Georgios Papanikolaou: How the Greek Doctor Changed Women's Health Forever

"The Pap test is one of the most important inventions in humankind."

Cervical cancer is both one of the greatest threats to women’s health and one of the most preventable and curable forms of cancer. Fortunately, we’re also able to screen for cervical cancer and diagnose it early. That crucial ability is in part possible because of a Greek immigrant named Dr. Georgios Papanikolaou, a pioneer researcher and the subject of a Google Doodle on Monday, the 136th anniversary of his birth.

The widely used “Pap smear” test is named for Papanikolaou, whose research led to its mainstream adoption in the ‘50s. Before then, cancer diagnoses often relied on biopsies, which required surgery. Today, the Pap smear is one of the most common cancer screening tests and is considered a necessary part of routine health care for women aged 21 to 65.

During a Pap test or smear, physicians look for any cells in the cervix that might be cancerous or abnormal enough to be considered precancerous. A medical examiner collects a sample of a patient’s cervical cells by first inserting a speculum (a tool that helps them see the cervix) into the vagina before using a wooden spatula and small brush to gently collect cells from the vagina surface and canal. The cells are then sent to a pathologist, who examines them under a microscope and evaluates them for abnormalities.

Georgios Papanikolaou, Google Doodle
Georgios Nikolaou Papanikolaou is the focus of Monday's Google Doodle.

Since it typically takes several years for abnormalities to become cancerous, routine Pap tests play an essential role in detecting mid-cellular changes. According to the American Cancer Society, cervical cancer can be found early — and sometimes prevented entirely — by having regular Pap tests. There are numerous treatment approaches for cervical cancer, each more effective with early diagnoses. (In recent years, scientists have also discovered new diagnoses can be reduced with an HPV vaccination.)

In 1914, Papanikolaou began studying cervical cancer at Cornell University Medical College and at the hospital now known as New York-Presbyterian. At the time, cervical cancer was one of the leading causes of cancer deaths in American women, killing nearly 40,000 individuals annually. Papanikolaou’s experiments on guinea pigs and humans led to the discovery that he could see the difference between normal and malignant cervical cells after viewing swab samples with a microscope. He presented his initial findings in 1928, but it took more than two decades for his work to be accepted by the medical community.

When it did, it literally saved lives. Although it only gained widespread acceptance by the medical community in the late ‘50s and 60s, after its introduction, the incidence and death rate of cervical cancer reduced by 60 percent between 1955 and 1992. It was once the leading cause of cancer death for American women, but now it ranks 14th in frequency.

Pap test, pap smear
A micrograph of a Pap test.

“We have had a significant drop in deaths from cervical cancer,” said Dr. Rema Rao, a pathologist at the Papanicolaou Cytopathology Lab at New York-Presbyterian, in an interview. “The Pap test is one of the most important inventions in humankind because it was extremely challenging to prevent cervical cancer and the severity of it.”

Despite Papanikolaou’s work, the incidence of cervical cancer is still high in some parts of the United States because of limited access to Pap smears and cervical cancer screenings. This is true in developing nations, where 80 percent of cervical cancer cases occur. Access to an early test for cancer screening is necessary for treating cancer before it’s too late — something that Papanikolaou was all too aware of decades ago.