The woman behind the pap smear

Many women dread their regular appointments for Pap smears to screen for cervical cancer.  Over a hundred years ago a woman subjected herself to daily pap smears for over 21 years as part of the effort to develop the test that is now the gold standard to predict cervical cancer.  The woman was Andromache “Mary” Papanicolaou, the wife of George Papanicolaou who together developed the Papanicolaou or Pap test; however, her contributions are largely overlooked.

Following the Balkan War in 1912, George, a trained physician and scientist, and his wife moved to America from Greece with just $250.  Neither spoke English fluently; however, they had dreams of a new life.  World War I eliminated any hopes of returning to Greece, but luckily George met Dr. Charles Stockard, Chairman of the Department of Anatomy at Cornell Medical College.  He offered George a position at Cornell in 1914, and Mary soon joined him as a volunteer technical assistant.

The team of Dr. Stockard, George, and Mary produced publications that led to the founding of the discipline of diagnostic cytopathology and what we now call the Pap smear.  Part of George’s research required him to figure out when animal subjects were ovulating.  He collected daily samples from the animals and examined vaginal fluids and cells from the surface of the cervix.  George found a pattern in the size and shape of the cells that correlated with ovulation.

George wondered if the same was true in humans; however, he could not get samples because he was not a licensed physician in New York.  This is where Mary’s heroic 21-year odyssey of providing daily vaginal samples which she processed, stained, and organized began.  George studied and tracked cellular changes throughout her life from childbearing age into menopause.  Mary recruited other women to expand the study and create a baseline of vaginal samples throughout a woman’s life.

A woman in the study developed cervical cancer, and George identified pre-cancerous cells in her sample that preceded the cancer.  George presented his new diagnostic technique in 1928; however, few gynecologists and pathologists took note. A collaboration with Dr. Herbert Traut and the Papanicolaous produced numerous publications.  Finally, in 1943, one of their publications defined the field of gynecological cytopathology and diagnosis of cervical cancers using the Papanicolaou test.

The “Pap smear” of today is not much different than what Mary did every day though the processing is now automated.  Thanks to the Pap smear, mortality from cervical cancer has dropped dramatically.  George received recognition for his work, including 18 nominations for the Nobel Prize in Physiology or Medicine.  Mary worked at Cornell for over 40 years and she never got paid for her work nor recognized for her contributions.  In 1969, several years after George’s death, Mary was awarded a special citation by the American Cancer Society, and later the Imperial Order of Saint Helen award.  She continued supporting cancer research until she died at 92.  The full extent of her contributions and work have not been fully appreciated to this day.

REFERENCE:  Galveston County The Daily News; 05 JAN 2023; Norbert Herzog and David Niesel