Georgios Papanikolaou

Georgios Papanikolaou

1883-1962

The subject of this post is probably not known to you by name but the procedure he developed saves thousands of lives per year.  Adult women know it well by another name: the Pap Smear.  Dr. Papanikolaou discovered that he could identify cervical cancer cells in smear of cells collected from the vaginal wall.  Though his fellow researchers were skeptical at first, his procedure has become a standard cancer screen which has dramatically reduced the incidence and mortality of cervical and uterine cancer.

Kymi, Greece

Georgio Papanikolaou was born in Kymi on the small Greek island of Euboea, the second son of the town’s mayor.  As a young man, he was interested in philosophy and music.  He attended University of Athens where he obtained his medical degree in 1904.  His interest in medical research took him to the University of Munich where he received his Ph.D. in Biology in 1910.  He returned to Greece, he met his wife Mary, and served in the Greek Army during the Balkan War.  After the war, he and his wife emigrated to the United States where he obtained a position at Weill Medical School’s Department of Anatomy at New York’s Cornell University in 1913.  Dr. Papanikolaou’s initial studies of reproductive endocrinology in Guinea Pigs led him to studying the human female menstrual cycle.  He developed a procedure for collecting cellular debris from the vaginal wall, smearing them on a glass slide, and examining them under the microscope.  Much to his amazement, he discovered that he could identify cancer cells in the smear.  He later wrote, “The first observation of cancer cells in the smear of the uterine cervix gave me one of the greatest thrills I ever experienced during my scientific career." His report of this finding in 1929 was met with skepticism in the medical community and the potential as a screening tool was not realized. 

It wasn’t until ten years later that Dr. Papanikolaou and Dr. Herbert Traut set about rigorously testing the use of the vaginal smear as a cancer diagnostic by studying over 3000 women. They published their findings in “Diagnosis of Uterine Cancer by the Vaginal Smear” in 1943. “This work describes a new approach to the diagnosis of uterine cancer and is of essential interest because its use promises to be of signal value in the recognition of early uterine cancer, especially that of the cervix. The method is based upon the recognition of exfoliated abnormal cells characteristic of carcinoma which may be found in the study of the stained vaginal smear.”  They cautioned that the smear “is not recommended as a means of ultimate diagnosis, but rather as a preliminary or sorting procedure to be confirmed by biopsy and tissue diagnosis.” The Pap smear as a cancer screen  finally received its due.

It would be decades before the effectiveness of the Pap smear would be seen  because initially most women didn’t get one.  In 1961, only 31% of American women had ever had a Pap smear. The incidence of invasive cervical carcinoma was 32.6 per 100,000, similar to the rate in developing countries today.  By the mid-80’s, 87% of American women had Pap smears and the incidence rate had dropped to 8.3 per 100,000 with a similar drop in mortality.  Today, while invasive cervical cancer is relatively rare, incidence in black women is 50% higher than white women while incidence in Hispanic women is almost double the white rate.  This discrepancy is probably due to differences in access to the Pap smear.

Dr. Papanikolaou worked at Cornell until a few months before his death in 1962.  He authored over 150 publications and received many awards in his lifetime.    His legacy, though, is that thousands of lives are saved every year because he proved that a smear of cells on a slide could be used to screen for cancer.

Question of the Day: Dr. Papanikolaou was on which Greek Drachma note?

Papanicolaou GN, Traut HF. "The diagnostic value of vaginal smears in carcinoma of the uterus". American Journal of Obstetrics and Gynecology. 1941;42:193.


Blaustein, A., Kurman, R. Blaustein's pathology of the female genital tract,  6th Edition. Springer.  2011