HPV vaccine

[ilovepath]

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Im an MSIII who was working w/ an FP doc who said the HPV vaccine will destroy a lot of bread and butter of a pathologist's income. I thought he had a very anti-path vibe to him trying to justify steering me away from path. Does he have any legitimacy to his claim?

 

[dermpathlover]

Im an MSIII who was working w/ an FP doc who said the HPV vaccine will destroy a lot of bread and butter of a pathologist's income. I thought he had a very anti-path vibe to him trying to justify steering me away from path. Does he have any legitimacy to his claim?

What a f'n *****. Getting rid of pap smears would be the best thing to happen to pathology. The only people in might hurt would be screening cytotechs as it is such a huge part of their workload.

 

[yaah]

Not quite. Pap smears aren't going anywhere for a long time. Even if HPV carriage rates decrease and so do HPV related illnesses, there is very little chance of a significant decrease in #s of pap smears performed. This is not a magic bullet that is going to wipe out cervical neoplasia - as said it only applies to those who have not yet been exposed, and it will be many years before the current population ages enough to make this relevant (presuming, of course, that the vaccine is 100% effective, which it will not be).

Perhaps, 20-30 years in the future, there will be a decrease in income as a result, but pap smears are a pretty small amount of income as it is anyway, and cervical biopsies are common but certainly not a huge proportion of specimens.

 

[yaah]

What a f'n *****. Getting rid of pap smears would be the best thing to happen to pathology. The only people in might hurt would be screening cytotechs as it is such a huge part of their workload.

The bigger threat to cytotechs is computerized screening technology, which uses algorithms to screen the slides, and mark ones that are suspicious for neoplasia.

 

[ilovepath]

he's a long list of idiots who talk out of their ass to dissuade ppl like me from this great field. maybe he's just jealous he didn't think about it. its quite ironic that drs in these 'ppl professions' like fp are so bitter.

 

[Brian Pavlovitz]

Not quite. Pap smears aren't going anywhere for a long time. Even if HPV carriage rates decrease and so do HPV related illnesses, there is very little chance of a significant decrease in #s of pap smears performed. This is not a magic bullet that is going to wipe out cervical neoplasia - as said it only applies to those who have not yet been exposed, and it will be many years before the current population ages enough to make this relevant (presuming, of course, that the vaccine is 100% effective, which it will not be).

Perhaps, 20-30 years in the future, there will be a decrease in income as a result, but pap smears are a pretty small amount of income as it is anyway, and cervical biopsies are common but certainly not a huge proportion of specimens.

My guess is that cytology might evolve to include endometrial sampling. There has already been some work in using a thin-prep type collection system for evaluating endometrial samples (I saw an article in Cancer Cytopathology last year sometime). To my knowledge, there is no documented atypia--dysplasia--carcinoma continuum yet, but it isn't a very easy area to sample for routine cytology. Of course, the cytologic criteria might be difficult to establish. But if clinicians will be able to sample the endometrium in a similar fashion as the cervix, who knows? Anyone else have thoughts about this?

 

[yaah]

Based on my clinical observations when I was in med school, I am not sure what benefit that would allow. An endometrial biopsy isn't an innocuous procedure, but it only involves sticking a small pipelle up into the cavity - and how would cyto sampling be much different? I figure in these cases, why institute a procedure that is less sensitive (and probably less specific as well) than biopsy if there is no real cost or time benefit? The beauty of pap smear is that it is non invasive and scrapes an accessable area without cutting.

 

[Path Mama]

The bigger threat to cytotechs is computerized screening technology, which uses algorithms to screen the slides, and mark ones that are suspicious for neoplasia.

The cytotechs would still end up re-screening any slide marked by the automated screener as having cells that don't fit the algorithm before the slide can be kicked up to the pathologist.

 

[cjw0918]

The vast majority of clinicians have NO IDEA what the specialty of pathology truly encompasses. Remember in medical school, you are not required to spend one single day in pathology despite the fact that you are required to spend weeks in FP, surgery, OB, psych, etc. Yet all of these specialties in some form or another will send SOMETHING to pathology, be it a surgical specimen or even a simple lab test. Don't listen to what others specialties say about path, they have no idea what we do.

 

[PathOne]

I'd have to concur, and intone with a bow towards Oscar Wilde, that: The Death of Pathology is Somewhat Overstated By Some. (anyways, who'd to the autopsy if pathology would indeed cease to be?).

Fact is, that as the population in the Western world continues to age, and the demand for ever-wider screening programs - with the always attendant false (and true) positives - I don't think that any sane and knowledgable person could argue that pathology is headed towards its own demise.

 

[rirriri]

i was talking to a cytopathology attending about this very subject yesterday...and they were saying that it will take a long time before the effects of the vaccine are fully observed...maybe even a couple generations. i'm sure the rates of cervical cancer will be affected, however to what scale and how soon remains to be seen.

the adminstration of the vaccine is just NOW beginning....and the Paps will continue indefinitely as long as Cervical Cancer exists.