Pituitary Awareness Month 2019

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PNA Spotlight: Dr. Sylvia Asa

Asa1This month the PNA Spotlight focuses on a world renowned expert in pathology, Dr. Sylvia Asa, one of the very first physician members of the PNA. Dr. Asa  joined Case Western Reserve University as a professor of pathology this year.

Dr. Asa was born in New York City, where her father was completing a residency in thoracic surgery. The family moved to Windsor, Ontario, Canada when Dr. Asa was four years old. She graduated from medical school at the University of Toronto in 1977, did her residency in pathology there, and then received her Ph.D. in pathology from the same institution. The university has seven affiliated teaching hospitals and in 1985 Dr. Asa began working as a pathologist at Saint Michael’s Hospital. She left there in 1992 to join Mt. Sinai hospital. In 2000, Dr. Asa became Head of Pathology at the University Health Network, the largest group of affiliated hospitals in the network, comprising three hospitals within the University of Toronto system. She was kind enough to answer some questions from the PNA. Her answers follow.

What inspired you to choose your career path?

I come from a family of physicians and always knew that I would be a doctor, but in my early years, I focused on surgery. My father was a surgeon and in the days before privacy and safety concerns, I was fortunate to see the operating room as a child. I made rounds and saw patients whose lives were saved by good doctors. Once I reached medical school, I realized that there were more complex and fascinating things to study, and endocrinology was one of the highlights; I was especially impacted by the patients of Dr. Calvin Ezrin at the Toronto General Hospital. I started off my postgraduate training in Internal Medicine but came to pathology by chance; I did an elective because I really wanted to better understand how pathology works, and the visual aspects of this specialty, along with the ready access to research, made me change my focus. I was very fortunate to be able to work with Kalman Kovacs, who also had trained in both endocrinology and pathology, and his wife Eva Horvath. Those early experiences made it clear to me that endocrine pathology was a field with tremendous opportunity and the opportunity to study pituitary diseases became the subject of my PhD thesis.

What is the primary focus of your work/research?

My research work has always focused on studies to clarify the basis for development of endocrine tumors, improve diagnostic tests and identify targets for therapy of those diseases. Pituitary tumors are the main area of this work, since the pituitary is truly the “master gland”, but I also study other neuroendocrine tumors, as well as thyroid and adrenal tumors.

What do you consider to be the future of your field?

Endocrine pathology, like other fields of pathology, is undergoing major changes and we will see the implementation of new technologies. This field was always a leader in the use of ancillary diagnostic tools, starting with electron microscopy in the 1970s, immunohistochemistry in the 1980s, molecular studies in the 1990s and epigenetic analyses in the 21st century. However, pathology has now broached a new frontier – my department and others have led the way in digital technologies. As traditional microscopy is replaced by whole slide images of glass slides, we pave the way for new ways of practicing this discipline, including remote telepathology that will give every patient access to the right pathologist at the right time, and the opportunity for application of artificial intelligence (AI) tools to enhance what pathologists already see in the interpretation of what those images contain. I believe that the morphologic aspects of pathology represent the synthesis of genetics, proteomics and epigenetics, and AI will help us to provide more accurate diagnoses, better prognostic information and the right prediction of a therapeutic approach for each patient.

What should patients know about your field/what deserves more recognition/awareness?

Pathology has traditionally been a laboratory-based discipline that has as an advantage - the ability to do research - but suffers from a lack of patient interaction. Unlike many other pathologists, I like to have the opportunity to meet with patients, discuss their pathology findings and assist in their care plan. I encourage my colleagues to do the same. I will take this opportunity to encourage patients to get to know their pathologist. After all, it is the pathologist who makes one of the most important decisions in the care of a patient: their diagnosis! It is important that patients recognize that pathology is NOT a black box that issues a result. Especially in anatomical pathology where we examine tissue, there is a significant interpretive component that requires knowledge and experience. I imagine that most patients would not want to have surgery performed by a surgeon they have never seen or met, nor would anyone want to get chemotherapy from an oncologist they do not know. In the same vein, I encourage patients to get to know their pathologist and not just accept the diagnosis without confidence that the individual is knowledgeable and experienced.

What would you like to convey about yourself to your patients?

The most important message that any physician can give to a patient is that they care about that individual. I encourage patients to contact me because I care about them. I want to help people understand their situation and make educated decisions about their health. Knowledge is power and the more information that any patient receives about their disease, the more knowledge they have to take control of their future.

Why did you get involved with the PNA and what is the extent of your involvement?

I started to work with the PNA before it was even called that. In 1992, I met Bob Knutzen, a giant of a man with the biggest heart and the strongest ambition to help pituitary patients. He won me over instantly and I began to work with him and what was then the Pituitary Tumor Network Association (PTNA). I have been there as the organization evolved to the wider focus of the current PNA; I have helped with many meetings, given talks, and supported numerous initiatives including publications and awareness drives. Along with my husband, Dr. Shereen Ezzat, and our children who have come along with us to many events, we feel that the PNA is a part of our family.

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