NARRATOR: In New York City, the line stretched around the block.
In Philadelphia, women waited for hours outside their local church.
While way out in Wyoming, even the smallest mountain town was ready.
Everywhere, in the year 1958, women were asking for a brand new medical test: a pap smear –
and nobody had ever seen anything like it.
RACHEL GROSS, WRITER: In the 1940s and 50s, cervical cancer is killing thousands and thousands of women. This was definitely a major priority of American healthcare. The stakes are very high.
NARRATOR: For the first time in history, there was a simple screening test for cancer.
Its rollout and its propaganda were utterly unprecedented.
ARCHIVAL AUDIO: Deborah Kerr: Costly cancer deaths, they deprive the world of too many people we love.
ARCHIVAL AUDIO: Audrey Hepburn: Now is the time to strike back at cancer.
NARRATOR: The campaign would require nothing short of a full national mobilization.
DEIRDRE COOPER OWENS, HISTORIAN: It’s so ubiquitous now that we kind of don't think about the fact that it’s not even 100 years old yet. When we first hear about a pap smear, we don't know that it's actually named after a human being.
ARCHIVAL AUDIO: This is the doctor, George N. Papanicolau, professor emeritus of Cornell Medical College.
NARRATOR: The truth was, George Papanicolaou never set out to revolutionize cancer detection. And not a single thing about bringing the pap smear to the people had been simple.
BARRON LERNER, MD, HISTORIAN: There were lots of barriers and lots of steps to get to where the Pap test really became a life-saving test.
NARRATOR: Behind it all was a coalition as remarkable as it was unusual – from a Japanese-born artist, to a doctor in Philadelphia, to an entirely new class of female scientists. Yet they all shared a singular goal: to save American women from cancer.
KIRSTEN GARDNER, HISTORIAN: One of the things that surprises me about this story is sometimes when we look at things in retrospect, it seems inevitable that they were going to happen. When I look at this story, nothing seems inevitable about it.
NARRATOR: The Cornell Medical College, in the year 1914, was home to practically every kind of scientific endeavor imaginable. Here, one lab studied the bacteria in human saliva. A floor below, researchers were developing treatments for diabetes – by removing the pancreas from dogs. Then there was the scientific illustrator who would have 5,000 live mosquitos shipped by mail as “artist’s supplies.”
Amidst it all was a 31-year-old Greek immigrant, a zoologist by the name of George Papanicolaou.
Always at his microscope, Papanicolaou was convinced that cells – the building blocks of all life – could tell us more than anyone else had realized. It was their secrets that he’d been chasing for years.
SAM KEAN, WRITER: When he was in Greece growing up, George Papanicolaou’s father wanted George to become a doctor, but George liked science more, he also was called to help people. So he wanted to combine both of those doing medical research.
NARRATOR: “It is not my ideal to be wealthy,” he’d once written to his parents, “but to work to create.”
KIRSTEN GARDNER, HISTORIAN: He ends up going on an oceanic voyage to help identify different sea creatures. He loved to categorize things. I think it really translates to his later work when he makes his way over to the United States.
NARRATOR: When he landed in New York City with his young wife, Mary Mavroyeni, in 1913, Papanicolaou was an ambitious scientist on the rise. But nothing went as planned.
RACHEL GROSS, WRITER: He spoke German and Greek, but neither of them spoke much English at all.
SAM KEAN, WRITER: He was taking odd jobs. Playing his violin in a restaurant. He was working as a clerk at a Greek newspaper. He was a carpet salesman for a bit, and he was supposedly the worst carpet salesman they’d ever had. He could not close any deal. He just wasn't a forceful personality in that way.
NARRATOR: Still, George was luckier than most immigrants. His doctoral work had brought him some renown, and he was offered a job studying reproduction in the laboratory of one Charles Stockard, an anatomist, zoologist, and prominent American eugenicist.
SAM KEAN, WRITER: George’s boss believed in controlling reproduction, controlling who reproduced with the supposed aim of improving the stock of humankind.
BARRON LERNER, MD, HISTORIAN: At the time, people thought they knew what good genes and bad genes were. Good genes were you were white, with healthy young children. Unfortunately, if you were an immigrant, a person of color, if you had a disease like epilepsy, you were often stigmatized as having bad genes.
RACHEL GROSS, WRITER: There was an inkling that if you could control female reproduction that would give you the tools to create the population you wanted.
