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George N. Papanicolaou, MD, PhD
Cytopathology

Paul A. Elgert CT(ASCP), CMIAC, Gary W. Gill CT(ASCP)
DOI: http://dx.doi.org/10.1309/LMRRG5P22JMRRLCT 245-246 First published online: 1 April 2009
Figure1

George N. Papanicolaou (1883–1962) The Pap Test

George Nicholas Papanicolaou was born in the seaport town of Kymi, on the eastern slopes of the Greek island of Euboea, on May 13, 1883. George was the third of four children to Maria and Nicholas Papanicolaou.

In 1898, he entered the University of Athens and pursued the study of medicine to please his father, a physician and a politician as well. Dr. Nicholas Papanicolaou was a general practitioner, one-time Greek senator, and mayor of Kymi. George graduated from medical school in 1904.

On October 3, 1904, Dr. George Papanicolaou was called to military service in the third regiment of infantry. In January 1906, he was promoted to assistant surgeon and remained in the military until his obligation was over on August 15, 1906. After his military service, Dr. Papanicolaou returned to Kymi and reluctantly practiced medicine with his father. He was not interested in medicine, but yearned for a career of scientific research.

In the spring of 1907, Dr. Papanicolaou left for Jena, Germany, to begin his postgraduate studies under Professor Ernst Haeckel, one of Europe’s greatest early proponents of Darwinism. However, after one semester, he moved to Freiburg under the tutelage of August Weismann, a brilliant early geneticist. Again, after one semester of further disappointing mental stimulation, he moved to Munich to work at the Zoological Institute. This was considered to be the greatest zoological research center in the world at the time. Dr. Papanicolaou earned his PhD in Zoology in 1910.

While returning home from Athens, he unexpectedly traveled in the company of the Mavroyeni family who spent their summer vacations in Kymi. During this trip, he was reacquainted with their daughter, Mary. They soon married on September 25, 1910.

Dr. Papanicolaou was employed briefly at the Museum of Monaco as “preparateur” from January 1 to July 19, 1911, the day he sailed with Prince Albert I of Monaco on the oceanographic vessel, L’Hirondelle II. During this voyage, Dr. Papanicolaou, employed as a “physiologist,” examined and classified marine specimens. The voyage ended in September 1911.

Dr. Papanicolaou was again called into military service on October 15, 1912, as the Balkan War began. He was promoted to Lieutenant, Medical during this time. Dr. Papanicolaou and his wife Mary arrived in New York on October 19, 1913. Unable to find work, he obtained a job as a rug salesman for Gimble’s department store. He quit this job on his second day, too embarrassed to show some rugs to a woman he had met during his first-class passage with Mary to the United States.

Dr. Papanicolaou was able to find a part-time position as assistant in the Department of Pathology and Bacteriology of the New York Hospital, then on 16th Street. Dr. Papanicolaou came to Cornell Medical School in September 1914 and began work as assistant in the Department of Anatomy. Mrs. Papanicolaou was also given a job in the department as her husband’s technician. In March 1915, he published his first American work in science, entitled “Sex Determination and Sex Control in Guinea Pigs.” In continuing his work on sex determination, he asked to use some animals in order to test the theory of sex determination by X and Y chromosomes in spermatozoa and ova.

The experiments required obtaining the ova of the female guinea pigs at a precise stage of development near ovulation. As the work progressed, the existing notions of the period of ovulation in the guinea pig were of no practical value or were incorrect. He was determined to make a minute examination of the vaginal contents of a number of virginal females every day to ascertain whether the guinea pig had oestrous changes or flow that may not have been noticed on casual observation. Using a small nasal speculum to introduce into the vagina of each guinea pig, he made daily observations of the vaginal discharge. Later, he decided to take vaginal smears so that microscopic changes could be assessed. He discovered that the oestrous cycle occurred for 24 hours every 15 or 16 days. The next task was to correlate the smear pattern with changes in the ovary and uterus. When this was accomplished, it was possible to obtain the mature ova required for his research at precisely the right time. The results were first described in Science in July 1917 followed in September with a more detailed report in the American Journal of Anatomy, “The Existence of a Typical Oestrous Cycle in the Guinea-Pig with a Study of its Histological and Physiological Changes.” It appeared under the authorship of Stockard and Papanicolaou, giving credit for his work to his chairman (it was required that the chairman’s name appear first in each paper). This upset Dr. Papanicolaou considerably and Dr. Stockard appreciated his concern and assured him that his name would never again have to be attached to Dr. Papanicolaou’s work.

