Do you know which test is named after Georgios Papanikolaou?
The Pap smear, or Pap test, has commonly been used to screen for cervical cancer. This month we investigate the history of the test, which can be dated back to the 1940s, and speak to Professor Annabelle Farnsworth, professor of pathology, anatomical pathologist and specialist gynaecological histopathologist and cytopathologist, to discover where we are now.
Taking his name, Georgios Papanikolaou, the Pap smear is a procedure which tests for the presence of precancerous or cancerous cells in the cervix. It was in 1916 when Papanikolaou made his first steps in this area, when he discovered that the reproductive cycles of animals could be timed by examining smears of their vaginal secretions. This initial research, carried out on guinea pigs, was/went on to be published in the American Journal of Anatomy in 1917.
From 1920, Papanikolaou turned his attention to humans and he began taking similar scrapings from women. He soon began to notice that he could distinguish differences between the cytology of normal and malignant cells, although his presentation on the topic in 1928 was met with scepticism.
Undeterred, Papanikolaou continued with his work and in 1939 collaborated on a clinical study with gynaecologic pathologist Herbert F Traut, MD. Their aim was to determine the diagnostic potential of a vaginal smear and involved taking smears from various women, which Papanikolaou interpreted. Many asymptomatic cancer cases were discovered, therefore proving that normal and abnormal smears taken from the vagina and cervix could be viewed under the microscope and be correctly classified.
The vaginal smear went on to be called the Pap smear, after Papanikolaou, and quickly became the standard for cervical screening from the early 1940s. Due to its simplicity and low cost, the Pap smear was used widely and therefore resulted in a significant decline in the incidence of cervical cancer thanks to its ability to detect malignancies early.
In Australia, as of 1st December 2017, the Pap smear test was replaced with a new Cervical Screening Test. Whilst the Pap smear test looked for abnormal cells in the cervix, the Cervical Screening Test looks for human papilloma virus (HPV) infection. The new test for HPV can identify women who could be at risk of cervical cancer earlier than the Pap test.
Commenting on the success of the screening programme, Professor Annabelle Farnsworth said,
“We are continuing to make huge steps in our efforts against cervical cancer, not just in terms of screening but in our understanding of HPV. Australia has one of the best screening programs in the world and it has saved countless lives since its introduction. What made the programme so successful is the quality of our cytology, which has a great emphasis on quality control.
“It is predicted that with the current screening programme and the vaccination programme, we will be able to eliminate cervical cancer by 2035. We will probably be one of the first countries in the world to do that.”
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This article appeared in the November 2019 Edition of ePathWay which is an online magazine produced by the Royal College of Pathologists of Australasia (http://www.rcpa.edu.au/Library/Publications/ePathway).
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