NARRATOR: Papanicolaou’s new work in Stockard’s laboratory involved answering basic questions, still unknown, about female biology.
KIRSTEN GARDNER, HISTORIAN: Dr. Papanicolaou was interested in tracing the cellular changes that happened during the reproductive cycle. He was very invested in finding that pattern and when did cells change.
NARRATOR: Papanicolaou threw himself into the work, and, unexpectedly, found a kindred spirit just down the hall.
SAM KEAN, WRITER: Hashime Murayama was born in Japan. He went to the Kyoto Art School. Then he got a job at Cornell. He was doing cell illustrations for doctors. He had a good eye for essentially drawing what he was seeing.
LEAH HAZARD, WRITER: There must have been some degree of kinship, between George and Murayama, as both were immigrants to America. Neither of them would've sounded or maybe looked like their American peers.
NARRATOR: At Cornell, Murayama was as interested in cells as George was, and had even patented a new technique to improve the accuracy of his drawings. Meanwhile, back in the Stockard laboratory, Papanicolaou had recently found himself questioning one of their basic research protocols.
Their lab animal was the guinea pig, and in comparison to the little aquatic “water fleas” George had worked with in graduate school, the rodents were… more complicated.
KIRSTEN GARDNER, HISTORIAN: In order to study the reproductive cells, he would have to kill the guinea pig, but when you kill the guinea pig you only get a slice of the story. So then he began to consider that the cells may be changing in the vaginal fluid.
NARRATOR: One morning, Papanicolaou took a tiny tool and scraped cells from inside a live guinea pig’s cervix. Then he smeared the sample on a glass plate, and applied a series of stains. At last, he sat down at his microscope – and it all came into focus.
RACHEL GROSS, WRITER: George found that there were changes in the cells. He could see differences in these cells, shape and size, and they very clearly showed him what was happening in the uterus.
NARRATOR: The discovery helped launch a new field: exfoliative cytology, the non-invasive study of cells. Papanicolaou had the highest hopes for his new method. And now, he couldn’t help but wonder, could this novel technique also work for that most mysterious animal of all?
DEIRDRE COOPER OWENS, HISTORIAN: There are many antiquated ways that scientists wrote about the female body. For instance, one might read that women are led, or guided by their uteri, and not their brains.
LEAH HAZARD, WRITER: Historically their bodies have really been subject to the male gaze. The reproductive tract has been seen as having two purposes: penis goes in, baby comes out. But in reality, there's all this other stuff happening 99.9999% of the time.
NARRATOR: Mary Papanicolaou was well aware that women’s bodies had other functions.
Seven years her husband’s junior, she’d not only followed him to America, but into the laboratory as well, where she worked as both his technician and lab manager.
KIRSTEN GARDNER, HISTORIAN: They went to the lab every day together. They often worked to the point where it was dark when they came home at night.
NARRATOR: Recently, George had embarked on a new experiment – and Mary had just become a guinea pig of sorts herself.
BARRON LERNER, MD, HISTORIAN: It was very common in the early 20th century for scientists to do experiments on their spouses, and on people they knew. And the idea behind this was, "If I'm willing to do an experiment on myself or my family, it's safe enough for me to experiment on other people."
NARRATOR: Every day, George would collect cells from Mary’s cervix. Their goal: to be the first to document the minute morphological changes expressed during a human ovarian cycle.
Mary was the heart, the soul, and the cervix of the operation.
RACHEL GROSS, WRITER: Mary is the first person to get a Pap smear, but she also collects her own smears, organizes them, fixes them and stains them, and helps analyze them. She is an integral part of this scientific work.
NARRATOR: Making their experiment possible was a gynecological tool perfected back in the nineteenth century – the speculum.
DEIRDRE COOPER OWENS, HISTORIAN: No one really looked in the vaginal cavity, because it was taboo. And most certainly, a gentleman is not supposed to look into the inner cavity of a lady.
NARRATOR: The speculum’s controversial inventor, a physician named James Marion Sims, who would be remembered by some as the “father” of American gynecology, would later write that he hated nothing more than investigating the organs of the female pelvis.
RACHEL GROSS, WRITER: There was this repeated association of female genitals with something that you should hide and cover up. Every time a, usually, male anatomist would discover the clitoris or the vulva, they would name it after the word shame. So in the 1500s, a French anatomist studied the human clitoris, and he named it the shame member. We still have today in OB/GYN textbooks, this word pudendum, which means the part for which you should be ashamed.
