Biomedical Engineering Reference
In-Depth Information
3
What's in a Pap smear?
Biology, culture, technology and
self in the cytology laboratory
Anette Forss
Introduction
The Papanicolaou (Pap) smear, also called the Pap test, cyto test, cervical
smear or cervical cytology, has been described as the most widely used
and established cancer-screening technology in the world. It has also been
described as a very simple technology including a brush, a microscope slide,
fi xative and cervical cells from women. In 1928, George N. Papanicolaou, a
Medical Doctor, investigator, PhD in zoology and Aureli Babes (1928/1967),
a Romanian pathologist, each independently claimed to have found a 'very
simple' technique, which provided a new possibility for early diagnostics
of cancer/malignant tumours in the female genital tract/uterine cervix. The
technique was subsequently named after Papanicolaou who, according
to Wied (1964: 174), was more successful than Babes in 'stimulating the
introduction of mass screening projects which are the actual benefi t of the
method'.
1
In Sweden and other countries the Pap smear technology triggered what
is today an established secondary preventive intervention directed towards
'healthy' women to detect those at risk for developing cervical cancer, a
potentially fatal disease, as well as those with the disease (Royal National
Board of Health 1966). Today, approximately 950,000 Pap smear tests are
carried out each year, within and outside organised screening in Sweden
(Swedish National Board of Health and Welfare 1998).
2
Further testing
and medical follow-up is needed in approximately 4 per cent of the cases
(ibid.).
Approximately 260, mostly female, cytodiagnosticians examine the vast
majority of Pap smears in Sweden. They have no direct contact with the
women taking the Pap smears. Their daily work involves the visualisation
and interpretation of small excerpts from living human bodies, an essential
component in the larger context of cervical cancer screening. As the vast
majority of the Pap smears are normal the identifi cation of normal cells
constitutes the bulk of a cytodiagnostician's work. The cytodiagnosticians
expertise concerns cytology.
3
They distinguish between normal cells and
cells showing pathological changes by examining cytology samples down
