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History of the Pap Smear

Posted Jun 13 2009 12:12am

Let’s talk about how Pap smears got to where they are today. A lot of people never consider the name of the test and where it originates. Even ones who do think about the name assume Pap smears have something to do with human “PAP”illoma virus, or other such gynecological term contain the word “Pap.” However, notice Pap is also capitalized. That is because it is named after the man who rather serendipitously discovered this method of detecting cervical cancers (and occassionally other cancers): George N. Papanicolaou. (Quite a mouthful.)

George N. Papanicolaou (1883-1962) emigrated from Greece to the United States after serving in the Balkan War from 1912-1913. Cornell University Medical College hired Papanicolaou, a graduate of the University of Athens medical school, to research sex determination in pregnancy. He cytologically examined microscope slides of vaginal liquid samples.

In January 1928, Papanicolaou reported that, “he had detected cells that were characteristic of cervical cancer.” [1] The criteria of the time held that cervical cancers were only those that had invaded and penetrated the cervical tissue, not just superficially present cancer cells. Papanicolaou’s findings showed that abnormal cytological findings could predict cancer incidence. However, most of his colleagues at the time were uninterested in these findings or in implementing them in cancer screenings and thus dismissed it.

In 1937, the chair of the Department of Anatomy at Cornell urged Papanicolaou to return to his earlier work. Papanicolaou began a study of vaginal smears taken from women admitted to gynecological services at New York Hospital. In 1943, he published his findings as a “Diagnosis of Uterine Cancer by the Vaginal Smear” (a uterine cancer referring to any cancer of the uterus and attached structures, including the cervix).

In this study, Papanicolaou discovered 179 unsuspected cases of uterine cancer, 127 of which were cervical cancers. Again, many physicians and researchers discounted the importance of these findings. [2] However, after hearing of this breakthrough Mary Lasker, wife of advertising mastermind Albert Lasker, enlisted her husband to help reformulate the American Society for Cancer Control into a research-funding organization to support Papanicolaou’s research. Under the guidance of Lasker, the American Society for Cancer Control refocused its aims and became the American Cancer Society (ACS). The ACS supported Papanicolaou and his method for finding gynecological cancers and pre-cancers. Throughout the 1940s the ACS raised funds to finance Papanicolaou and other scientists in substantiating his initial findings.

In 1948, Papanicolaou published a refinement of the techniques of how to detect gynecological cancers via his method now called the “Pap smear.” The ACS fully-embraced the Pap smear as a cancer detection method for women and advocated its use alongside ACS campaigns for self-exams for breast cancer. By the late 1950s, nearly one-third of American women had had a Pap smear. The Pap smear became the standard diagnostic procedure for cervical cancer in all Western nations by the 1960s. [3]

So, the next time you get a Pap smear remember the Greek immigrant who discovered this indispensable tool in gynecological care. Questions? Comments? I’m waiting.

[Note: Most of the above is directly quoted from my senior honors thesis on record at Ekstrom Library at the University of Louisville if you are interested. Always use the rules of good research and cite!]
1. Barron H. Lerner, The Breast Cancer Wars: Fear, Hope, and the Pursuit of a Cure in Twentieth Century America (Oxford, UK: Oxford University Press, 2001), 48.
2. Ibid., 50-53.
3. Kirsten E. Gardner, Early Detection: Women, Cancer, and Awareness Campaigns in the Twentieth Century (Chapel Hill, NC: University of North Carolina Press, 2006), 120-123. In Britain, where it is known as the “smear test,” it is particularly effective and prevents death in 95% of cervical cancers.

 

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