NARRATOR: For the Papanicolaous, nothing about their new work was shameful.
“We stand at the very threshold,” George would explain, “of this new science.”
Now, George was hoping to expand the study beyond what he termed his “special case.”
Soon, there were rumors that if you went to the Paps’ for dinner, female guests might be asked to sit for a smear.
LEAH HAZARD, WRITER: Mary herself was fundamental in recruiting some of her friends to come and get smear tests in the name of medical progress. It’s difficult to kind of piece together exactly how those initial smear parties really happened. But I think what we can say is that George was very keen on expanding this sample size.
NARRATOR: In February 1925, George was finally able to establish a collaboration with the Woman’s Hospital of the City of New York.
SAM KEAN, WRITER: So he started looking at cysts, started looking at fibroid matters, trying to figure out if there was a correlation between these changes in the cells and the diseases that women were experiencing.
NARRATOR: Then, one day at the microscope, Dr. Pap saw something altogether different. A sample with cells oddly shaped, their nuclei overlage, their chromosomes jumbled.
There was no mistaking those distinctive signs: it was cancer.
LEAH HAZARD, WRITER: This was not what George was looking for, but so much of good science is about luck and opportunity and incidental findings. And George being a keen and perceptive scientist must have known the significance of what he has detected.
NARRATOR: He would remember it as the single “most thrilling experience of [his] career.”
At hand was a new technique that had the power to save millions of women’s lives.
And the fight Dr. Pap was now joining could not have been more urgent.
RACHEL GROSS, WRITER: Cancer was deeply feared at this time. It was known as the dread disease. Often doctors wouldn’t even use the word cancer giving you a diagnosis.
DEIRDRE COOPER OWENS, HISTORIAN: Cervical cancer patients suffered in pain. By the time they found out that it was cancer, it was too late, so it was certainly a death sentence.
NARRATOR: By the late 1920s, cancer was on the rise. And it seemed to be killing mostly women – some 40,000 a year.
A new organization, the American Society for the Control of Cancer, had recently been created to get the word out.
BARRON LERNER, MD, HISTORIAN: For its first 30 years, it was sort of a mom and pop shop. So the money that they did raise mostly went to people with cancer. It was almost a bit like a charity organization.
NARRATOR: The Society occasionally printed pamphlets, like What Every Woman Should Do About Cancer. But that was the full extent of their campaign.
BARRON LERNER, MD, HISTORIAN: The notion of trying to find a cervical cancer early wasn't on anyone's radar screen, because nobody had thought of it before, and nobody thought there was a way to do that.
NARRATOR: In early January, 1928, armed with his new cancer detection method, Dr. Pap traveled to Battle Creek, Michigan, excited to tell his colleagues about his discovery.
It was called the Race Betterment Conference, a high-profile event sponsored by prominent members of the eugenics movement.
DEIRDRE COOPER OWENS, HISTORIAN: It is a who’s who of the academic world. It's a who's who of the scientific world. You had a number of prominent thinkers who were invested in these racist ideas.
BARRON LERNER, MD, HISTORIAN: It was very common for mainstream scientists not doing eugenic research to present at these conferences. Dr. Pap didn't see his research particularly as promoting the eugenics cause, but it was reproductive research. So he took the chance and decided to present there.
NARRATOR: On the third day, Papanicolaou took the stage, and launched into an explainer of his new technique.
KIRSTEN GARDNER, HISTORIAN: It was a disastrous presentation. The first problem was his slides, by all accounts, were terrible. So if you're making a presentation where you're trying to argue that the key to identifying irregular cells is so that you can create these classifications and then your slides are some of the worst that anyone has seen at the conference, it's just not that convincing. Two: the gold standard was the biopsy.
NARRATOR: The biopsy involved an operation to collect tissue from within a tumor. It was effective, but often painful.
LEAH HAZARD, WRITER: So doctors at this betterment conference don’t understand why it would be appealing to switch from the biopsy, a painful, invasive diagnostic to one that was arguably uncomfortable, but not painful. There probably wasn't really a recognition that the woman's comfort and the patient's preference would be in any way a deciding factor.
NARRATOR: When journalists caught wind of Papanicolaou’s findings, it made national headlines.
