Dr. George Papanicolaou, a dedicated researcher

Dr. George Papanicolaou, a dedicated man

This dedicated pathologist made an exciting discovery. He noted "The first observation of cancer cells in a smear of the uterine cervix was one of the most thrilling experiences of my scientific career." He kept working and comparing and analyzing, six and seven days a week. In 1928 he presented his initial results. A medical world wrapped up in gross anatomical specimens gave him only criticism. Even a newspaper article in the New York World grasped the potential to save lives and prevent disease even though the modest pathologist refused to confirm this. Established medicine and leading pathologists did not believe that individual cancer cells could be identified. Of course they did not have the benefit of decades of observation and research. At the time gross anatomy had yet to acknowledge cell biology. Delays in recognition have not been uncommon in medical developments. Perhaps this was a combination of poor medical leadership, the inflexibility of established medicine, or bias against those born in other nations.

Fortunately he had the support of his department, his school, and eventually others. Finally Dr. Papanicolaou had to make an end run around journals by publishing a monograph with the assistance of foundations, his own publications, and the American Cancer Society http://www.cof.org/whatis/grants/pap/pap.htm Invasive cervical cancer has became a thing of the past in the United States. This is unfortunately not true for other nations http://www.harvard-magazine.com/on-line/070283.html Dr. Pap was barely able to see the results of his work before he died in 1962. His contributions to pathology and cytology will likely never be matched.

1883 – born in Greece

1904 – MD from University of Athens

1910 – PhD in Munich

1913 – arrived in US

1914 – began research at Cornell

1920 – began studies on human vaginal cells

1928 – presented research findings on cervical cancer cells,

became US citizen, became Assistant Professor

1941 – first clinical trials

1943 – Publish Monograph: “Diagnosis of Uterine Cancer by the Vaginal

Smear” with Herbert Traut, M.D. .

1956 – published landmark Atlas of Exfoliative Cytology

1960 – American Cancer Society lobbies for acceptance of pap smear

1962 – died

Discovery plus passion plus dedication "The first observation of cancer cells in a smear of the uterine cervix was one of the most thrilling experiences of my scientific career."

From http://www.whonamedit.com/doctor.cfm/2402.html :

Much of his work was done in collaboration with the biochemist Charles Rupert Stockard (1879-1939) and E. Shorr. His studies on human beings, from 1939, was done to a large degree in collaboration with the gynaecologist Herbert Frederick Traut (born 1894).

Bibliography:

· G. N. Papanicolaou and C. R. Stockard:
The Existence of a Typical Oestrous Cycle in the Guinea Pig; with a Study of its histological and Physiological Changes.
American Journal of Anatomy, 1917, 22: 225-283.
The vaginal smear test for oestrus. It demonstrates the histological changes occurring in the vagina during the menstrual cycle.

· G. N. Papanicolaou:
New Cancer Diagnosis.
Proceedings of the Third Race Betterment Conference, January 2-6. 1928. 1928: 528-534.

· G. N. Papanicolaou and Herbert Traut:
The diagnostic value of vaginal smears in carcinoma of the uterus.
American Journal of Obstetrics and Gynecology, St. Louis, 1941, 42: 193-206.
Smear diagnosis of carcinoma of the cervix. Papanicolaou first reported in 1928 that he could recognise cancer cells but the importance of his findings was not generally accepted and he abandoned the work for some years.

· G. N. Papanicolaou and Herbert Traut:
Diagnosis of Uterine Cancer by the Vaginal Smear. New York, 1943.

· G. N. Papanicolaou:
Atlas of Exfoliative Cytology. Cambridge, Massachusetts, 1954.

· G. N. Papanicolaou:
Dedication of the Papanicolaou Cancer Research Institute.
Journal of the American Medical Association, 1962, 182: 556-559.

· H. Speert:
Obstetric and Gynecologic Milestones. New York, 1958, p 286.

· D. E. Carmichael:
The Pap Smear: Life of George N. Papanicolaou. Springfield, Illinois, 1973.

From http://www.papsociety.org/drpap.html Papanicolaou was born in 1883 in Kyme, Greece. He attended school in Greece and at the age of 21 obtained the Doctor of Medicine degree from the University of Athens. In an effort to further his studies, he went to Germany to study the philosophy of biologic sciences. After a brief period of studying with August Weisman, Papanicolaou went to Munich. There he earned his PhD degree in Zoolgy. He then returned to Greece where he met Andromachque Mavroyeni, later known as Mary Papanicolaou or Mrs. Pap. She became his lifelong companion and a great source of support for him.

Dr. and Mrs. Papanicolaou then went to France where Dr. Pap worked as a physiologist. From there, just before the outbreak of the Balkan War, the couple returned to Greece. While serving in the Greek Army, Dr. Pap met United States volunteers who told him of the opportunities in the United States. Dr. Papanicolaou obtained a position as assistant in the Department of Anatomy at New York's Cornell Medical School in 1913. His wife, Mary, also worked there as his technician.Dr. Papanicolaou worked at Cornell from 1913 until a few months before his death.

