Pap Smear (cont.)
In this Article
With Pap smears so available, why are women still dying of cervical cancer?
It is critically important to recognize that the women who are at highest risk
for abnormal Pap smear testing are those who are not getting regular Pap
testing. Therefore, it follows that in order to improve overall cervical cancer screening, women who are not getting regular Pap smears should be educated about
and offered Pap testing. These under-served women should be the most heavily
targeted for Pap screening.
Between 60% and 80% of American women who are newly diagnosed with invasive
cervical cancer have not had a Pap smear in the past five years and may never
have had one. Women who have not had Pap smear screening tend to be concentrated
in certain population groups including:
- Older women;
- The uninsured;
- Ethnic minorities, especially Latino, African
American, and Asian American women;
- Poor women; and
- Women in rural areas.
Many physicians feel that the emphasis should be on universal access to proper
Pap screening as opposed to the comparatively small benefit that would come from
utilizing the newer technologies in women already undergoing screening. Cervical
cancer is one of the most common causes of cancer worldwide. It is also one of
the most preventable and treatable cancers.
Historical note: Dr. Pap
The Pap smear is named after Dr. George Papanicolaou (1883-1962). Born in
Greece, Dr. Papanicolaou received a medical degree from the University of Athens
in 1904 and a PhD in zoology from the University of Munich in 1910. He came to
the United States in 1913 as an assistant research biologist under Dr. Charles
R. Stockard at Cornell Medical College in New York City. He stayed at Cornell
for 47 years. There, he studied the role of chromosomes in sex
determination. In the process, he noticed recurring changes in the cells in the
vaginal discharge
of the guinea pig over the menstrual cycle.
Extending his studies to humans, "Dr. Pap" began examining vaginal smear changes
in 1923. He unexpectedly discovered that women with uterine cancer had "abnormal cells, with enlarged,
deformed, or hyperchromatic nuclei." He called the discovery of these abnormal
cells on the smear "one of the most thrilling experiences in my scientific
career."
Dr. Pap's new test was at first viewed as quite unnecessary for the diagnosis of
cervical cancer. Then, in 1943, he and the gynecologist Herbert F. Traut
published a report entitled "Diagnosis of uterine cancer by the vaginal smear."
They demonstrated clearly how cellular abnormalities could be detected before
the tumor became invasive. It was a revolution in the management of cervical
cancer. The Pap smear test was soon accepted as a routine screening technique.
Within two decades, cervical cancer dropped from first to third place as a cause
of cancer death in women.
Dr. Pap was the founder of what is called exfoliative cytology, which is the
microscopic examination of cells shed from the surface of the body, or from a
tumor, in order to among other things, detect cancer and gauge the effect of
hormones. Dr. Pap applied his technique to other types of tumors including those
in the respiratory, gastrointestinal, and urinary tracts and the breast. His
method has also been used to predict cancer radiosensitivity and to evaluate the
effectiveness of radiotherapy. However, it is as the creator of the Pap smear
that Dr. Pap is best remembered today.
Next: Pap Smear At A Glance »
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