But as Dr. Pap himself would note, “[I] failed to convince my colleagues of the practicability of [the] procedure.”
SAM KEAN, WRITER: George just sort of shrunk back and took the criticism. And he didn't really give up on the work, he just wasn't pushing for it. He wasn’t that assertive of a person.
NARRATOR: Little did George know, the war on cancer was just beginning – and new voices, and new faces, were about to change the nature of the fight.
ARCHIVAL AUDIO: Cancer challenges every man and woman, it is a test of our civilization’s ability to organize for health and happiness.
NARRATOR: The Women’s Field Army, an offshoot of the American Society for the Control of Cancer, was determined to make cancer a part of the national conversation, and, soon, their message seemed to be everywhere.
KIRSTEN GARDNER, HISTORIAN: The idea is they are going to invade American homes with knowledge about cancer. And whether that means knocking on doors and giving out pamphlets, getting placards in the subway, going to fairs and setting up a health booth these women were going to do it.
NARRATOR: By 1938, the Women’s Field Army had even successfully lobbied congress to make April Cancer Control Month.
KIRSTEN GARDNER, HISTORIAN: What begins to happen is women carving out an identity for themselves really as public health activists. We might not be the MDs who have these theories, but we can certainly be the educators who translate these theories to the public so that they can be more effective.
NARRATOR: But the outreach, as groundbreaking as it was, mostly ignored the plight of large swaths of the population.
AMEENAH SHAKIR, HISTORIAN: The Women's Field Army are, kind of, documenting some of these cases in white women patients, there was not as much of a focus on how uterine and ovarian cancer were actually impacting Black women. The perception at the time was that African-Americans did not live long enough to get cancer, were not civilized enough to get cancer. Cancer was considered to be a disease of the elite.
NARRATOR: An hour south of the Field Army’s Manhattan headquarters, down in Philadelphia, a young doctor was about to discover a very different reality. Her name was Helen Dickens.
Born in Dayton, Ohio, to parents Daisy and Charles Dickens, her father had escaped from slavery in Kentucky. He’d taught himself to read, and took the name Charles Dickens, whose writings he loved.
Tragically, he’d died when his daughter was just eight years old.
ARCHIVAL AUDIO: Helen Dickens: He always wanted me to be a nurse. But somewhere along the way, I decided that if I was going to be a nurse, I might as well be a doctor. I had never seen a woman doctor either black or white. It never occurred to me that there was a barrier.
JAYNE HENDERSON BROWN, MD, DAUGHTER OF DR. HELEN DICKENS: Oh, my mother loved school. She wanted to know so much and learn so much and that was what she was about.
NARRATOR: At 17, Dickens graduated from high school, taking night classes and summer school to finish early. Three years later, she was accepted to medical school at the University of Illinois, where she was the only Black woman in her class.
RACHEL GROSS, WRITER: In medical school students would taunt her, use slurs and gestures. And she said her strategy for avoiding them was always to sit in the front row of the class where she couldn't see them, and if anyone else wanted a good view, they had to sit next to her.
NARRATOR: By June, 1934 the medical school had a new graduating class. And there, was Helen Dickens.
DEIRDRE COOPER OWENS, HISTORIAN: Helen Dickens was black and a woman. And because she exists in one body with those intersecting identities, it was a challenge. And yet, here she rose, to the top, to become an MD.
NARRATOR: Now, age 26, Dickens had taken a job in North Philadelphia, working with a doctor who would change the course of her career.
AMEENAH SHAKIR, HISTORIAN: Virginia Alexander, African-American woman physician who had something called the Aspiranto Health Home. This was similar to what we would now call, like, a birthing home.
ARCHIVAL AUDIO: Dickens: The patients came to us. She had two rooms in her house for patients and one little room where you delivered patients. Oh it was different. The OB patients stayed in nine days. Most of them were poor. People weren’t able to pay, they weren’t expected to pay a lot.
NARRATOR: Aspiranto was a world onto itself – in a segregated society.
DEIRDRE COOPER OWENS, HISTORIAN: Not as if Black people can just go to the county hospital. You have to go to the hospital for the Negro. And oftentimes they're underfunded, they're understaffed. The chief physicians tend to be white men, and there is a condescension that goes on, a kind of patronizing attitude.
