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HPV 18 caused 19  percent of all cervical cancer cases in Sweden, in particular adenocarcinomas. High vaccination coverages are required to eliminate the most oncogenic HPV types like HPV 16 and HPV 18, while medium-oncogenic viruses such as HPV 31, 33, 45, 52, and 58 are easier to eliminate due to their lower reproduction number. Women born 1994-1998 were offered catch-up vaccination against HPV 16 and HPV 18 at ages 13-18, but only about 55 percent participated, which is insufficient to eliminate these viruses. Offering vaccination against HPV 16, 18, 31, 33, 45, 52, and 58 to women born in 1994-1998 and achieving around 70 percent participation should eliminate the medium-oncogenic viruses and achieve population immunity also for HPV 16/18. A national project offering free vaccines and screening against these HPV types is ongoing since 2021. Already at the start of the project, there was only a single case of HPV 18 in age groups with high vaccination coverage, implying that extinction of this virus is imminent.

The centennial anniversary of Hans Hinselmann's initial publication describing colposcopy is approaching. In the 100 years since the inventor's seminal paper, colposcopy has become indispensable in the diagnosis and management of cervical cancer. It remains central in diagnosing precancerous and cancerous cervical lesions and has dramatically reduced cervical cancer incidence and mortality since the mid-20th century., Previous descriptions of colposcopy's development in medical literature obscure the dark history of its earliest days, arising within the center of German Nazism. The pioneers of colposcopy benefited from the Nazi government's public health focus and exploited the environment fostered by the Nazi medical establishment. They made use of the apparatus of the Auschwitz concentration camp to position colposcopy for expanded postwar adoption, ultimately accomplishing Hinselmann's stated goal that colposcopy become a routine part of gynecologic examination and care. This historical exposition clarifies the Nazi past of colposcopy, highlights the important role that unethical treatment of victims of Auschwitz played in cementing this procedure within standard cervical cancer screening programs globally, and offers steps to reckon with this tragic legacy., Competing Interests: Disclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-2735.

Background: The earliest cytotechnologists are largely unknown., Summary: In 1943, the book "Diagnosis of Uterine Cancer by the Vaginal Smear" by Papanicolaou and Traut recognized several women who have largely faded from memory. While Mary Papanicolaou and Charlotte Street are familiar names, others like Alberta Kuder and Huldah Boerker, who inadvertently laid the groundwork for the field of cytotechnology, remain obscure. There were also women like Christine Rassias and Adele Reboul who did not receive recognition. Notably, Mrs. Lady Mary G. Papanicolaou, despite her significant contributions both in the lab and at home since 1914, was not acknowledged in her husband's work until the publication of his Atlas in 1954., Key Message: These women set the benchmark for future cytotechnologists, unknowingly shaping the profession as we know it today., (© 2024 S. Karger AG, Basel.)

Background: Gynecologic cancers seriously threaten women's life and health. This study aims to assess the long-term trends of mortality from the three major gynecologic cancers in China and to examine the age-, period-, and cohort-specific effects behind them during the period 1990 to 2019., Methods: The mortality data of cervical, ovarian, and uterine cancer in China were obtained from the Global Burden of Disease Study 2019 and were analyzed with the age-period-cohort framework., Results: It was found that the net drift for cervical cancer mortality was -0.19% (95% CI, -0.46% to 0.08%) per year, for ovarian cancer was 0.76% (95% CI, 0.57% to 0.95%) per year, and for uterine cancer was -3.09% (95% CI, -3.44% to -2.76%) per year from 1990 to 2019. During this period, while cervical cancer remained the most common cause of death among gynecologic cancers among Chinese women, ovarian cancer replaced uterine cancer as the second leading cause of death in gynecologic cancers after about 2005. Significant age, cohort, and period effects were found for the mortality trends of all three major gynecologic cancers., Conclusions: The secular trends of mortality from the three major gynecologic cancers in China and their underlying age, period, and cohort effects are likely to reflect the progress of diagnosis and treatment, rapid socio-economic transitions, and the accompanying lifestyle and behavior changes. More priorities of further epidemiology studies and efforts on the prevention and control should be given to three major gynecologic cancers., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests, (Copyright © 2021. Published by Elsevier Inc.)

