Critical Values - January 2009 - (Page 29) Volume 2 • Issue 1 • January 2009 vaccine shot. Furthermore, it appears that some highrisk groups are significantly less likely to be vaccinated. Therefore, a major reason not to jump the gun with overly optimistic extrapolations about decreasing highgrade dysplasia rates is that most young girls are not yet being vaccinated. The unknowns are the extent to which vaccination will be administered, how long protection will last, and whether boosters will be needed. One cause for concern is that girls are not necessarily returning for all their shots. So they may receive one shot or two shots but not all three shots. There’s a tendency to immediately start thinking about how to dramatically change screening soon. Much of that discussion is extremely premature and frankly is actually being driven by some of the manufacturers and their encourage cash-strapped administrators to close cytology schools, which has already happened. It’s attractive to think there are molecular solutions for everything, but the idea that molecular utopia is close has been overstated. A great deal of confusion results. Q. What would you say to cytotechnologists? A. Cytotechnologists should be incredibly proud of the accomplishments of their profession. Given the fact that the profession as a group in the United States is graying and that many are nearing retirement, there are opportunities ahead. I also think that emerging combinations of cytology and molecular testing are exciting. A cytotechnologist surrogates. Data are needed on the impact of the vaccine on high-grade dysplasia rates and invasive cervical cancer. There are no data showing that the rate of dysplasia in the overall screening population is decreasing due to the vaccine. Q. What will be the impact on the profession of cytotechnology? A. Unfortunately, many mixed messages are out there. The suggestion that there will be less screening is irresponsible and has substantially come from professionals with longstanding close collaborative relationships with manufacturers. The notion of getting rid of the Pap test is also a bad message, because it can inadvertently encourage women to think maybe they don’t need to be screened at all. It can also undermine the cytotechnologist workforce that’s still needed to perform screening and even inadvertently at the University of Pittsburgh Medical Center–Magee recently earned ASCP certification in molecular testing. We congratulated her, promoted her, and even gave her a raise! However, there’s an over-enthusiasm by some about pushing the Pap test off the cliff. This is driven mostly by corporate communication messages and also by some wellintentioned people who intuitively believe that molecular methods are the answer for everything. Fewer than 200 cytotechnologists a year are graduating in the United States. The chances are great that there will actually be a shortage of cytotechnologists in the future. So I see cytotechnology as a professional field that offers some very exciting and remunerative opportunities. Dr. Austin is Professor of Pathology at the University of Pittsburgh School of Medicine and the Director of Cytopathology at Magee-Womens Hospital of UPMC. 29
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