Dr. Papanicolaou began using vaginal cytology of the human in 1920, using a “special case” that he continued to study for the next 21 years. This special case was later known to be that of his wife. Just how early he began his work with the vaginal smear in cancer detection had not been clearly defined. His recognition of abnormal cells was purely by accident. Dr. Koss, in a speech before the Royal College of Surgeons, stated “It is not known who was his consultant in the identification of the abnormal cells as cancer cells, but it is likely that it was James Ewing, Chairman of Pathology at Cornell.

Papanicolaou’s greatest weakness was his lack of any background in tissue pathology and therefore he relied on pathologists for the accuracy of his diagnoses.” Dr. Papanicolaou presented his findings at the Third Race Betterment Conference in Battle Creek, MI, in January 1928. This report received little scientific notice at the time. When Dr. Joseph Hinsey became chairman of the department in 1939, he encouraged Dr. Papanicolaou to discontinue his endocrine research (for which he was well known) and continue his work on the cytological method for cancer detection. Dr. Papanicolaou was teamed with Dr. Herbert Traut from the Department of Obstetrics and Gynecology, a collaboration that resulted in the March 11, 1941, paper “The Diagnostic Value of Vaginal Smears in Carcinoma of the Uterus” and, in 1943, “Diagnoses of Uterine Cancer by the Vaginal Smear.” Dr. Papanicolaou discouraged widespread use of the method, realizing that this method may fall into disrepute before adequate training of people to read the smears was available. It was Dr. Charles Cameron from the newly formed American Cancer Society who encouraged the First National Cytology Conference in Boston in 1948. From 1947, as Professor of Anatomy, Dr. Papanicolaou continued his research, perfected the cytological method, and trained others in the cytological method in courses that ranged from a few weeks to a few months to as long as 6 months. He was assisted by his faithful and loyal technologist, Charlotte Street, BS, considered to be the first professional cytotechnologist (Mrs. Papanicolaou was unpaid). In 1954, Dr. Papanicolaou published the Atlas of Exfoliative Cytology.

Dr. Papanicolaou was honored with Professor Emeritus of Anatomy in 1957. From 1961 until his death, he was the director of the newly created Papanicolaou Research Institute, a lifelong dream of his. Dr. Papanicolaou and Dr. Naylor briefly discussed the work of Dr. Aurel Babeş on Friday, February 16, 1962. Apparently, Dr. Papanicolaou was unaware of the independent work of Dr. Aurel Babeş of Hungary that was published in a French journal in April 1928, when he presented his paper in Battle Creek, MI, four months earlier and in subsequent publications. This was rumored to be a significant issue with the Nobel Committee that prevented Dr. Papanicolaou from receiving the Nobel Prize in Medicine. Dr. Naylor was to show him the reference that next Monday. However, Dr. Papanicolaou died of coronary obstruction on the morning of February 19, 1962, after having published 158 articles and books on endocrinology and cytology.

Dr. Papanicolaou’s legacy is the Pap test or Pap smear. This screening test for the early detection of cancer or lesions that may progress into cancer has reduced the death from this widespread and devastating disease over 70% in the United States since it was introduced in the late 1940s. It is the most successful cancer screening test yet developed in the entire history of medicine. Of the approximately 4,000 women who will die from cervical cancer in 2009, approximately half of the cervical cancers diagnosed in the United States are in women who have never been screened, and an additional 10% of cancers occur in women who have not been screened within the past five years.

New technologies aimed at improving sampling and preservation of the cells of the cervix and computer technologies to aid or replace professional microscopic screening with molecular testing and vaccination against human papillomavirus can only hope to improve on this already successful testing method, but only for the women who go regularly to their health care provider to be tested. This emphasizes the need for regular Pap testing.

National Cytotechnology Day is celebrated annually on May 13, Dr. Papanicolaou’s birthday.

Acknowledgments

Grateful acknowledgment to Dr. Leopold G. Koss, Chairman Emeritus and Professor Emeritus, Montefiore Medical Center, Department of Pathology, and The Albert Einstein College of Medicine, Bronx, New York, for lending his personal copy of this hard to find biography, as well as for sharing his personal remembrances of Dr. Papanicolaou.

References

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