The Pap Smear: the Gift Science Has Given You
A story about the bond between a raunchy exchange student and a 20th century Greek scientist.
Erasmus Gone Wrong
When I was 22, I was an exchange student in Austria. My first experience living abroad and the exciting international student dorm life meant endless parties, trips across Europe, new friends from all over the world and chaotic conversations in multiple languages. This year largely defined who I would become. But…
There was one particular incident that threatened to overshadow it all. Having been suffering from endometriosis since menarche, accompanied by a generally unfavorable medical history, life taught me the importance of regular heath check ups. Since I became sexually active, I had been doing a regular pap test once a year, and this year, as crazy as it was, wasn’t going to be the exception.
Hello, Gyno
At the gynecologist’s office, I was told that everything seemed fine. If any test results should look suspicious, I would be summoned. Two weeks later, I got a letter in the mail urging me to come back to see the gynecologist ASAP because of something called “Krebs”. My German was ok enough to read the letter and understand what I should do, but my mind went straight to STD land. Crabs. I got crabs. I didn’t know much about it other than the sexual transmission part, and let’s face it — it would come as no surprise if the dorm turned out to be an STD infestation spot. Despite my fear and shame, I pep talked myself into going back to the doctor’s and getting this ordeal sorted hastily. I, sadly, had no idea just how scared I should’ve actually been.
The lovely gynecologist used the best of their English to very calmly explain to me what was happening. Quite soon, I learned that Krebs wasn’t the German word for crabs, but for cancer. My pap smear suggested I had cervical cancer.
Cervical Cancer Doesn’t Discriminate
How? What? When? How could I not notice? How could cancer be asymptomatic? I could barely comprehend the answers. We were most likely looking at pre-cancerous cells, the doctor had said to me, and we’re going to run all the additional tests calmly until we’re completely sure. By the time it was all said and done, my exchange would come to an end and I could go back home with a definitive stack of papers that will lead me straight into the surgical ward. I was young, they said, it was unusual for a young person’s cancer to advance so quickly, we could afford to take it slow.
My Greek Hero
Jump back to 1883. Georgios Papanikolaou was born in Kimi, a small town in Greece. A multi-talent, Papanikolaou studied music and humanities at the University of Athens. His father was a physician, and eventually persuaded Georgios to switch to medical school, which he later graduated with honors. Whether young Georgios really chose this out of his own free will and curiosity or it was the result of a major family feud where the patriarch put his foot down — we will never know. We do know, however, that hundreds of thousands of women owe their lives to this interesting change in career path.
Papanikolaou seems to have led an exciting life. He worked as a military surgeon, then cared for leprosy patients, later moved to Germany to get a PhD in zoology of all things. He got married, went back into military service in 1912 when the First Balkan War broke out, and eventually, a year of bloodshed later, decided to emigrate to the United States with his wife Andromache Mavroyeni (who called herself Mary in the States), $250 in hand and no plan. Starting with menial jobs to get by, eventually the Papanikolaou family prove their genious to the Americans. Georgios was employed by the New York University’s Pathology Department and Cornell University Medical College’s Anatomy Department. Mary joined in as a technician.
Studying sex hormones on guinea pigs (some ethical questions here), he eventually realized the abundance of information a vaginal smear offers, and switched to working on human cytopathology in 1920. It took a while until people picked up on the grandness of his discovery (namely until a publication in 1943). Papanikolaou had realized that normal and abnormal (cancerous) smears taken from the vagina and cervix could be viewed under the microscope and be correctly classified. In short, he found a way to detect cancer before it was even fully formed.
In 1947, a renowned Canadian obstetrician got interested in the test and the procedure. Head of the department of obstetrics and gynecology, Anna Marion Hillard introduced the so-called pap test to the newly formed Cancer Detection Clinic. We owe Hillard a lot, as she committed to creating a simplified version of the test (read: less invasive, less painful, more accessible) based on the female experience. This is the test that we use today: a quick, relatively painless swab, with results ready in a couple of days, accessible (in theory) to everyone, and in most countries — free.
Under the Knife
Fast forward back to 2012. My Erasmus ends with tears for the city I’m leaving behind, the friendships and adventures that will be no more. I get on a bus to take me south with my gloomy stack of papers. I only broke the news to my parents once I arrived — there was no way I was going to risk them cutting my Erasmus short because of something as silly as cancer. As it most often goes in the country of my childhood, a few strings had to be pulled so that I’m not seen by a random butcher but by the very best surgeon available. I was introduced to the head of the hospital, a very warm woman who fast forwarded all my documentation, re-did some tests to assess the progression of the disease, and got me on top of the waiting list.
Almost a full year later, the LEEP equipment finally arrived and I was in the first batch of women to be treated. We stood lined up outside of the doctor’s office and much like on an assembly line, we’d pop in and pop out in under 30 minutes. The surgeon was flawless and her work has since been complimented by all my later doctors everywhere I went (I moved a lot). The surgery was painful, I won’t lie about that. 3cm2 were cut out of my cervix as I lay there awake, trying to breathe, getting scolded by the nurses that I shouldn’t be wining because this was just like labor, only much shorter. How dare I make a peep or shed a tear during this insignificant experience, when women were giving birth right in the next room? I walked out in a daze, and the next girl came in. A revolving door to another chance at life. A week or so later, I discussed my results with my surgeon. We got all of it, she said. Thank God you came when you did, it was a mean one, she added.
As far as I’m concerned, I owe my life to Georgios Papanikolaou and Anna Marion Hillard first, and then to all my personal doctors. Papanikolaou gave the women of this world an incredible gift — the gift of life. Cervical cancer is so common that WHO had issued a call for action to eliminate cervical cancer as a public health problem. This is partly being done with HPV vaccination which has proven to significantly lower cervical cancer cases, and is estimated to be able to eliminate cervical cancer by the end of the century.
The Gift of the Pap Smear
Less than a hundred years ago, people who have dedicated their entire lives to studying the human body and creating solutions for its many ailments and fragilities, found a way to detect cervical cancer. They gave us a gift. What was once a common reason for the death of a woman is now a 2 minute test away from being cut at its roots.
January is cervical cancer awareness month. Be aware. Go get your pap test done. Make a pact with yourself that you’ll do it every January — that’s the best resolution you can go into the new year with.
Appreciate the gift you’ve been given. If for no other reason, go and do it as a Thank You for the years of dedication and effort from people who never knew you, but still wanted to give you the best chance at life they could.
Cheers to Georgios and Marie Papanikolaou, and Anna Marion Hillard! You are appreciated.