AMEENAH SHAKIR, HISTORIAN: So Dickens and Alexander really provide this alternative. Alexander helped Dickens to formulate a consciousness around how healthcare could be used as a site of activism.
NARRATOR: Beyond the walls of the Aspiranto Health Home, Dr. Dickens was working more and more out in the community.
ARCHIVAL AUDIO: Dickens: You were going in the middle of the night, and you were going into all kinds of communities. You were going into the homes. You were seeing all these people. You were taking responsibility for care of people.
JAYNE HENDERSON BROWN, MD, DAUGHTER OF DR. HELEN DICKENS: The more she was in it with the women she came across, the more she knew about what their struggles and concerns were health-wise.
NARRATOR: One of the things that Dickens saw, again and again, was cancer. Her patients were dying, and she now knew that the perception that Black people didn’t get cancer was a lie. Dickens was determined to document cancer’s deadly toll, and to tell Black women what they so urgently needed to know.
NARRATOR: Back in New York, in 1939, Dr. Papanicolaou had had 11 years to stew about the failure of his smear technique to pique the interest of the medical community. He’d moved on to other research, but he and Mary had always carried on with the daily smears.
KIRSTEN GARDNER, HISTORIAN: He stayed in the same lab. He stayed in similar work. He always had his wife next to him, that was probably incredibly comforting while he continued with his work.
NARRATOR: There’s a saying in science that luck comes to the prepared. Death, of course, comes for us all. Both came to the Cornell Medical College that April. Charles Stockard, Papanicolaou’s boss, had died aged 60, and he was replaced by one Dr. Joseph Hinsey.
SAM KEAN, WRITER: George’s new boss–he understood how deadly cervical cancer was and he wanted to help women. Coincidentally, George had been rethinking his work because before he was looking at tumors when they were already pretty advanced, at that point, fairly deadly. But he started thinking, maybe we could look at cells on their way to becoming cancer.
NARRATOR: If he was to try to detect cancers earlier, Papanicolaou needed new subjects. And by October, he had them. The top brass at New York Hospital had decreed that every woman admitted to the gynecological unit would now be required to have a smear. The results were better than even Dr. Pap could have expected. The smear was able to identify suspicious cells some ten years before they developed into cancer.
RACHEL GROSS, WRITER: His research was already a game-changer, to be able to find cancer when there are no outward signs, but now he also realizes that you can find cancer before it technically exists, so that really is unprecedented.
NARRATOR: Remembering his disastrous slides at the Race Betterment Conference, this time, Papanicolaou was determined to launch the smear the right way. And he knew that, to do so, he would need some help.
NARRATOR: Scientific illustrator Hashime Murayama wasn’t just down the hall anymore.
Back in 1921, he’d been offered his dream job as a staff illustrator at the National Geographic Society, and had moved his family down to Washington, D.C.
Murayama and his wife Nao had kept in touch with the Papanicolaous over the years. There’d been the usual pleasant exchange of Christmas cards, and family news.
In January, 1941, Murayama was retiring from a remarkable 20-year career during which his attention to detail had become as famous as his drawings of fish and fowl.
LEAH HAZARD, WRITER: The pictures are absolutely stunning. The colors are rich. The attention to detail is immaculate.
SAM KEAN, WRITER: There were famous stories of him counting all the scales on the fish that he would draw because he wanted to make sure he got things exactly right. He was a really nice combination of meticulous attention to detail but also bringing things to life.
NARRATOR: Murayama once explained that, “Art is the expression of feeling without reason, science [...] the expression of reason without feeling. Mine is the task of depicting scientific facts, so that they shall have both human and artistic interest.”
RACHEL GROSS, WRITER: Scientific illustrators are science communicators. There's a million tiny judgments about what to leave out and what to enhance and what will be the most useful, but also visually compelling, and what will get people's attention.
NARRATOR: In New York, Dr. Pap and Mary were in the midst of putting together a definitive book about their revolutionary diagnostic tool. Knowing what a difference Murayama’s illustrations could make, George wrote to his old friend, and by October 1st, Murayama had taken on the massive project of illustrating the progression of cancer across cervical cells.
KIRSTEN GARDNER, HISTORIAN: So when you are drawing these small little parts of the cell, he would spend an agonizing amount of time getting them correct. He used colors in a way that made differences in the cells much easier to identify–they were very rich and they were very defined.
NARRATOR: Murayama had been on the project for only two months when everything changed.
