Behind the Pap Smear: A Greek Woman Named Papanicolaou, Swabbed Daily for 20 Years, The Original Source For The Crucial Cervical Cancer Test

The woman who played a vital role in the invention of the Pap smear for cervical cancer, Andromache (Mary) Papanicolaou, is getting some of her long desired due in honor of Women’s History Month. Her husband, Dr. George Papanicolaou, invented the Pap smear, which is a test used to detect cervical cancer or changes in cervical cells that suggest a woman is at risk of developing cervical cancer. However, Mary was the original experimental subject for his pap smear test. According to news outlet BBC, she took a smear test “every day for 20 years to provide him with more evidence” of its effectiveness.

Cervical cancer begins in the cells lining the cervix, the lower part of the womb (uterus).

By the late 1920s, cancer was on the rise, claiming around 40,000 women’s lives a year. Then, Dr. George Papanicolaou, with his wife Mary, developed a test that would change everything.#CancerDetectivesPBS premieres Tue Mar 26 at 9/8c on @PBS → https://t.co/txjzA0Wur3 pic.twitter.com/wJmHK9RXhr

Read More

— American Experience (@AmExperiencePBS) March 7, 2024

“Her decades of dedicated swabbing and sampling that she and her pathologist husband George developed the cervical cancer screening method we know today as the Papanicolaou or Pap test,” ABC News reported.

Dr. Papanicolaou began sampling vaginal fluid in guinea pigs to detect cervical cancer or changes in cervical cancer cells before moving on to humans, more specifically, his wife, Mary.

She “processed and stained her own (vaginal fluid) samples in the lab to enhance parts of the cells,” allowing Dr. Papanicolaou to monitor her cells from her reproductive years through menopause.

Over the years, Mary was able to convince some of her friends to donate their vaginal fluid to be monitored for signs of cervical cancer. One of her friends developed cervical cancer, allowing Dr. Papanicolaou to observe cancerous and non-cancerous cells under a microscope, thus allowing better detection. He noted his findings in his book “Diagnosis of Uterine Cancer by the Vaginal Smear” where it described “physiological changes of the menstrual cycle and the influence of hormones and malignancy on vaginal cytology” research on the discovery of the pap smear said in the Singapore Medical Journal.

Although Dr. Papanicolaou’s method of detecting cervical cancer was not widely accepted at first by the scientific community, it eventually became the “gold standard in screening for cervical cancer.”

 

View this post on Instagram

 

A post shared by HPV Cancers Alliance (@hpvcancersalliance)

Mary died in 1982, but her legacy lives on. The HPV Cancer Alliance dedicated a social media post to her contributions to women’s health.

“With Mary’s willingness to have her cervix samples daily (for years!), she laid the foundation for the invention of the Pap test and, ultimately, for the HPV test and HPV vaccine,” the HPV Cancer Alliance said.

Pap Smear Detection

A Pap smear involves collecting cells from the cervix and examining them. The test can detect cervical cancer, as well as changes in cells that may increase a woman’s risk of developing cervical cancer in the future.

In recent years, the World Health Organization (WHO) recommended the human papillomavirus (HPV) DNA-based test as the preferred screening method for cervical cancer over the Pap smear. However, its availability varies globally.

HPV is a group of more than 200 related viruses, some of which are spread through vaginal, anal, or oral sex, according to the National Cancer Institute. It can cause a handful of cancers, including cervical and throat cancers.

While Pap smears are still effective at detecting cervical cancer, the primary HPV test is more sensitive. The HPV test looks for DNA or RNA from certain high-risk strains of HPV — those that cause cancer — in samples taken from the cervix.

The U.S. Preventive Services Task Force (USPSTF) recommends “screening for cervical cancer in women 21 to 65 years of age with cytology (Papanicolaou [Pap] smear) every three years or, for women 30 to 65 years of age who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every five years.

Helping You Better Understand Cervical Cancer

Cervical cancer forms in the cells of the cervix, the lower, narrow end of the uterus (womb), which connects the uterus to the vagina, according to the National Cancer Institute (NCI).

“Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which abnormal cells begin to appear in the cervical tissue,” the NCI explains.

“Over time, if not destroyed or removed, the abnormal cells may become cancer cells and start to grow and spread more deeply into the cervix and surrounding areas.”

While symptoms tend to be difficult to detect during cervical cancer’s early stages, some signs can still indicate something is amiss and needs a closer look.

