Pap Smear (cont.)

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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.

Previous contributing author: Carolyn Crandall, MD, FACP

Medically reviewed by Mikio A Nihira, MD; American Board of Obstetrics & Gynecology

REFERENCE:

"Cervical cancer screening tests: Techniques and test characteristics of cervical cytology and human papillomavirus testing"
uptodate.com


Medically Reviewed by a Doctor on 2/21/2014

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