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53. Preface

Author

Koss, Leopold G., primary and Coleman, Dulcie V., additional

Published
1981
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57. The Papanicolaou test for cervical cancer detection: the triumph and a tragedy

Author

Koss, Leopold G.

Subjects
Pap test -- Evaluation, Cervix uteri -- Medical examination, Cancer -- Diagnosis, Exfoliative cytology -- Methods
Abstract

The complex system for detecting and treating precancerous growths and early cancer of the cervix is described and discussed in detail. The most difficult and underestimated component of the diagnostic series is the screening and interpretation of smear samples from the cervix ("Pap" smears). Analyses of cell samples thus obtained may fail due to inadequate samples, insufficient screening time, or human error caused by fatigue. Other problems include inadequate patient compliance, non-reproducible test results and ineffective aftercare. For example, taking a second smear to refute a diagnosis is often misleading. Although the cancer detection system has helped reduce disease and death from cervical cancer in properly screened populations, there is no evidence that the pap test has anywhere succeeded in eradicating this theoretically preventable disease. The public should be informed about these failures of the system and the reasons for them., ABSTRACT: The complex detection system leading to the discovery and treatment of precancerous lesions and early cancer of the uterine cervix is described in detail and discussed. By far the most difficult and underestimated component of this system is the screening and interpretation of cervical (Papanicolaou) smears. Cytologic case finding may fail because of inadequate samples, insufficient time devoted to screening, or human fatigue. Other weak points of the system, such as an inadequate clinical component, inadequate patient compliance, poor reproducibility of diagnoses, and ineffective aftercare, are also described. For example, obtaining a second smear to confirm or refute a diagnosis of cellular atypia is often a misleading practice. Although this cancer detection system has been shown to be effective in reducing the rate of morbidity and mortality from invasive cervical cancer in appropriately screened populations, there is no evidence that the Papanicolaou test has succeeded anywhere in complete eradication of this theoretically preventable disease. It is important to inform the public about the potential failures of the system and the reasons for them.

Published
1989

62. Expression of ras oncogene p21 protein in early gastric carcinoma and adjacent gastric epithelia

Author

Czerniak, Bogdan, Herz, Fritz, Gorczyca, Wojciech, and Koss, Leopold G.

Subjects
Oncogenes -- Evaluation, Ras genes -- Evaluation, Stomach cancer, Tumor markers -- Research, Health
Abstract

Oncogenes are genes in human cells which, when activated, may be related to the development of cancer. They are sometimes activated as well during fetal development. Oncogenes, like other genes, contain the code which directs the production of specific proteins, and the ras family is one such group of proteins and oncogenes. Because the ras genes and proteins may be involved in the early stages of carcinogenesis, the levels of one of them, ras p21, has been measured in early gastric (stomach) cancers, in adjacent premalignant cells, and in normal gastric cells. Two types of gastric cancer have been postulated, an intestinal type and a diffuse or gastric type. Both types were examined in this study. Compared with normal cells, the levels of p21 were elevated in both types of early cancer cells and in adjacent premalignant cells with dysplasia (abnormal cell structure) associated with diffuse type but not intestinal type cancer. Interestingly, the levels of p21 were greater in premalignant cells than in cancerous cells, suggesting that p21 does not correlate with extent of cancerous changes. In fact, not all malignant cells contained p21. The data suggest that increased levels of ras p21 may be related to early events of gastric cancer development, but its continuous presence is probably not essential for maintenance of the cancerous cell. Also, the results indicate that the tests for the presence of p21 would not be useful as diagnostic markers for stomach cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1989

63. Cervical and vaginal squamous cell abnormalities in women infected with human immunodeficiency virus

Author

Schrager, Lewis K., Friedland, Gerald H., Maude, Diana, Schreiber, Klaus, Adachi, Akinori, Pizzuti, David J., Koss, Leopold G., and Klein, Robert S.