Soon after the United States declared war on Japan, Murayama was arrested, his house back in DC ransacked.
KIRSTEN GARDNER, HISTORIAN: Murayama faced a lot of discrimination because of his ethnicity. At this time there was widespread anti-Japanese hysteria.
ARCHIVAL AUDIO: J Edgar Hoover: We ask every citizen to immediately report any information regarding espionage, sabotage, or un-American activities to the Federal Bureau of Investigation.
NARRATOR: On March 26, 1943, the Enemy Alien Hearing Board – a citizen-led Department of Justice project that decided the fate of each Japanese, Italian, or German immigrant – placed Murayama in an internment camp, on Ellis Island.
SAM KEAN, WRITER: It was used as a detention camp for people like Murayama who’d done nothing wrong besides being born in Japan.
NARRATOR: Every professional acquaintance of Murayama’s was interviewed, and asked to give a written statement about his loyalties.
A file was prepared for Hoover and the FBI. The Murayama case, like so many tens of thousands of others, grew to include masses on masses of documents, a sea of paper chasing a crime that simply wasn’t there. Papanicolaou tried to argue on his collaborator’s behalf, writing to the Board that “Murayama’s work [...] could not well be duplicated by anyone not having his talent.”
In mid-June, in a letter three pages long, Murayama himself wrote:
“I am 64 years old, having lived here for more than a half of my life, [I] have no intention to return to Japan. I intend to remain here, and to devote the remainder of my life to the precious work which would contribute toward saving [...] American women’s lives.”
Then, on August 9th, some four months after his arrest, something remarkable happened.
SAM KEAN, WRITER: The Attorney General of the United States, Francis Biddle intervenes on behalf of Murayama. Biddle knows about the work that Papanicolaou is doing on cancer screening. And Biddle considers this of vital national importance.
NARRATOR: As luck would have it, the man in the Attorney General’s office had long harbored doubts about the country’s policy of internment.
ARCHIVAL AUDIO: Francis Biddle: We must remember our grandparents or our great grandparents all were aliens in their day.
NARRATOR: But behind Biddle’s decision there was, also, proof of something else.
LEAH HAZARD, WRITER: The fact that Murayama was released from Ellis Island shows just how seriously the government took this threat of cervical cancer, and consequently, the value of George's research and Murayama's role in it.
NARRATOR: As the Papanicolaous and the Murayamas celebrated his release that summer, the book that they had all been working on was finally published. It was the result of untold hours at the microscope. 3,014 women had given the smears that made it all possible. But it was Murayama’s illustrations that made it a sensation.
LEAH HAZARD, WRITER: Science really is nothing without our ability to communicate it to the rest of the world. To have accurate, powerful, illustrations of those cells was completely fundamental to the success of George's work.
KIRSTEN GARDNER, HISTORIAN: What those visual images did is they allowed the public to imagine how you could categorize cancerous cells. If you have an epiphany at your desk and then you have no support for it, it's not going to go anywhere. So these moments of change and innovation, they're part of a network.
RACHEL GROSS, WRITER: There’s this period right after World War II where there's a lot of faith in technology as the thing that helped us win the war. And it's now being applied to medicine.
NARRATOR: Nowhere were the postwar changes more evident than at the American Society for the Control of Cancer. Newly renamed – and fully rebranded – the American Cancer Society had become a completely different organization. Its transformation had been led by the will of one woman.
ARCHIVAL AUDIO: Mary Lasker: I have some pictures here by Cézanne, and Manet, and Renoir, Van Gogh.
BARRON LERNER, MD, HISTORIAN: Mary Lasker was a philanthropist, and she had a housekeeper who had died of cancer and she was surprised to learn how little was being done to prevent these cancers, and treat these cancers. So Lasker made it her goal to modernize the American Society for the Control of Cancer, and that's what she did.
ARCHIVAL AUDIO: Lasker: The amount of money that's being spent for medical research is…well it’s just piddling. Less is spent on cancer research than we spend on chewing gum!
NARRATOR: Lasker’s new fundraising tactics soon paid off, and in no time the Society’s annual budget had grown over a hundred fold. Now, what the ACS really needed was a big, ambitious project – something to show the public that cancer was a disease that you could actually do something about.
The pap smear was the perfect tool for the job, but its roll out would introduce an entirely new set of challenges.