This article discusses the structuring of the Hospital of Gynecology in Belo Horizonte, Minas Gerais, which was founded by the gynecologist Clóvis Salgado in 1939 as part of efforts to control cervical cancer. Created as a space for practical teaching in the School of Medicine, the hospital was a pioneer in introducing colposcopy in the state and establishing a structure specifically for care and diagnosis. This analysis investigates how promoting and attempting to assert diagnostic technologies were important in organizing this institution and its professional staff. The hospital firmly established itself in terms of activities to control cervical cancer by disseminating colposcopy as a technique, establishing dialogs with similar national institutions, and participating in exchanges with German science.

Background and Objectives: This article examines a cervical screening incident from the 1960s and draws lessons for screening policy., Study Design and Setting: Concern about harmful overtreatment of symptomless lesions prompted university gynecologist Herbert Green to study, between 1965 and 1970, a 'special series' of 33 women with carcinoma in situ (CIS) who were managed with only limited punch or wedge biopsy. These women were carefully followed up but not treated unless they showed evidence of progression to invasive cancer. This paper examines source documents and subsequent publications in order to ascertain lessons from this incident., Results: In keeping with the 1964 Helsinki Declaration, written consent was not sought. Green published the outcomes for his patients with CIS including the 'special series.' A Judicial inquiry (the Cartwright Inquiry) in 1987 concluded that some women had suffered harm and some had died, but numbers and evidence were not clearly stated. Medical case review for the Inquiry identified 25 women with only punch or wedge biopsy; in 21 of these, there were reasons why no further treatment was given; two had developed cervical cancer, and none were recorded as having died. The case review found eight patients, not necessarily in the 'special series,' who 'in retrospect and by 1987 standards' might have benefited from earlier conisation or hysterectomy., Conclusion: Subsequent claims relating to Green's practice have wrongly stated that as many as one hundred women or more had treatment withheld and over 30 died as a result. These claims are inaccurate., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Mammographic screening for breast cancer is a widely used public health approach, but is constantly a subject of controversy. Medical and historical research on this topic has been mainly conducted in Western Europe and North America. In Brazil, screening mammography has been an open topic of discussion and a challenge for health care and public health since the 1970s. Effectively, Brazilian public health agencies never implemented a nationwide population-based screening programme for breast cancer, despite the pressures of many specific groups such as advocacy associations and the implementation of local programmes. This article examines the complex process of incorporating mammography as a diagnostic tool and the debates towards implementing screening programmes in Brazil. We argue that debates about screening for breast malignancies, especially those conducted in the late twentieth and early twenty-first centuries, took place in a context of change and uncertainty in the Brazilian health field. These discussions were strongly affected both by tensions between the public and the private health care sectors during the formative period of a new Brazilian health system, and by the growing role of civil society actors. Our study investigates these tensions and their consequences. We use several medical sources that discussed the topic in Brazil, mainly specialised leading oncology journals published between 1950 and 2017, medical congress reports for the same period, books and theses, institutional documents and oral testimonies of health professionals, patients and associations collected in the framework of the 'The History of Cancer' project from the Oswaldo Cruz Foundation and Brazilian National Cancer Institute., (© The Authors 2019.)

Background: Cervical cancer (CC) incidence in Estonia is the third highest in Europe, even though an organised nation-wide screening program has been in place since 2006. The aim of the study was to analyse the incidence and survival of CC in Estonia, focusing on age, morphology and stage at diagnosis., Methods: Data from Estonian Cancer Registry were used to analyse age-standardized (world) and age-specific incidence for 1968-2014 rates. Joinpoint regression was used to estimate the annual percentage change (APC) for incidence trends. Age-period-cohort model was used to summarise time trends in terms of cohort and period effects. Relative survival ratios (RSR) were calculated for cases diagnosed in 1995-2014. Union for International Cancer Control version 7 of the TNM classification for malignant tumours was used to categorise stage., Results: The age-standardized incidence of CC increased since 1980s at a rate of 0.8% per year. A significant increase was seen for all age groups except for 70+. The incidence of squamous cell carcinoma mimicked the overall trend, while adenocarcinoma showed increase since mid-1990s (APC 6.7). Age-period-cohort modelling showed strong cohort effects with the lowest risk for birth-cohorts born around 1940 and significantly increasing risks for successive cohorts born thereafter. No period effects were seen. The proportion of stage IV cases increased from 13% in 2005-2009 to 18% in 2010-2014. A significant increase was seen in the overall 5-year RSR from 1995 to 1999 to 2010-2014 (58% vs 66%). In 2010-2014, the 5-year RSRs ranged from 89% in women aged 15-39 to 41% in age group 70+. For stages I to IV, the respective RSRs were 98, 74, 57 and 22%., Conclusions: The inadequate uptake and insufficient quality of the Pap-smear based screening program has not brought along a decline in the incidence of CC in Estonia. Stage distribution has shifted towards later stages. New approaches are needed to prevent CC in Estonia.

