HPV testing and vaccinations may change scope of training for lab professionals

By now we have all heard or seen commercials promoting testing and vaccination of human papillomavirus (HPV), a virus with more than 100 strains, 30 of which are sexually transmitted.

While the debate continues about whether prevention and vaccination is socially acceptable, another issue has risen behind the scenes.

What will gynecological cytopathologists do now that the HPV vaccination reduces the demand for their expertise in Papanicolau (Pap) test administration and analysis? If HPV testing and vaccination continues to evolve, regular Pap tests will not be required as often. And the cytotechnology market will face a serious labor crisis.

"Laboratory directors, managers and cytology educators face a balancing act in providing and retaining sufficient quality, skilled cytology practitioners to meet the current needs of the health care system while preparing the practitioners to shift their focus to nongynecological cytology and molecular pathology as Pap test volumes shrink," writes Jamie L. Covell, CT (ASCP) in an upcoming related American Journal of Clinical Pathology (AJCP) article. "We, as cytology practitioners, can choose to adapt and fight to establish a new role in the evolving process of cervical cancer prevention, or we can flee and leave the field to others."

But the industry has time to figure out its next move because there are some issues that may slow the HPV testing and vaccination machine down. Thought leaders are concerned that women who are told that Pap smears are not needed as often may discontinue other necessary health and wellness monitoring. Mandatory testing for adolescent girl is still facing major societal and cultural opposition. There is no assumption that women and practitioners will easily adapt to and accept HPV testing as a substitute for short-interval Pap test, a trusted method since the 1950s. Also, vaccinations are not effective on women already infected -- 27 percent of U.S. women between ages 14-59, and almost 45 percent among women ages 20-24, according to a 2007 Journal of the American Medical Association (JAMA) report ("Prevalence of HPV Infection Among Women in the United States, Dunne, Eileen F., M.D., et al. JAMA. 2007;297:813-819).

The Numbers

An article in the October issue of the AJCP indicates that in the current labor market, the demand for cytotechnologists increases by 3.6 percent every year and the supply increases by 4 percent. (Three percent vacancy rate).

The projection shows that with adherence to current screening guidelines, there will be a decrease in demand of almost half of requested Pap tests by the year 2010.

Instead of the demand for cytotechnologists being around 8,033 in the year 2010, the demand will only be around 5,623; by 2026, only 8,358 instead of 14,146.

Despite a decrease in the number of cytotechnology programs and a fledgling 76 percent occupancy rate, there is still an annual net growth of 1.6 percent growth in this workforce supply.

Compared to other healthcare fields, only 65 percent of cytotechnology students are reportedly getting work in laboratories.