ARCHIVAL AUDIO: Papanicolaou: A trained and skilled cytotechnician cannot examine more than twelve specimens a day. That is about 60 a week or 3,000 a year. You can figure out how many technicians are needed to study the specimens from the population of the United States.
NARRATOR: Recently, Papanicolaou’s lab had become a teaching center, a place where the next generation of cytologists could be trained. At the heart of the classes and the instruction was, more often than not, Mary Pap herself.
KIRSTEN GARDNER, HISTORIAN: Every technician that came in there, she sat down and she worked with them in terms of how we stain the slides, how we identify the slides.
NARRATOR: Mary would later explain that she believed that people are born scientists. She’d been the one who’d decided they wouldn’t have children, so that they could keep working together, always. “There was no other option for me,” she’d say, “but to follow him inside the lab, making his way of life mine.”
For 21 years, she’d had a smear every day – some 7,665 smears in all.
LEAH HAZARD, WRITER: You can just imagine what that was like – or can you? I mean, none of us have submitted to such a kind of long-term invasive campaign of personal investigation. To involve your body, and your life, to that extent in your partner's work is really remarkable. And I think, to describe her as an equal partner in George's work is almost even to do her a discredit, because she immersed herself in it, body and soul.
NARRATOR: Mary Papanicolaou had made the smear possible. But there were limits to what even she could do.
LEAH HAZARD, WRITER: It would've been really challenging to win hearts and minds, especially in the 50s, you know. To be invited in for a screening program where you have to lift your dress and open your legs would not have been an easy sell.
NARRATOR: As both George and Mary well knew, there were millions of women in America. Every single one of them needed to hear how the Pap could save their life. And for that, what was really needed were people on the ground.
NARRATOR: In Philadelphia, in 1948, Helen Dickens was busier than ever.
AMEENAH SHAKIR, HISTORIAN: She would do workshops like Cancer in Women, Cancer in the Uterus. But also working specifically with these club women's groups in Philadelphia, like the Pyramid Club, the Junior Business and Professional League. But Dickens doesn't just work with those societies. She also would do workshops for hairdressers.
JAYNE HENDERSON BROWN, MD, DAUGHTER OF DR. HELEN DICKENS:: People kept calling on her to speak here and there. The more she did, the more people heard about her. Word spread, quickly.
NARRATOR: Now, Doctor Dickens was in a new position of power. After passing her boards to become the only Black female OBGYN in all of Philadelphia, she’d taken a job as the head of the department at Mercy Hospital.
JAYNE HENDERSON BROWN, MD, DAUGHTER OF DR. HELEN DICKENS: She didn't leave the office and come home. She didn't do that. There were phone calls at home. She called patients back. She was interested in their families. Many of them became friends. In retrospect, I get it. As a kid, I was like, "Oh my goodness." She was gone. She was there for them.
NARRATOR: Always on the lookout for any cutting-edge medical tool that could help her patients, when a publication about the smear came across her desk, Dickens saw its potential at once.
JAYNE HENDERSON BROWN, MD, DAUGHTER OF DR. HELEN DICKENS: She did study what Dr. Papanicolaou was doing, and thought that if she could just spread that technique, it was lifesaving. But it was an uphill battle.
NARRATOR: Since its very beginnings, the practice of gynecology in America had been tied to – and made possible by – the institution of slavery. Surgeons like James Marion Sims, the man behind the modern speculum, had developed the field without any ethical restraints whatsoever.
DEIRDRE COOPER OWENS, HISTORIAN: James Marion Sims founds the first hospital dedicated to women's conditions in the 1840s in Montgomery, Alabama. And it's essentially a hospital for enslaved women. They are experimented on for a number of years, one young woman, Anarcha, she was experimented on almost 30 times…without anesthesia.
NARRATOR: With the rise of the eugenics movement, certain doctors had advocated for – and performed – sterilizations on women of color.
DEIRDRE COOPER OWENS, HISTORIAN: It was considered Mississippi appendectomy. Oftentimes that's what the doctors would tell these patients. And they would go in, and perform hysterectomies on very young Black women. The long-term effect of those sterilization surgeries is that you have a community of people who do not trust doctors, particularly when it comes to reproduction.
NARRATOR: For years, Dickens had worked to gain her patients’ trust – and now she was going to need it.