Since 1970, the Gynecologic Oncology Group (GOG) has been at the forefront of evaluating and helping to implement ground breaking and paradigm changing research in the management of cervical cancer. While the most dramatic example of this impact was a series of clinical trials published in 1999 that evaluated chemoradiation therapy versus radiation therapy alone for patients with various clinical scenarios, including both locally advanced as well as post radical hysterectomy patients, investigation has continued to further refine and improve therapy. In 2014, based on the results of GOG protocol 240, bevacizumab became the first approved targeted therapy in a gynecologic cancer in the United States. Most recently, clinical trial work from the GOG is changing the standard of care for all clinical scenarios. Finally, an emphasis on survivorship and special populations are now top priorities., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Ernst Wertheim was a pioneer in the history of the surgical treatment of cervical cancer. His English-language manuscript "The extended abdominal operation for carcinoma uteri (based on 500 operative cases)," which was published in 1912, detailed his standardization of the radical hysterectomy and formed the basis of the current treatment for early stage cervical cancer. We contextualize the Wertheim hysterectomy, emphasizing medical advances that allowed for its development and subsequent modification. We then discuss modifications to the originally proposed procedure, including a maximally extended parametrical resection pioneered by Takayama, and the addition of the Taussig en bloc lymph node dissection by Meigs, both of which afforded an improved mortality profile due to decreased disease recurrence. Finally, we discuss progress that has been made in the present day, such as the development of nerve-sparing and fertility-sparing surgeries, as well as the introduction of the robotic platform. In this way, we hope to provide a historical background for the Wertheim hysterectomy-a cornerstone of gynecologic oncology., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Disparities in Cervical Cancer (CC) mortality outcomes between African American (AA) and White women have been studied for decades. However, conclusions about the effect of race on CC survival differ across studies. This study assessed differences in CC survival between AA and White women diagnosed between 1985 and 2010 and treated at two major hospitals in the southeastern US. The study sample included 925 AA and 1192 White women diagnosed with cervical adenocarcinoma, adenosquamous cell carcinoma, or squamous cell carcinoma. Propensity score adjustment and matching were employed to compare 5-year survival between the two racial groups. Crude comparisons suggested relevant racial differences in survival. However, the racial differences became of small magnitude after propensity-score adjustment and in matched analyses. Nonlinear models identified age at diagnosis, cancer stage, mode of treatment, and histological subtype as the most salient characteristics predicting 5-year survival of CC, yet these characteristics were also associated with race. Crude racial differences in survival might be partly explained by underlying differences in the characteristics of racial groups, such as age at diagnosis, histological subtype, cancer stage, and the mode of treatment. The study results highlight the need to improve access to early screening and treatment opportunities for AA women to improve posttreatment survival from CC., (© 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Instituto de Ginecologia (Institute of Gynecology), in Rio de Janeiro, headed by Dr. Arnaldo de Moraes, was the first institution in Brazil to introduce and divulge medical techniques for the control of cervical cancer in the mid-1900s. It became a benchmark for actions geared towards the disease at the time, organizing a specific diagnostic procedure that set Brazilian medicine apart in the field, in which it remained a leader until the 1970s. The aim of this text is to discuss the organization and running of the institution from two perspectives: its role in enhancing the position of gynecology as a medical specialty, and its role in spreading a standard practice for the control of cervical cancer.

