[Skip to Content]
[Skip to Content Landing]
Article
October 16, 1948

EARLY DIAGNOSIS OF CANCER BY STUDY OF EXFOLIATED CELLS

Author Affiliations

Boston

From the Laboratory of the Vincent Memorial Hospital (the Gynecological Service of the Massachusetts General Hospital).

JAMA. 1948;138(7):469-474. doi:10.1001/jama.1948.02900070001001
Abstract

Until the cause or causes of cancer are discovered, the only way cancer can be controlled is by early diagnosis and the consequent eradication of the malignant lesion at its inception. In the majority of cancers early diagnosis is not now possible. How is the physician to suspect, much less perform a biopsy of, a symptomless cancer of the stomach or lung which cannot be visualized? How shall one suspect cancer of the cervix in the presence of a grossly normal organ and before abnormal bleeding? In many parts of the body malignant lesions present for months or even years may be attended by their first clinical symptom only after invasion or metatasis has taken place.

Because of its recognized value and in order to check its misuse we propose to outline the present status of the cytologic method of cancer diagnosis. We believe that in certain regions of the

References
1.
Scheffey. L. C., and Rakoff, A. E.:  The Cytology Test for Uterine Cancer ,  Philadelphia Med. 43:435, 1947.
2.
 The Papanicolaou Test for Uterine Cancer , editorial,  J. A. M. A. 136:331-332 ( (Jan. 31) ) 1948.
3.
Pouchet, F. A.:  Théorie positive de l'ovulation spontanée et de la fécondation des mammifères et de l'espèce humaine, basée sur l'observation de toute la série animale , Paris, J-B. Baillière, 1847.
4.
Stockard, C. R., and Papanicolaou, G. N.:  The Existence of Typical Oestrous Cycle in Guinea-Pig, with a Study of Its Histological and Physiological Changes ,  Am. J. Anat. 22:225-283, 1917.Crossref
5.
Papanicolaou, G. N.:  A General Survey of theVaginal Smear and Its Use in Research and Diagnosis ,  Am. J. Obst. & Gynec , 51: 316-328, 1946.
6.
Papanicolau, G. N.:  New Cancer Diagnosis ,  Proceedings of Race Betterment Conference, 1928 , pp. 528-534.
7.
Papanicolaou, G. N.:  The Sexual Cycle in the Human Female as Revealed by Vaginal Smears ,  Am. J. Anat. ( (supp.) ) 52:519-637, 1933.
8.
Papanicolaou, G. N., and Traut, H. F.:  The Diagnostic Value of Vaginal Smears in Carcinoma of the Uterus ,  Am. J. Obst. & Gynec. 42: 193-206, 1941.
9.
(a) Meigs, J. V.; Graham, R. M.; Fremont-Smith, M.; Kapnick, I., and Rawson, R. W.:  The Value of the Vaginal Smear in the Diagnosis of Uterine Cancer ,  Surg., Gynec. & Obst. 77:449-461, 1943.
10.
Meigs. J. V.; Graham, R. M.; Fremont-Smith, M.; Janzen, L. T., and Nelson, C. B.:  The Value of the Vaginal Smear in the Diagnosis of Uterine Cancer ,  Surg., Gynec. & Obst. 81:337-345, 1945.
11.
Coman, D. R.:  Decreased Mutual Adhesiveness, a Property of Cells from Squamous Cell Carcinomas ,  Cancer Research 4: 625-629, 1944.
12.
Papanicolaou, G. N., and Traut, H. F.:  Diagnosis of Uterine Cancer by the Vaginal Smear , New York, The Commonwealth Fund, 1943; footnote 7.
13.
Firor, W. M., and Gey, G. O.:  Observations on the Conversion of Normal into Malignant Cells ,  Ann. Surg. 121:700-702, 1945.
14.
Papanicolaou and Traut.10 Papanicolaou, G. N.:  A New Procedure for Staining Vaginal Smears ,  Science 95:438-439, 1942.
15.
TeLinde, R. W., and Galvin, G.:  The Minimal Histological Changes in Biopsies to Justify a Diagnosis of Cervical Cancer ,  Am. J. Obst. & Gynec. 48: 774-797, 1944.
16.
Pund, E. R., and Auerbach, S. H.:  Preinvasive Carcinoma of the Cervix Uteri ,  J. A. M. A. 131:960-963 ( (July 20) ) 1946.
17.
Younge, P.: Study of One Hundred and Thirty-Five Cases of Carcinoma-in-Situ at the Free Hospital for Women, personal communication to the authors.
18.
Maliphant, R. G.:  Cancer of the Cervix Uteri: The Results of Treatment with Radium ,  J. Obst. & Gynaec. Brit. Emp. 54:155-163, 1947.
19.
Todd, O. E.:  Cancer of the Cervix: Time Wasted ,  J. Michigan M. Soc. 40: 191-196, 1941.