Subjects
Cervix dysplasia -- Causes of, HIV (Viruses) -- Physiological aspects, Pathology, Cellular -- Causes of, Genitourinary organs, Papillomavirus infections -- Complications, Health
Abstract

Women whose immune systems are suppressed have a greater risk of human papillomavirus (HPV) infections. HPV infection is associated with the development of precancerous disease or cancer in the lower genital tract. The association between HPV infection and human immunodeficiency virus (HIV) infection in women was examined. Cell abnormalities in cervicovaginal smears from women who were infected with HIV were compared with those from women who were not infected. Eleven out of 35 (31 percent) of HIV-infected women had cell abnormalities compared with 1 out of 23 (4 percent) of women who were not infected. Nine of the 35 (26 percent) women who were infected with HIV were also infected with HPV, compared with 1 out of 23 (4 percent) of the women who were not infected. When other factors that may have contributed to the development of cellular abnormalities and HPV infection were examined, it was found that the women who were infected with HIV had an increased incidence of sexually transmitted diseases, a decreased use of barrier contraceptives, a shorter time interval since sexual contact with an individual with AIDS, and decreased numbers of T helper cells (indicating suppression of the immune system), compared with those with were not infected with HIV. Therefore, women who are infected with HIV have a high chance of having abnormalities in the cells of their vagina and cervix and of having HPV infection. Further study is necessary to see if women who are infected with HIV have an increased risk of developing cancer in their lower genital tract. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1989

65. Testing in cervicovaginal cytology

Author

Koss, Leopold G.

Subjects
Cytology -- Testing, Pathological laboratories -- Standards, Medical tests -- Evaluation, Medical tests -- Standards
Published
2006

85. Medicolegal Affairs

Author

Frable, William J., primary, Austin, Robert Marshall, additional, Greening, Shirley E., additional, Collins, Robert John, additional, Hillman, Roger L., additional, Kobler, Terry Paul, additional, Koss, Leopold G., additional, Mitchell, Heather, additional, Perey, Ron, additional, Rosenthal, Dorothy L., additional, Sidoti, Mark S., additional, and Somrak, Theresa M., additional

Published
1998
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86. Computerized Screening Devices and Performance Assessment: Development of a Policy Towards Automation

Author

Bartels, Peter H., primary, Bibbo, Marluce, additional, Hutchinson, Martha L., additional, Gahm, Thomas, additional, Grohs, Heinz K., additional, Gwi-Mak, Elaine, additional, Kaufman, Edward A., additional, Kaufman, Raymond H., additional, Knight, Bryan Kenyon, additional, Koss, Leopold G., additional, Magruder, Louise E., additional, Mango, Laurie J., additional, McCallum, Shan M., additional, Melamed, Myron R., additional, Peebles, Anne, additional, Richart, Ralph M., additional, Robinowitz, Max, additional, Rosenthal, Dorothy L., additional, Sauer, Torill, additional, Schenck, Ulrich, additional, Tanaka, Noboru, additional, Topalidis, Theodoros, additional, Verhest, Alain P., additional, Wertlake, Paul T., additional, Whittaker, Judith A., additional, and Wilbur, David C., additional

Published
1998
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87. Quality Assurance/Control Issues

Author

Krieger, Paul A., primary, McGoogan, Euphemia, additional, Vooijs, Peter, additional, Amma, Sreedevi, additional, Cochand-Priollet, Beatrix, additional, Colgan, Terence J., additional, Davey, Diane D., additional, Geyer, James W., additional, Goodell, Roberta M., additional, Grohs, Dawn H., additional, Gupta, Subhash Kumari, additional, Jones, Bruce A., additional, Koss, Leopold G., additional, Mango, Laurie J., additional, McCallum, Shan M., additional, Nielsen, Mary, additional, Robinowitz, Max, additional, Sauer, Torill, additional, Schumann, Janet L., additional, Syrjänen, Kari J., additional, Suprun, Harry Z., additional, Topalidis, Theodoros, additional, Wertlake, Paul T., additional, and Whittaker, Judith, additional

Published
1998
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89. Significant reduction in the rate of false-negative cervical smears with neural network-based technology (PAPNET testing system)

Author

Koss, Leopold G, primary, Sherman, Mark E, additional, Cohen, Michael B, additional, Anes, Allen R, additional, Darragh, Teresa M, additional, Lemos, Luciano B, additional, McClellan, Betty Jane, additional, Rosenthal, Dorothy L, additional, Keyhani-Rofagha, Sedigheh, additional, Schreiber, Klaus, additional, and Valente, Philip T, additional

Published
1997
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92. Esophageal Carcinoma Metastatic to the Retina

Author

Cangiarella, Joan F., primary, Suhrland, Mark J., additional, Cajigas, Antonio, additional, Chess, Jeremy, additional, Koss, Leopold G., additional, Berkowitz, Daniel, additional, and Schlesinger, Kathie, additional

Published
1996
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