Biography of George Papanicolaou: Pioneer of the Pap Smear

Singapore Med J 2015 5610 586587 doi 1011622smedj2015155 Medicine in Stamps 586 1Emeritus Professor of Medicine University of Hawaii 2Research carried out during 1st year residency Transitional Residency Program University of Hawaii Honolulu USA Correspondence Prof Tan Siang Yong 2226 Liliha Street Suite B104 Honolulu HI 96817 USA sianghawaiiedu G eorge Nicholas Papanicolaou was a pioneer in elucidating the physiology and cytologic characteristics of the female reproductive system He is best known for creating the Papanicolaou test commonly known as the Pap smear which revolutionised the early detection of cervical cancer EARLY CAREER Born on May 13 1883 in the town of Kimi on the island of Euboea Greece Papanicolaou was one of four children He attended the University of Athens majoring not in biology but music and the humanities However his physician father influenced his eventual decision to pursue a career in medicine In 1904 he graduated from medical school with top honours After graduation Papanicolaou worked in the military as an assistant surgeon for a short time then returned to his hometown Kimi For the next two years he cared for leprosy patients on the outskirts of his hometown These outcasts were socially isolated and Papanicolaou gave them both medical and personal care with compassion and grace However his desire to work in science soon took hold and he travelled to the University of Munich in Germany receiving a PhD in zoology in 1910 At this leading research institution he worked with Professor Ernst Haeckel one of the first great supporters of Darwinism FROM GREECE TO AMERICA Shortly thereafter Papanicolaou married Andromache Mavroyeni Mary who was from a famous military family The young couple returned to Greece following the death of his mother When the First Balkan War broke out in 1912 Papanicolaou returned to military service as a lieutenant in Greeces medical corps However he became interested in career opportunities in the United States US and decided to emigrate arriving in New York on October 19 1913 This was a bold and momentous choice given that neither husband nor wife spoke English and the couple had in cash only slightly more than USD 25000 the amount required to enter the US Arriving with little money and no arrangements for employment both Papanicolaou and his wife were forced to take any job that they could get Mary worked at a department store as a seamstress and Papanicolaou was a rug salesman at the same store but he lasted only one day He subsequently took other jobs violin player in a restaurant and clerk at a Greek newspaper In 1914 he finally obtained a position at New York Universitys Pathology Department and Cornell University Medical Colleges Anatomy Department where his wife joined him as a technician PAP TEST While Papanicolaous research would eventually be on human physiology he began his studies with guinea pigs In 1916 while studying sex chromosomes he deduced that reproductive cycles in the experimental animals could be timed by examining smears of their vaginal secretions From 1920 he began to focus on the cytopathology of the human reproductive system He was thrilled when he was able to discern differences between the cytology of normal and malignant cervical cells upon a simple viewing of swabs smeared on microscopic slides Although his initial publication of the finding in 1928 went largely unnoticed that year was filled with other happy events for Papanicolaou He became a US citizen and received a promotion to Assistant Professor at Cornell As part of his research at the New York Hospital he collaborated with Dr Herbert Traut a gynaecological pathologist eventually publishing their landmark book in 1943 Diagnosis of Uterine Cancer by the Vaginal Smear It described physiological changes of the menstrual cycle and the influence of hormones and malignancy on vaginal cytology Importantly it showed that normal and abnormal smears taken from the vagina and cervix could be viewed under the microscope and be correctly classified The simple procedure now famously known as the Pap smear or test quickly became the gold standard in screening for cervical cancer As it cost little was easy to perform and could be interpreted accurately the Pap smear found widespread use and resulted in a significant decline in the incidence of cervical cancer Papanicolaou was not the first to show that cancerous cells could be identified under the microscope That honour goes to British physician Walter Hayle Walshe who referred to this phenomenon in a book on lung diseases one century before Nor was Papanicolaou the first to study cervical cytopathology in women In 1927 a Romanian physician by the name of Aurel Babeş used a platinum loop to collect cells from a womans cervix to detect the presence of cancer However medical history has sided with Papanicolaou as the originator of the Pap test as the two methods were viewed to be substantially different Still in George Papanicolaou 18831962 Discoverer of the Pap smear Siang Yong Tan1 MD JD Yvonne Tatsumura2 MA MD Medicine in Stamps 587 honour of Babeş Romania refers to the test as Methode Babeş Papanicolaou In 1951 Papanicolaou became Emeritus Professor at what was then Cornell University Medical College where two laboratories now bear his name Shortly thereafter in 1954 he published Atlas of Exfoliative Cytology a treatise containing comprehensive information on the cytology of both healthy and diseased tissue not just in the female reproductive system but also in other organ systems In total Papanicolaou authored four books and over one hundred articles He was the recipient of numerous awards including honorary degrees from universities in the US Italy and Greece The scientific world recognised him with the Borden Award of the Association of American Medical Colleges 1940 the Amory Prize from the American Academy of Arts and Sciences 1947 the prestigious Albert Lasker Award for Clinical Medical Research from the American Public Health Association 1950 and the Medal of Honor from the American Cancer Society 1952 Additionally he was conferred honorary membership in the Obstetrical and Gynecological Society of Athens and the New York Academy of Sciences His image was featured on the Greek 10000drachma currency note prior to its replacement by the euro and on various Greek stamps In 1978 the US Postal Service honoured him with a commemorative 13cent postage stamp PERSONAL LIFE Papanicolaou was a dedicated scientist as modest as he was hardworking He did not take vacations worked seven days a week and relished immersing himself in the wonders of his research His capable wife Mary managed both laboratory and household affairs even functioning as an experimental subject in some of his studies After nearly 50 years at Cornell Papanicolaou finally decided in 1961 to leave New York to develop and head the Cancer Institute of Miami Mary was both thrilled and relieved as she was increasingly concerned over his recent distracted behaviour and fascination with dream analysis and parapsychology Unfortunately Papanicolaou died within three months of his arrival in Miami suffering a fatal myocardial infarction on February 19 1962 He was 78 years old In his honour the Miami Cancer Institute was renamed the Papanicolaou Cancer Research Institute In a 1998 article an admiring author accurately summed up this great pioneers discovery His monumental contribution proved that cancer can be beaten the Papanicolaou screening test will remain one of the most powerful weapons against this disease Those of us who looked upon him as a guiding star will always owe him our gratitude and those women who were helped by his test owe him their lives BIBLIOGRAPHY Carmichael DE The Pap Smear Life of George N Papanicolaou Springfield IL Charles C Thomas Pub Ltd 1973 Papanicolaou Society of Cytopathology Dr George Nicholaus Papanicolaou online Available at httpwwwpapsocietyorggpbio html Accessed February 19 2008 Georgios Papanikolaou Available at httpsenwikipediaorgwiki GeorgiosPapanikolaou Accessed September 6 2015 George Nicholas Papanicolaou In Whonamedit A dictionary of medical eponyms online Available at httpwwwwhonameditcomdoctor cfm2402html Accessed February 19 2008 Michalas SP The Pap test George N Papanicolaou 18831962 A screening test for the prevention of cancer of uterine cervix Eur J Obstet Gynecol Reprod Biol 2000 901358 George Papanicolaou Biography 18831962 Available at httpwww faqsorghealthbios80GeorgePapanicolaouhtml Accessed February 24 2008 Papanicolaou GN Traut HF The diagnostic value of vaginal smears in carcinoma of the uterus 1941 Arch Pathol Lab Med 1997 12121124 Vilos GA The history of the Papanicolaou smear and the odyssey of George and Andromache Papanicolaou Obstet Gynecol 1998 9147983