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Dr. Miguel Sanchez ...

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Dr. Sanchez

Profiles in Cytopathology

Joan Cangiarella, M.D., New York University School of Medicine, New York, NY

Dr. Miguel Sanchez is the first recipient of the Y.C. Oertel Award by the Papanicolaou Society of Cytopathology recognizing outstanding contributions to the practice and teaching of fine needle aspiration. Dr. Sanchez is Chief of Pathology and Medical Director of the Cytodiagnosis and Breast Care Center at Englewood Hospital and Medical Center. Dr. Sanchez holds professorial appointments at both the Mount Sinai School of Medicine and the New York University School of Medicine.

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Dr. Sanchez completed his training in pathology at Temple University in Philadelphia and St. Vincents Medical Center in New York City and then pursued fellowship training in oncologic pathology at Memorial Sloan Kettering Cancer Center. He spent several months at the Karolinska Institute in Stockholm where he received specialized training in the performance and interpretation of aspiration cytology.

Dr. Sanchez has authored numerous publications and book chapters. His expertise in fine needle aspiration is recognized worldwide. He has given hundreds of lectures in the United States, Europe, Latin America, China and Australia, primarily on the early detection of breast cancer, but also on studies of the humanities in medicine and on philosophy. He was instrumental in developing the concept of the multidisciplinary breast center after some observations of the Swedish system. The Cytodiagnosis and Breast Care Center run by Dr. Sanchez was designated by Congress in 1994 as a national model for breast care diagnosis and management. The center is an international training site for fine needle aspiration cytology.

Dr. Sanchez’s commitment to education in diseases of the breast has been recognized both nationally and internationally. He is the recipient of the American Cancer Society Award for Physicians in the Forefront, a Zonta Award for Health Care to Women, The Gold Medal Award from The Chinese Academy of Medical Sciences, the Herbert Dardik Research and Education Award and recently was awarded a Nicaraguan Medal of Medical Merit from the Nicaraguan government for his research and teaching in breast cancer. He was named on the Castle Connolly Best Doctor and New York Magazine Best Doctor in New York list several years in a row. He is also a member of the Advisory Board of The Susan G. Komen Breast Cancer Foundation, North Jersey Affiliate, and since 1995 has served as Vice Chairman of the National Cancer Institute Subcommittee on Indications of Breast Biopsy. He is also a member of the International working group for Breast MRI from the U.S. Public Health Service.

I had the opportunity to talk with Dr. Sanchez about his accomplishments in the field of cytopathology. Here are some excerpts from our conversation:

How did you decide on cytopathology as a career choice?
I started my medical career as an internist and budding cardiologist and became profoundly bored rather fast. The microscope always intrigued me. I asked a senior internist "What do you think about Pathology?". His answer " was “its okay but you will never be able to know everything". That was the best answer to encourage me to go into Pathology. As a resident in Philadelphia working with Wally Clark and Irena Koprowska, I had my first exposure to neoplastic pathology (melanomas) and to cytology. Somehow I seemed to get the hang of cell analysis better than other fellow residents. Subsequently, in 1973, as part of my fellowship at Memorial Sloan Kettering Cancer Center I spent a month with Grace Durfee and Mike Melamed, Chief of Cytology at the time and learned two important things. One, anybody can make an observation and two, you must have the courage of your convictions.

How did you get interested in aspiration cytology?
I got interested in Fine needle aspiration, first because of my friend Charlie Curtin, a pathologist in Scranton and fellow with me at MSKCC. Then I met Gert Auer, in a Cytology meeting in Montreal. Gert was a researcher at the Karolinska Institute in Sweden, and after a few days of having a great time he invited me to pursue a rotation in Stockholm. There, in 1983, my Swedish period started. Sixten Franzeen, Torsten Lowhagen and Jerry Waisman,(who was in Stockholm at that time), became, with Gert Auer, lifetime friends and role models. I returned to Stockholm several times after that. The last two visits I was invited to lecture about "The Englewood model" of breast care. It was really about “what have you done with what we taught you". The last invitation was to serve as Master of Ceremony for the dinner to celebrate the memory of Torsten.

Your center for aspiration biopsy has grown remarkably over the last two decades. How difficult was it to convince your surgeons and hospital on the benefits of aspiration cytology?
The evolution of the Center was not that difficult at Englewood. You have to identify the key people and bring them to your side. Persuasion, availability, affability and ability, as you know, are the elements of success in any medical practice, in that order. Having Roz Stahl by your side is surely a plus.

What do you see as the future of cytopathology?
I think that Cytopathology is going through a transformation period. The fact that new molecular technology is adapting itself to smaller and smaller samples will be the new explosion of cytopathology.

What do you think about the future of aspiration cytology for lesions of the breast?
Breast cytopathology is also going through a difficult period. I'm convinced that with adequate training of both clinicians and pathologists, breast cytopathology will recover the position that it should never have lost. But prudent and at the same time decisive interpretations are needed. A cytopathologist that finds everything "atypical" is useless, and clinicians realize that very fast. Interpretation of breast cytopathology in a vacuum is also a mistake. I see the breast cytopathology renaissance within the context of the multidisciplinary breast center. There are so many decisions that can be made with immediate evaluation of a breast cytology sample!!

You have traveled all over the world lecturing in cytopathology. What was your most rewarding experience?
Besides being invited back to the Karolinska to show what I have done with what I have learned there, probably the most rewarding experience has been helping with setting up FNA programs in developing countries, especially Nicaragua.

What advise can you give to young cytopathologists trying to establish a Center in aspiration cytology?
To the young cytopathologist I would advise never to forget the teachings of giants like Leo Koss. To practice cytopathology you need a strong background in Surgical Pathology and Medicine in general. If not, Pathology and its branches become a form of "aesthetic morphology" instead of a unique form of practicing medicine.

What hobbies do you enjoy?
Some of my friends will tell you that I do not have "hobbies" in the traditional form. I do not believe in moderation, but passion. So I'm a dedicated, (if only mildly competent), golfer. An Opera fan that lectures in Opera analysis and travels around the world to see the latest production of Wagner's "Ring" and an amateur Egyptologist in the process of learning to read hieroglyphs from the New Kingdom. But by far my two greatest passions are my sons, Julian, a writer in Washington DC, and Thomas, a May 2004 graduate of NYIT-VIP program.

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