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July 7, 1989

Incidence of Cancer of the Cervix: Triumph or Tragedy?

JAMA. 1989;262(1):32-33. doi:10.1001/jama.1989.03430010044022

To the Editor.—  Few people besides Dr Koss1 could have covered the strong and weak points of the Papanicolaou (Pap) smear so well. However, I raise an objection to the subtitle of his article, "A Triumph and a Tragedy." For those of us from the pre-Pap years, the triumph should be trumpeted abroad; the tragedy deserves no more than extremely fine print. There is considerable danger in even suggesting that the two are equal.To me, a pathology resident at a large university hospital in the late 1950s, it seemed that we did an autopsy a week on some woman between 30 and 50 years of age who had died of invasive cervical carcinoma. Carcinoma in situ was a rarity, found almost exclusively adjacent to invasive tumors; I did not hear of cervical dysplasia until after my training.Today, solely because of 30 years of using the Pap smear,