20.
Todd.16 Hodge, R. H.:  Carcinoma of the Cervix: Time Lost Before Treatment ,  Virginia M. Monthly 69:200-203, 1942.
21.
Leach, G. E. and Robbins, G. F.:  Delay in the Diagnosis of Cancer ,  J. A. M. A. 135: 5-8 ( (Sept. 6) ) 1947.
22.
Gates, O., and Warren, S.:  A Handbook for the Diagnosis of Cancer of the Uterus by the Use of Vaginal Smears , Cambridge, Mass., Harvard University Press, 1947, p. 8.
23.
Isbell, N. P.; Jewett, J. F.; Allan, M. S., and Hertig, A. T.:  A Correlation Between Vaginal Smear and Tissue Diagnosis in 1,045 Operated Gynecologic Cases ,  Am. J. Obst. & Gynec. 54:576-583, 1947.
24.
Scheffey, L. C.; Rakoff, A. E., and Hoffman, J.:  An Evaluation of the Vaginal Smear Method for the Diagnosis of Uterine Cancer ,  Am. J. Obst. & Gynec. 55:453-460, 1948.
25.
Fremont-Smith, M.; Graham, R. M., and Meigs, J. V.:  Vaginal Smears as an Aid in the Diagnosis of Early Carcinoma of the Cervix ,  New England J. Med. 237:302-304, 1947.
26.
Graham, R. M.; Sturgis, S. H., and McGraw, J. A.: A Comparison of the Accuracy in Diagnosis of the Vaginal Smear and Biopsy in Carcinoma of the Cervix, to be published.
27.
Pund, E. R.; Neiburges, H. E.; Nettles, J. B., and Caldwell, J. D.:  Preinvasive Carcinoma of the Cervix Uteri: Seven Cases in Which It Was Detected by Examination of Routine Endocervical Smears ,  Arch. Path. 44:571-577 ( (Dec.) ) 1947.
28.
Kraushaar, O. F.: Personal communication to the authors.
29.
Palermo, A. A.: Personal communication to the authors.
30.
Fremont-Smith, M., and Graham, R. M.:  The Vaginal Smear: Its Value to the Internist, with Report of Diagnosis of Unsuspected Uterine Cancer in Four Cases ,  J. A. M. A. , 137:921-922 ( (July 10) ) 1948.Crossref
31.
Herbut, P. A., and Clerf, L. A.:  Bronchogenic Carcinoma: Diagnosis by Cytological Study of Bronchoscopically Removed Secretions ,  J. A. M. A. 130:1006-1012 ( (April 13) ) 1946.Crossref
32.
Dudgeon, L. S.:  On the Demonstration of Particles of Malignant Growth in Sputum by Means of the Wet-Film Method ,  St. Thomas's Hosp. Rep. 1: 51-65, 1946.
33.
Gowar, F. J. S.:  Carcinoma of the Lung: The Value of Sputum Examination in Diagnosis ,  Brit. J. Surg. 30:193-200, 1943.Crossref
34.
Wandall, H. H.:  A Study of Neoplastic Cells in Sputum as a Contribution to the Diagnosis of Primary Lung Cancer ,  Acta chir. Scandinav . ( (supp. 93) ) 91: 1, 1944.
35.
Herbut, P. A., and Clerf, L. H.:  Cancer Cells in Bronchial Secretion ,  M. Clin. North America 30: 1384-1392, 1946.
36.
Herbut, P. A.: Personal communication to the authors.
37.
McKay, D. G.; Ware, P. I.; Atwood, D. A., and Harken, D. E.: The Diagnosis of Bronchogenic Carcinoma by Smears of Bronchoscopic Aspiration, to be published.
38.
Woolner, L. B., and McDonald, J. R.:  Bronchogenic Carcinoma: Diagnosis by Microscopic Examination of Sputum and Bronchial Secretions; Preliminary Report ,  Proc. Staff Meet., Mayo Clin. 22:369-381, 1947.
39.
Woolner, J. B.: Personal communication to the authors.
40.
Young, H. H.:  The Cure of Cancer of the Prostate by Radical Perinial Prostatectomy ,  J. Urol. 53:188-256, 1945.
41.
Herbut, P. A.: Personal communication to the authors.
42.
Welch, C. E., and Allen, A. W.:  Carcinoma of the Stomach ,  New England J. Med. 238:583-589, 1948.Crossref
43.
Papanicolaou, G. N.:  Diagnostic Value of Exfoliated Cells from Cancerous Tissues ,  J. A. M. A. 131:372-378 ( (June 1) ) 1946.Crossref
44.
Papanicolaou, G. N., and Cooper, W. A.:  The Cytology of the Gastric Fluid in the Diagnosis of Carcinoma of the Stomach ,  J. Nat. Cancer Inst. 7:357-360, 1947.
45.
Hunter and Richardson ( Cytologic Recognition of Cancer in Exfoliated Material from Various Sources [Useful Modifications of the Papanicolaou Technique] ,  Surg., Gynec. & Obst. 85: 275-280, 1947) embedded and sectioned sediments of many body fluids.
46.
Graham, R. M.; Ulfelder, H., and Green, T. H., Jr.:  The Cytologic Method as an Aid in the Diagnosis of Gastric Carcinoma ,  Surg., Gynec. & Obst. 86:257-259, 1948.
×