It Happened Here: Dr. Georgios Nikolaou Papanicolaou

Against many odds, an immigrant doctor created a game-changing test to detect cervical cancer.

When Dr. Georgios Nikolaou Papanicolaou began developing a test to detect cervical cancer, he relied on his wife to serve as his research subject, because he had no other option at first.

Dr. Papanicolaou, who at 21 completed his medical studies at the University of Athens in 1904, and his wife, Mary, had arrived in Manhattan from their native Greece in 1913 so he could pursue basic science research, a more established field in the U.S. Neither spoke English, and they had little money, so they took any job they could get. Mary worked as a seamstress at the Gimbels Department Store in New York City, and Dr. Papanicolaou was a rug salesman, a violin player at restaurants, and a clerk at a Greek newspaper. A year later, in 1914, he landed a part-time research role in the department of pathology at the former New York Hospital and soon moved to a full-time research position at Cornell University Medical College, in the department of anatomy. There, he commenced his studies on cervical cancer, which, in the early 1900s was the leading cause of cancer deaths in women, claiming nearly 40,000 lives every year.

He would then work at what is now NewYork-Presbyterian/Weill Cornell Medical Center for the next 47 years, retiring as professor emeritus of clinical anatomy, director of the Papanicolaou Research Laboratory, and consultant to the Papanicolaou Cytology Laboratory.

Though the presence of cancer cells in sputum and urine were being researched and studied at that time, the focus on cervical cancer was fairly new. To do the research, Dr. Papanicolaou needed female research subjects.

“At the time, he did not have a physician’s license to practice in the U.S.,” says Dr. Rema Rao, an assistant attending at the Papanicolaou Cytopathology Laboratory at NewYork-Presbyterian Hospital and an assistant professor of pathology and laboratory medicine at Weill Cornell Medicine. “That’s probably the reason his wife was his subject.”

Mary served in this role for the next 10 years, but he later would have opportunities to make observations on patients at the gynecologic clinic at Cornell. Typically at that time, when cervical cancer was diagnosed, the disease had already reached an advanced stage. His goal was to detect it earlier through scraping cells from tissue in the cervix for microscopic examination. According to the National Center for Biotechnology Information, Dr. Papanicolaou had deduced that reproductive cycles in guinea pigs (his earliest test subjects) could be timed by examining smears of their vaginal secretions. When he turned his attention to the human reproductive system, he was able to spot the differences between the cellular biology of normal and malignant cervical cells upon viewing swabs smeared on microscopic slides.

He presented his initial findings in 1928 at the “Third race betterment conference” in Michigan, but they weren’t widely accepted by the medical community. After years of research and relentless pursuit, he continued to publish his breakthrough findings, which ultimately led to the Pap test. It took more than 20 years for his work to be accepted by the medical community.

Dr. Rema Rao

“Because he was Greek and he didn’t learn to speak English very well, a lot of what he presented apparently had spelling errors,” says Dr. Rao. “He struggled to communicate to the medical community what he was trying to say. Also, exfoliative cytology was not a common practice in those days, as pathologists relied heavily on tissue biopsy for diagnosis of cancer.”

Despite that lack of acknowledgment, Dr. Papanicolaou kept conducting research. “He was very persistent,” says Dr. Rao. “I believe he did not even take a single vacation.”

In the years since its invention, the Pap test has had a profound impact on women.

“We have had a significant drop in deaths from cervical cancer,” says Dr. Rao, estimating that the Pap test has reduced the mortality rate of cervical cancer by 70 percent. Dr. Papanicolaou’s contributions as both a doctor and an inventor were game-changing. “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. The only answer was the Pap test.”

Ultimately, Dr. Papanicolaou’s contributions were recognized worldwide. He was nominated several times for a Nobel Prize and in 1953 received the Cross of Grand Commander, the highest decoration bestowed by the King of Greece. He would go on to establish his own cancer research center in Miami shortly before his death in 1962.

Today, Dr. Rao works in the same NewYork-Presbyterian/Weill Cornell Medical Center building as Dr. Papanicolaou did. The center remains vital to cervical cancer research.

“We test about 43,000 gynecological samples every year,” says Dr. Rao. “This institution is where all this started, and I am so proud to be a part of it.”