AMEENAH SHAKIR, HISTORIAN: With the Pap Smear what she's really concerned about educating the public about, “This is not a form of sterilization, but it in fact will help to prevent you from getting cancer.”
DEIRDRE COOPER OWENS, HISTORIAN: She understands some of the trepidation, and she's saying, “Look, I'm a product of this, and I'm telling you that you can trust me.
NARRATOR: In 1953, a new cancer center opened under Dickens’ direction at Mercy Hospital – it would finally document the instances of reproductive cancer in the Black community.
As Dickens would argue, “No woman need die from cervical cancer.”
But it remained an open question. When those clinics opened, would women go?
LEAH HAZARD, WRITER: The first wide-scale screening program that involved the pap smear took place in Tennessee.
SAM KEAN, WRITER: A lot of this work was done at clinics, but they also used what they called Pap stations that would pop up. Small, mobile clinics, at schools, businesses.
NARRATOR: It was called the Memphis Cancer Survey Project. Over five years, from 1952 to 1957, it would enroll hundreds of thousands of women, and become the first real-world test of the pap smear.
Meanwhile, across the country, the American Cancer Society was funding the training of an entirely new labor force – and it was an army of women.
LEAH HAZARD, WRITER: There's a story about how these women were looking at these cell samples, and on the wall they had Murayama's paintings and so if they were looking at a slide and, "Oh. I'm not quite sure. Does that look normal?" they could look at this amazing reference point and go, "Oh, yeah. Okay. That's what I should be looking for. This is cancer," or "This isn't cancer."
NARRATOR: Hashime Murayama, by this time, was well and truly retired. But there was no question that he’d delivered on his promise: he’d devoted his considerable skill to helping save American women’s lives.
RACHEL GROSS, WRITER: The mass trials in Tennessee reveal that this test is 98% or more effective at detecting cancer. And that's really the kind of confirmation that you need to start spreading this as a medical tool.
NARRATOR: In Philadelphia, Dr. Helen Dickens was leading the charge.
She’d gone out and taught the technique to as many other Black doctors as possible – and soon had grown her army of one into a force more than 200 strong.
ARCHIVAL AUDIO: Helen Dickens: You took a wagon and went out to the churches in various places, and invited women into the van, like, to have a pap smear done.
RACHEL GROSS, WRITER: She really made it her mission to use any means available to her to get the word out. She would recommend that families appoint a female representative who made sure every woman in the family got their pap smear.
NARRATOR: In the end, Dr. Dickens had simply refused to wait for people to come. She’d gone to them.
AMEENAH SHAKIR, HISTORIAN: She's always thinking of herself as a worker, and for her, work means the liberation of Black people through medical activism.
JAYNE HENDERSON BROWN, MD, DAUGHTER OF DR. HELEN DICKENS: Her legacy is the gift she gave of healthcare to every woman who came, you know, within 10 feet of her.
ARCHIVAL AUDIO: Helen Dickens: The care of women. Dealing with women. That was the specialty I liked.
NARRATOR: By 1958, the pap smear was triumphant, and both George and Mary were invited to the White House, where they dined with Eisenhower, and the Queen of Greece. Their simple test for cancer had long since left the lab, to become a vital part of women’s lives.
BARRON LERNER, MD, HISTORIAN: The Pap test helped de-stigmatize cancer. By the late 1960s, you could go to the public and say, “Go get this test at your doctor. Sure, we might find cancer, but we have something to do about it.” Let’s get cancer out of the closet. Let’s make this a disease that everybody can talk about.
ARCHIVAL AUDIO: WOMAN 1: I have an appointment that I make once a year for my checkup.
ARCHIVAL AUDIO: WOMAN 2: Of course I go for a Pap Test, every lady should.
ARCHIVAL AUDIO: WOMAN 3: My daughter went for a Pap Test and she’s fine.
DEIRDRE COOPER OWENS, HISTORIAN: The ways that this medical discovery literally changed the globe is incredible. The pap smear educated people about medicine, and preventative healthcare. And more importantly, it saved people’s lives.
LEAH HAZARD, WRITER: The Pap smear changed the landscape for cancer, for its detection, its diagnosis, and treatment. Suddenly we could envision a time when we could screen healthy people, and we could all be thriving in a new and quite exciting way.
CARD: BY SOME ESTIMATES, THE PAP SMEAR HAS SAVED MORE THAN ONE MILLION LIVES.