The NCI explains that symptoms of early-stage cervical cancer may include:

• vaginal bleeding after sex
• vaginal bleeding after menopause
• vaginal bleeding between periods or periods that are heavier or longer than normal
• vaginal discharge that is watery and has a strong odor or that contains blood
• pelvic pain or pain during sex

A Common Cause

Cervical cancer starts in the cervix, and more than 70% of cases are caused by the human papillomavirus (HPV). More than 90% of HPV-related cancers, including cervical cancer, are preventable in people who get the HPV vaccine that is recommended for all preteens (both girls and boys) 11 to 12 years old in two doses administered between six and 12 months apart. The shots can also be started as early as nine years old.

“The key with the vaccine is that you received the vaccine before you ever reach sexual debut or have sexual encounters. So that’s why these vaccines are approved for young children ages 9, 10, 11 years old, up to 26,” Dr. Jessica Geiger, a medical oncologist at Cleveland Clinic Cancer, told SurvivorNet.

The American Cancer Society recommends cervical cancer screenings begin at age 25, and HPV screening is recommended every five years after that.

Understanding HPV

The human papillomavirus (HPV) is “a group of more than 200 related viruses, some of which are spread through vaginal, anal or oral sex,” the National Cancer Institute says.

HPV infection is linked to multiple cancers, and the majority of sexually active people will get the disease at some point in their lives.

Although nearly all cases of cervical cancer are indeed caused by HPV, people should also be aware that HPV puts both men and women at risk of developing several other cancers, such as oral cancer and cancers of the vagina, penis, anus, and throat.

Overall, HPV is believed to be the cause of 90% of anal and cervical cancers, approximately 70% of vaginal and vulvar cancers, and 60% of penile cancers.

“There are no screening guidelines for throat cancer, unlike cervical cancer with pap smears,” says Dr. Jessica Geiger, a medical oncologist at Cleveland Clinic Cancer Center who previously told SurvivorNet. There are no standard tests to determine if you harbor the virus.”

On the plus side, HPV-related throat cancers are generally very responsive to a combination of radiation and chemotherapy treatments, according to Dr. Geiger.

“The cure rates for people who have HPV-related disease are a lot higher than those who have tobacco-related throat cancer,” she said.

WATCH: HPV’s link to cancer.

Protecting Against HPV

Nearly 80 million Americans have HPV today, according to the Centers for Disease Control and Prevention. It impacts men and women and won’t cause problems for most people.

However, in a small percentage of cases, it can lead to cancer.

The HPV vaccine is recommended to protect against HPV and, therefore, HPV-related cancers.

Gardasil 9 is an HPV vaccine that offers protection against “nine HPV types: the two low-risk HPV types that cause most genital warts, plus seven high-risk HPV types that cause most HPV-related cancer,” according to the National Cancer Institute.

The vaccine creates an immune response to HPV 16, the primary cause of 92% of head and neck cancers. Once children are vaccinated, they cannot be infected with that strain. For parents, the HPV vaccine enables them to protect their children from developing cancer in the future.

“The key with the vaccine is that you receive it before you have sexual encounters,” says Dr. Geiger. “So that’s why these vaccines are approved for young children … ages 9, 10, 11 years old, up to age 26.”

According to the CDC, the HPV vaccine is recommended for all male and female preteens 11 to 12 years old, and it is given in two doses between six and 12 months.

The series of shots can also start as young as nine.

The CDC also notes that teens and young adults through age 26 who didn’t start or finish the HPV vaccine series also need the vaccine.

Additionally, people with weakened immune systems or teens and young adults between 15 and 26 who started the series should get three doses instead of two.

Although adults up to 45 can still receive the vaccine, it’s not recommended for everyone older than 26. Still, a person older than 26 could choose to get vaccinated after talking to their doctor about possible benefits, even despite it being less effective in this age range, as more people have already been exposed to HPV by this point.

WATCH: Should children get the HPV Vaccine?

Vaccine hesitancy can impede people from getting the vaccine. The concern may come from parents who may feel the vaccine paves the way for early sexual activity. For this reason, some health practitioners educate the public differently about the vaccine.

“I think rebranding the vaccine as a cancer vaccine, rather than an STD vaccine, is critically important,” says Dr. Ted Teknos, a head and neck cancer surgeon and scientific director of University Hospital’s Seidman Cancer Center.

Dr. Teknos believes concerted efforts to “change the mindset around the vaccine” can make a difference.

Learn more about SurvivorNet's rigorous medical review process.

---