An Open Letter to the flow cytometry community: I have spent a good deal of my career studying and developing flow cytometric cell-cycle analysis. Approximately a year ago, a panel of unnamed scientists commissioned by ASCO published a recommendation that flow cytometry NOT be performed on breast or colorectal tumors in a clinical setting (Journal of Clinical Oncology, 1996;14:2843-77). Using ASCO's own statistics on papers dealing with colorectal cancer from the last 8 years, 24 of 31 studies found ploidy to be prognostic in colorectal cancers. In 13 of 17 studies where the question was asked, ploidy was found to be an INDEPENDENT prognostic indicator. 4 of 7 papers found S-Phase to have prognostic significance 3 of those determined S-Phase to be an INDEPENDENT indicator. Their report was much more vague when reporting the outcome of the breast cancer literature search. However the panel did note that the majority of studies show S-Phase to have independent value in some patient subsets. The author's complaint here was that the studies were retrospective and used different cut-points for high vs. low S-Phase. The panel also noted that MANY studies had found INDEPENDENT prognostic value to S-Phase determination in axillary node negative patients. However they expressed the same concerns as previously noted. Most of the findings in this report are positive and the negative recommendation is not deserved. It is my concern that the recommendations in this report are being taken on face value without regard to the underlying findings of the panel. Many of the concerns expressed can be overcome with more stringent standardization and further prospective studies. Because of the bottom-line negative recommendations, this report is having a chilling effect on the oncology community, probably preventing the very studies that the panel is looking for. We, in the flow cytometry community, have an obligation to counter this negative bias with sound data. It is ultimately the cancer patient that suffers when independent prognostic information is withheld from their clinician. I am afraid that is exactly what is happening as a result of this report. However, there is still time to act. First, we need to get real standardization. Second, the Consensus Committee report from 1993 needs to be revisited and strengthened. Further, We need to talk to oncologist to present the data that is already in the literature. If we remain passive our potential contribution to the wellness of these patients will go unused.
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