This issue’s cover article, written by Barbara Apgar, M.D., M.S., University of Michigan Medical Center, Ann Arbor, Mich., and Gregory Brotzman, M.D., Medical College of Wisconsin, Milwaukee (see page 1905), reviews management of women with cervical cytologic abnormalities. The article presents a series of algorithms that summarize appropriate triage of women with cytologic abnormalities, based on the American Society for Colposcopy and Cervical Pathology (ASCCP) 2001 Consensus Guidelines.
The guidelines were developed at a consensus conference sponsored by the ASCCP and attended by major organizations, including the American Academy of Family Physicians, and were based on new data about human papillomavirus (HPV), HPV DNA testing and liquid-based cytology, drawn from the ASCUS-LSIL Triage Study (ALTS). The evidence-based algorithms that Drs. Apgar and Brotzman present in their article will help family physicians distinguish women with a significant risk of high-grade cervical disease from those with minimal or no disease. An editorial on page 1866, by Daron G. Ferris, M.D., provides additional background on the ASCCP guidelines. ASCCP histology guidelines will be presented in an upcoming AFP article co-authored by Dr. Apgar.
Dr. Apgar, whose titles include clinical professor of family medicine and service chief for the Family Medicine obstetric service at the University of Michigan Hospital, has served as associate editor of AFP for the past 11 years and has had a special interest in women’s health for at least as long. Her early work in teaching colposcopy led to publication of one of her first articles in AFP, on LEEP (loop electrosurgical excision procedure). Eventually Dr. Apgar would make the leap toward publication of a 900-page textbook and atlas on colposcopy.
How did Dr. Apgar come to be a leader in family medicine as an editor, author, and teacher in women’s health? She always knew she wanted to be a family physician, she says. As a child, Dr. Apgar lived in the southwest, moving from Oklahoma to New Mexico and Texas. She earned a master’s degree at the University of Michigan before attending medical school at Texas Tech University School of Medicine, Lubbock. The desperate need for family physicians in rural Texas reaffirmed her career decision to pursue family medicine as her specialty. After Dr. Apgar finished her residency in family medicine at Texas Tech, she worked in a practice alongside two subspecialists in obstetrics-gynecology, who reinforced her interest in women’s health.
One of her early teaching efforts involved publishing an article on group B strep in AFP. Dr. Apgar credits one of AFP’s manuscript editors—Barrett Schroeder—with inspiring her efforts as an editor-author. Barrett led her through the publication process and never gave up on her, validating her strengths as a good editor should, she says. Since then, Dr. Apgar has had many opportunities for teaching, speaking, writing and mentoring on her own.
In her free time, Dr. Apgar is a conservationist who’s always looking out for endangered species, such as wolves in Yellowstone, black bears in Maryland, and alligators in Louisiana. She also loves to spend time with her dogs at her home in Ann Arbor, Mich. At one time she had a team of sled dogs that she drove on a five-mile track around the woods nearby. Now she keeps just seven sled dogs, but animals seem to know to seek safe haven on her back step, and she tends to collect them under her care. Dr. Apgar is a physician who emulates the spirit of family medicine, one who cares not only for the whole extended family, but also our planet earth and its other animal inhabitants.