I was so intrigued I dove into researching the development of the Pap test. Although cervical cancer remains one of the most common forms of cancer in women, it is among the most preventable. The Pap test, which allows doctors to diagnose early cervical changes which can lead to cervical cancer, was developed based on research which started out with the study of the vaginal discharge of a guinea pig. Literally, guinea pigs. It makes me wonder, is that where the term guinea pig came from when referring to medical testing?
George Papanicolaou was born in 1883 on an island off of the coast of Greece. In 1904 George earned his MD at the University of Athens. George furthered his education by earning his PhD in zoology in 1910 from the University of Muich. In 1913 the doctor and his wife, Mary, immigrated to the United States. They spoke no English and had no prospects when they arrived at Ellis Island. The couple did what they needed to do to survive in New York City, George and Mary both worked at Gimbel’s department store. Although he was working at Gimbel’s, he never lost his desire to complete medical research. George found work at a New York hospital. He was hired on as an assistant in the pathology department; later, he was hired on as an assistant in the Department of Anatomy at Cornell Medical College. Through the use of his academic background he moved up the ranks quickly.
Through the Department of Anatomy at Cornell, George was able to begin conducting research on guinea pigs. Through the use of a pediatric nasal speculum he was able to venture into the vaginas of guinea pigs to retrieve cell samples. These samples where tested by being smeared on a slide and studied. George determined that the samples collected could be used to map ovulation cycles of the guinea pigs.
This is all interesting, but how did we get from literal guinea pigs to humans? How did Mary end up becoming her husband’s test subject? How did we get the Pap test? Research indicates that in the 1920s George moved to testing human cells. However, he was not a clinician in the United States. He had limited access to human samples. This is where Mary comes into play. Mary was the test subject! Mary was his first, and long term, test subject allowing her husband to take samples from her cervix to develop this test, a test which now saves lives. I cannot imagine that could have been a pleasant experience.
Eventually he was able to expand his research to additional human samples through his connection with Cornell. Cornell affiliated with the gynecologists at the Women’s Hospital of New York and they were able to obtain a supply of human samples from healthy and pathologically significant cases. George used a process on the slides to help distinguish between healthy and unhealthy cells. He was able to observe abnormal cells from a woman who was diagnosed with cervical cancer. It is then that George realized he had happened upon an easy and mostly non-invasive way to detect cancer! In 1928 Dr. Pap, as he was referred to at Cornell University Medical College, presented a paper on “New Cancer Diagnosis” at a conference. This article was later published in the New York World.
The Pap test was not welcomed with open arms, in fact for many years the normal practice of invasive tissue biopsies continued to be the primary diagnostic tool for cervical cancer. There were no effective screening tools in place, cervical cancer was typically deadly by the time it was caught. Dr. Joseph Hinsey became chair of the Department of Anatomy in 1939 and encouraged Papanicolaou to pursue his cancer research full time. He was able to team up with Cornell gynecological pathologist Dr. Herbert Traut and together they convinced the New York Hospital to use the smear test on all female patients. The results were undeniable. Their findings were published in 1941 and recommended use of the test as part of routine medical exams to detect abnormal cells in their pre-cancerous phase.
Dr. Pap and Dr. Hinsey began focusing on breaking down barriers and bringing the Pap test to the general public in the mid 1940s. They began their focus on training pathologist and cytologists to read Pap tests using specific techniques. Dr. Pap began teaching a course at Cornell University Medical College, the first ever course in cytology. One key element to the implementation of the Pap test was training people on how to read the smears. This continues to be the key to an accurate diagnosis.
Although there are additional preventative and screening measures available today, the Pap test remains a prominent test in women’s health care. Today it is recommended to utilize a co-testing method which would include an HPV test as well as a Pap test. Vaccination against HPV is also recommended to lower your risk of contracting the high risk strands of HPV which are known to cause cervical cancer. Although you may find it a tad uncomfortable to sit in that doctor’s office and have a doctor perform the test on you, I encourage you that next time you go in for your annual visit to think about Mary. Mary Papanicolaou who was the original human test subject for this test. A test which can save your life today.
Think about Mary. Have you scheduled your well women’s exam yet?