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• W1493730163 abstract "The vaginal smear method appears to have established itself as a valuable screening test, but it is not comparable to biopsy as a decisive diagnostic procedure, nor can it distinguish between intraepithelial and invasive cervical cancer. The possibilities of vaginal and cervical cytology should be fully explored by those fully qualified to do so, and the chief workshop for this purpose should for the present be well-organized and well-equipped clinics. There are still too many pitfalls and limitations to recommend its general adoption among practicing gynecologists. There must still be uncertainty as to the future role to be played by cytological studies, and some justification for the feeling that their importance has been overaccentuated and overpublicized, for reasons elaborated in this paper. There is no need for vaginal smear studies in the vast majority of cases of clinical cancer, with existing lesions, either obvious or suspicious, though there can certainly be no criticism of their supplementary employment. The omission of biopsy in such cases is far more culpable than the omission of vaginal smears. While intraepithelial carcinoma is now commonly accepted as a precursor of invasive cancer of the traditional clinical type, there is still much uncertainty as to the chronological and histological relations between the two. The lack of crystallization of opinions as to the therapy of intraepithelial carcinoma is understandable in view of our still meager knowledge on these points. Only about 10 per cent of clinical cancers are in the favorable Stage I, so that there is still a tremendous need for the education necessary to enlarge this group. The precursory lesions thus far revealed constitute a numerically tiny group, and they appear to be receiving a disproportionate amount of the educational effort. Is our cancer campaign getting a bit out of balance? The study of lesions believed to be precursory to clinical cancer, especially intraepithelial cancer, is of intense interest, and has great scientific potentiality. On the other hand, it is my opinion that at the present time the lives of many more women will be saved by an intensification of our efforts to increase the proportion of Stage I cases than can be saved by the search for cancer in this preinvasive form. It is difficult at this time to predict whether or when vaginal cytology will ever become a generally available diagnostic aid. Until such time, which does not appear to be in the very near future, the practicing gynecologist who makes full and conscientious use of universally available methods, including biopsy in the presence of even very small suspicious lesions, will not miss many cancers in a still highly favorable therapeutic stage. In the screening field, vaginal cytological methods offer definite advantages over biopsy, even of the multiple type, but smears in themselves should not be made the basis for treatment. The limitations of biopsy in women with ostensibly normal cervices can be largely overcome by some such method of surface biopsy as that described in this paper. It is recommended as a valuable procedure, especially in cases where the cytological smears have been positive." @default.
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• W1493730163 date "1949-11-01" @default.
• W1493730163 modified "2023-09-27" @default.
• W1493730163 title "What constitutes an adequate cancer detection examination of the cervix?" @default.
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• W1493730163 doi "https://doi.org/10.1016/0002-9378(49)90196-9" @default.
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