Great questions!!!!
From my experience (as a Molecular Pathologist/Anatomic Pathologist/Geneticist):
1. the crux of the issue is what "interpretation" means. A PhD can interpret a variant as a true positive finding. They cannot interpret what the clinical implications of the finding are. A physician should do that. More specifically, a pathologist who understands: 1- the underlying biology and genetics of the tumor; 2- the laboratory methods and their liabilities; 3- the clinical significance of the findings in terms of diagnoses, prognosis, and predictive (therapeutic) implacations
2. Oncologists CANNOT generally interpret how the results drive treatment strategy. I say generally. At MGH/WashU/Hopkins whatever, they may all be experts or even PhDs in genetics themselves. In general, most oncologists know next to nothing about genetics. They may know very superficially very common things (like EGFR mutations and the use of erlotinib), but even common findings can easily lead them astray (like EGFR L858R mutation + EGFR T790M mutation, in addition to many other variants and mutations present). They want someone to explain all this to them. A molecular pathologist should be able to do this: 1- understand the diagnosis of lung adenocarcinoma; 2- understand the genomics/genetics of lung adenocarcinoma; 3- understand the ramifications of the molecular findings- in the example above it would be to advise the oncologist to d/c erlotinib/gefitinib and consider osimertinib therapy; in consideration with other clinical factors.
This is IMHO the most exciting field in all of medicine, and we are at the precipice of a paradigm shift in our approach to the patient with precision medicine. Molecular Pathology has the opportunity to be at the center of this change.
