Today, women throughout the United States receive regular Pap smears as part of a screening for cervical cancer. This test practice is directly linked with the incidence of cervical cancers in the United States falling by at least 70 percent in the United States from the 1920s to the 2000s.
The Pap smear is named after Georgios Papanicolaou, a Greek-American pathologist who was the first to discover how to identify cancerous cells in the evidence gathered from a woman’s vagina during a routine test swab. His research was first published in 1928 and represented an important advance in women’s health, write Siang Yong Tan and Yvonne Tatsumura for the Singapore Medical Journal. “With this discovery he essentially founded the modern field of cytopathology,” or the practice of diagnosing diseases by examining body cells, writes Ellen Elliott for The Jackson Laboratory. But although Papanicolaou’s test bears his name, its practical utility in the screening and prevention of cervical cancer owes a lot to pathologist Elizabeth Stern.
Stern, who was born on this day in 1915, built on Papanicolaou’s work and took the study of cell pathology in whole new directions. She was born in Canada and earned her first medical degree at the University of Toronto before moving on to further study in the United States, writes Encyclopedia Britannica, becoming “one of the first specialists in cytopathology.” Then, as a professor of epidemiology at the UCLA School of Public Health, she turned her eyes to cervical cancer.
In the intervening years, writes medical historian Ilana Löwy, the Pap smear had been “rapidly adopted by gynecologists.” Cervical cancer was a major killer of women, and could in many cases be prevented when the presence of abnormal cervical cells was detected. However, gynecologists working in the 1940s and 1950s had no good way to tell when abnormal cells had become cancerous.
This state of affairs meant that many gynecologists promoted “radical treatment” such as radium therapy or hysterectomies to any women found to have abnormal cervical cells. “They assumed that even if some of these [abnormal cells] ... would never produce invasive cancers in the woman’s lifetimes, it was safer to view them as true malignancies and treat them accordingly,” Löwy writes. While it was true that these preventive measures did reduce the rate of cervical cancer, it also meant that numerous women were subjected to medically unnecessary surgeries and treatments. In one 1940s study, two of eight women who underwent hysterectomies to prevent cervical cancer died from the operation, and six of 66 women who underwent radiation therapy suffered "severe side effects...one remained permanently incapacitated," she writes.
Stern’s first research into cervical cancer was focused on figuring out how to tell what kinds of abnormal cells were likely to cause cancer, so that women could be saved from unecessary and possibly dangerous interventions. “Stern’s aim was to define how cervical cells change during cancer progression,” writes Elliott. With this work, she was able to give gynecologists more tools for monitoring potential cervical cancer cases using the Pap test. Stern was also the first to establish links between older forms of oral birth control and cervical cancer and HPV and cervical cancer.
But Stern also worked to standardize access to cervical cancer tests, by researching how women accessed clinics and advocating for women’s clinics even in low-income areas. “Because of her findings, doctors perform routine Pap smear tests and can identify cervical cancer at earlier stages,” writes Elliott. “She was also determined that these health care improvements would be available to everyone.”