The work at Cornell was rich in discovery. It was at Cornell where Dr. Papanicolaou worked examining vaginal smears of guinea pigs to determine the existence of a menstrual cycle. Using a small ear speculum, Dr. Papanicolaou observed the changes in the female genital tract of a guinea pig and added much to the basic understanding of endocrinology of reproductive organs. Eventually, Dr. Papanicolaou became interested in the menstrual cycle of women. In 1933 he published a monograph "The Sexual Cycle of the Human Female as Revealed by the Vaginal Smear". It was doing this work that he noticed cancer cells coming form the cervix.

It is well known that the acceptance of Dr. Papanicolaou's initial understanding of the significance of these cells as a diagnostic modality was not readily made. In 1939, the reevaluation of the vaginal smear for cancer detection began. At the New York Hospital all women patients were required to take a routine vaginal smear. Dr. Herbert Traut from the department of Obstetrics and Gynecology at Cornell, collaborated with Dr. Papanicolaou to validate the diagnostic potential of the vaginal smear. In 1943, they published their findings and conclusions in the famous monograph, "Diagnosis of Uterine Cancer by the Vaginal Smear." This diagnostic procedure was named the Pap test. In 1954, Dr. Papanicolaou's comprehensive scientific treatise was published. It was entitled, "Atlas of Exfoliative Cytology," which contained a compendium of cytological findings in health and disease involving multiple organ systems of the human body.

Dr. Papanicolaou authored over 150 publications, and throughout his life received many honors and awards. Dr. Papanicolaou died on February 18, 1962 of heart failure and pulmonary edema and is buried in New Jersey. Millions of women have received the Pap test and deaths from cancer of uterus has been greatly reduced because of the test. It was predominantly through Dr. Papnicolaou’s efforts that cytology became accepted as a basis for diagnosis. We as a Society are honored to carry Dr. Papanicolaou’s name.

Some information taken from Rhonda Karp, Editor, The ASC Cytoechnologists's Bulletin, Volume XIX, Number 1, 1982.

Are we repeating the delays of newer techniques still?????

Medicine by Model

Sue Goldie uses new tools to combat cervical cancer in the developing world.

by Nell Lake

Full story at http://www.harvard-magazine.com/on-line/070283.html

It's a troubling area, the economics of saving lives. Take cervical cancer, for example. In the United States we have spent enormous sums for the prevention and treatment of the disease and have even—unlike the case with most cancers—learned what causes it: the sexually transmitted human papillomavirus, or HPV. In the last 40 years, the incidence of the disease has declined by 80 percent in this country, due largely to aggressive screening for its precursors. Cervical cancer is now one of the less-fatal cancers for American women.

Deploying computer models rather than clinical trials, Goldie identifies life- and cost-saving strategies to detect cancer.

It's a different story in the developing world. In a stark example of international healthcare disparities, cervical cancer is the third most common cancer worldwide, and the leading cause of cancer death among women in some poor countries. Each year, 466,000 new cases develop—80 to 90 percent of them in developing countries, with rates highest in sub-Saharan Africa and Central America. Nearly 200,000 women in developing countries die from the disease annually.

Goldie builds mathematical models to study the patterns of infectious diseases and discover effective approaches to preventing and curing them.

Goldie tested five potential screening and treatment strategies, ranging from a simple, once-in-a-lifetime visual screening to more frequent laboratory Pap screens. The data are real, but the testing is "virtual": it happens not on people but on numbers in a computer, which uses algorithms to determine outcomes for each strategy, applying the gathered data.

The recommended U.S. strategy—annual Pap smears with subsequent visits, when necessary, for further diagnosis and treatment—carries an average lifetime cost of $2,520 per woman.

Compared with strategies that Goldie tested using South African data, the traditional U.S. method ranks low in simple cost-effectiveness terms. One South African strategy carried an estimated average lifetime cost of $41 per woman, and reduced the incidence of cervical cancer in the population by one-third. That strategy uses automated DNA screening to test women just once in their lifetimes for the carcinogenic HPV virus. During the same single visit, women with suspected precancerous lesions receive cryosurgery—the freezing of abnormal tissue with liquid nitrous oxide or carbon dioxide. Another strategy carried an estimated average lifetime cost of just $39 and reduced cervical cancer by one-quarter. The simple procedure is again performed only once in a woman's lifetime: a nurse or midwife applies vinegar to the cervix and examines it with her naked eye. Certain whitening of the tissue indicates precancerous cells. As with DNA testing, the strategy requires following the screening with immediate cryosurgery when necessary.

Still, as every HMO patient knows, greater cost-effectiveness does not necessarily mean better care. The U.S. method, though less cost-effective, saves more lives; African cervical cancer rates would not fall to the levels found in the United States even with the dramatic improvements Goldie's proposed strategies seem to offer. After she released her South African findings, some who work with the disadvantaged in developing countries criticized the project as advocating lesser care for poor women. Others, mostly researchers, urged further study, wanting clinical, "real-world" proof, beyond modeling, that the alternative screening methods work. "But doing nothing is a strategy also," Goldie says. "It has consequences. Arguing for another year to consider the issue means another 25,000 lives lost. It's unforgivable."

So was a 25 year delay in implementation of the pap smear - RCB

More at http://www.harvard-magazine.com/on-line/070283.html

Delays in recognition have not been uncommon in medical developments