In 1974, Valerie Beral published a landmark paper on the sexually transmitted origin of cervical cancer (CC) using statistics routinely available in the United Kingdom (UK). Among women born between 1902 and 1947, CC mortality rates correlated remarkably well with the incidence rates of gonorrhoea when they were 20 years old and both were highest among women born after 1940. Hence, if CC prevention and treatment had remained unchanged, the youngest generations of women would have experienced a high risk of CC death as they grew older. Fortunately, progress in CC prevention has helped avoid this scenario. The adverse consequences of the "sexual revolution" were greatly mitigated in the UK and other high-resource countries by the implementation of high quality cytology-based CC screening. An age-period-cohort analysis suggests that >30,000 cases or approximately 35% of expected CC cases may have been prevented by screening programmes in the UK between 1983 and 2007 and this percentage has been steadily increasing. In addition, the discovery of the causal role of HPV is reshaping primary and secondary prevention of CC. Cheaper HPV tests are becoming available and HPV-based primary screening may at last facilitate CC screening in low-resource countries. In the long-term, however, HPV vaccination, which has already been adopted by many countries, represents the best hope for preventing CC and overcoming socio-economic differences in CC risk within and across countries. The additional elucidation of HPV cofactors to which Beral has greatly contributed may also help control HPV infection in unvaccinated women., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

When mortality patterns for cancer of the uterine cervix were compared with trends in incidence of sexually transmitted diseases in both England and Wales and in Scotland, there were striking associations between the temporal, social class, occupational, and geographic distributions of these diseases. The data suggest that exposure to sexually transmitted infection is an important determinant of cervical cancer. Although they are still young, women born after 1940 are already experiencing increased cervical-cancer mortality. If cervical-cancer prevention and therapy remain unchanged, this generation's high risk of death from cervical cancer will probably continue to operate throughout their lives., (Copyright © 2015. Published by Elsevier Ltd.)

Cervical cancer (CC) is one of the best known malignancies. Currently, it is accepted that the etiological factor is persistent infection with high-risk human papillomavirus (HPV). Even before the identification of its etiological factors, methods such as Pap cytology and colposcopy were developed as tools for early diagnosis on CC and its precursor lesions. At the time when such tests were being developed, they were not fully accepted by the scientific community of the time; however, as time went by, the dissemination of knowledge, and more extensive application, these tests were finally included within the international guidelines. The implementation of programs with adequate coverage and quality allowed a significant reduction in the incidence and mortality of CC. However this did not occur widely, and CC is still a public health problem in developing countries. From the epidemiological and molecular viewpoint, knowledge on HPVs laid the foundations for the development of new prevention strategies based on vaccination and molecular detection of the causal agent, currently accepted as strategies for primary and secondary prevention. It is expected that the implementation of these strategies will have a greater impact on the control on CC and other malignancies associated with HPV infection.

This paper discusses the knowledge and medical practices relating to cervical cancer in Brazil. It analyses the growing medical interest in the disease at the beginning of the twentieth century, the development of prevention techniques in the 1940s, and the emergence of screening programs in the 1960s. It argues that the development of knowledge on cervical cancer was related simultaneously to a number of factors: transformations in medical knowledge, the development of the idea that the disease should be treated as a public health problem, the increased concerns with women's health, and major changes to the Brazilian healthcare system. The article concludes by identifying a number of issues that are still proving to be obstacles to control of the disease.

Background: The main purpose of this study was to model and analyze the dynamics of cervical cancer mortality rates for African American (Black) and White women residing in 13 states located in the eastern half of the United States of America from 1975 through 2010., Methods: The cervical cancer mortality rates of the Surveillance, Epidemiology, and End Results (SEER) were used to model and analyze the dynamics of cervical cancer mortality. A longitudinal hyperbolastic mixed-effects type II model was used to model the cervical cancer mortality data and SAS PROC NLMIXED and Mathematica were utilized to perform the computations., Results: Despite decreasing trends in cervical cancer mortality rates for both races, racial disparities in mortality rates still exist. In all 13 states, Black women had higher mortality rates at all times. The degree of disparities and pace of decline in mortality rates over time differed among these states. Determining the paces of decline over 36 years showed that Tennessee had the most rapid decline in cervical cancer mortality for Black women, and Mississippi had the most rapid decline for White Women. In contrast, slow declines in cervical cancer mortality were noted for Black women in Florida and for White women in Maryland., Conclusions: In all 13 states, cervical cancer mortality rates for both racial groups have fallen. Disparities in the pace of decline in mortality rates in these states may be due to differences in the rates of screening for cervical cancers. Of note, the gap in cervical cancer mortality rates between Black women and White women is narrowing.

