two months after that meeting with the DHSS. Within six months the Whitley Councils issued the re-grading document ‘reintroducing’ the cytoscreener grade with the four ‘O’ levels minimum entry included – the first of many successes for the NAC.
Within the first year, the NAC membership was over 350 and was still rising. In 1995, the NAC welcomed its 1000th member. Fees were kept low and were still only £30 for full membership when the NAC merged with the BSCC to produce the BAC in 2011.
One of the major successes of the NAC was the Continuing Education Certificate (CEC) which was launched in September 1993. The CEC has evolved to ensure that it meets the educational needs of its members. There have been over a 1000 members registered with the CEC scheme. The CEC has had good support from its Trade colleagues which has helped keep the running costs of the scheme to a minimum.
The NAC gradually became recognised as a voice for cytoscreeners and was invited to stand on various committees with other professional representatives such as the IBMS and the BSCC. In 1994, the NAC was invited by the NCN and NHSCSP together with the IBMS and the BSCC to produce a single examination for entry to the cytology profession. In 1996 the NHSCSP Certificate of Competence was introduced together with a more formal syllabus of training and the introduction of the cytology screening logbook. This examination was replaced by the City and Guilds NVQ 3 Diploma in Cervical Screening in 2006.
A very popular aspect of NAC life was the annual conference and the first was held at The University of Birmingham at Mason Hall in April, 1990 and there were many successful conferences held there until the NAC outgrew Birmingham to move to Warwick University in 1996. University campuses were always chosen as venues to keep the delegate costs to a minimum. At the peak of its success the NAC ASM drew 600/700 delegates to the conference. The NAC combined a highly topical scientific programme together with a fun social programme. The fancy dress night always bought some interesting sights and talking points. As the requirements for the conference changed, the venue changed again and moved to York University. Due in part to funding pressures numbers started to drop for the conference and the NAC ASM moved to Keele University in 2007 which has been its home up until its merger with the BSCC in 2011.
At the time the NAC was first formed, a newsletter was produced - Scan. Volume 4 went from a newsletter to a more formal publication. This was still the official newsletter of the NAC but had more articles, quizzes and reviews. A lot of the original sections are still present such as the articles from the President and Chair plus the media review titled as Daily Screener and then Media Watch. In the early volumes of Scan, there were issues covering backlogs and repetitive strain injuries - topics that are still relevant today.
In 1997, the NAC launched its website. The website provided information about the NAC, meetings and provided educational sections for members to gain CEC points. In 1998, Eileen Hewer, then President of the NAC, wrote to the Prime Minister, Tony Blair about the salary levels and retention and recruitment of primary screeners. The invitation to speak to the NAC Conference in April 1999 was declined, but the response from his Assistant Private Secretary was published in the February Issue of SCAN (Vol 10: No1, Feb 1999).
Representing cytoscreeners was a foundation stone of the NAC and cytoscreeners have always been a part of the Executive Committee and none more so than Carole Cowen who we proudly elected as president in 2002.
In the early 2000s the IBMS, BSCC and the NAC started to work more closely together with a representative from each Society sitting on each of the others Council/Executive meetings. This closer working relationship has resulted in the merger of the NAC and the BSCC into the British Association for Cytopathology (BAC) in 2011.