Through a number of isolated initiatives that began in the 1960s, Brazil accumulated knowledge and experience that in the late 1990s culminated in the implementation of the first nationwide public health action meant to coordinate health bodies and personnel from the federal, state, and municipal administrative levels to address a chronic degenerative disease. The main goal of this article is to analyze the process of construction of this public policy for cancer control in Brazil--more specifically, organized screening for the control of cervical cancer in the form of the Viva Mulher program. Our analytical approach relies on elements from the history of public policy and from the history of institutions, combining the use of documental sources, scientific literature, and interviews with managers involved in the process under study. Our analysis endeavors to show how and to what extent this national process incorporated the experiences of local projects and responded both to pressure from the social movement and to the country's political environment. It further shows how the new context, shaped by changes in the organization of the Brazilian health system, influenced this process.

The Aristides Maltez Hospital in Salvador (Bahia) was inaugurated in 1952. The hospital was a philanthropic institution of the Bahian League Against Cancer. The Aristides Maltez Hospital specialised in cancer treatment, especially cervical cancer, and became a reference centre for the control of cancer in northeastern Brazil. This article follows the creation and consolidation of the hospital as a treatment, research, and training centre, evaluating its role in discussions and action networks on cervical cancer in the mid-20th century. The institution has been a space of transition in the use of diagnostic tools and the organisation of campaigns to control cancer in municipalities of the hinterland.

The implementation of the Pap test as a primary technology in the control of cervical cancer in Brazil was the result of choices, agreements and disputes among certain professional groups, including physicians from various specialisations, pharmacists, biologists, biomedical scientists and cytotechnologists. The first part of the paper describes the process of formulating Brazil's first screening campaigns using the Pap smear, and the subsequent emergence of the profession of cytotechnology, whose practitioners interpret this test. Second, based on questions raised by international historiography in the field of science and technology, we explore in detail how the adoption of the Pap smear transpired within the Brazilian context, focussing on the debates among the various professional groups with an interest in the suitability of the test and on the relationships between the public and private healthcare sectors. We show that the professional career of cytotechnologists and the way in which the Pap smear has been implemented as a central technology for cervical cancer screening in Brazil have been shaped by the conflicting views of this technology held by different disciplines as well as by the relationship between these disciplines and labour market dynamics.

The Papanicolaou smear or cervicovaginal cytology has been the mainstay of screening for cervical cancer in women of over 60 years. In this article, the origins of the Pap smear as a screening method and the many changes associated with the use of the Pap smear are detailed.

Purpose: To provide historical background on the development and initial studies of the gynecological (gyn) applicators developed by Dr. Gilbert H. Fletcher, a radiation oncologist and chairperson from 1948 to 1981 of the department at the M.D. Anderson Hospital (MDAH) for Cancer Research in Houston, TX, and to acknowledge the previously unrecognized contribution that Dr. Leonard G. Grimmett, a radiation physicist and chairperson from 1949 to 1951 of the physics department at MDAH, made to the development of the gynecological applicators., Methods and Materials: We reviewed archival materials from the Historical Resource Center and from the Department of Radiation Physics at The University of Texas M. D. Anderson Cancer Center, as well as contemporary published papers, to trace the history of the applicators., Conclusions: Dr. Fletcher's work was influenced by the work on gynecologic applicators in the 1940s in Europe, especially work done at the Royal Cancer Hospital in London. Those efforts influenced not only Dr. Fletcher's approach to the design of the applicators but also the methods used to perform in vivo measurements and determine the dose distribution. Much of the initial development of the dosimetry techniques and measurements at MDAH were carried out by Dr. Grimmett., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Human papillomavirus has been a cause of infection in humans for thousands of years. The history of papillomaviruses, knowledge of their causative role in benign and malignant disease, and their structural characteristics have led to the development of vaccines to prevent cervical and anogenital cancers. Many questions remain unanswered before HPV vaccines can be optimised; however, the concept of virtual eradication of cervical cancer is not impossible, and remains a realistic aspiration., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The birth of the "do not delay" principle in cancer treatment has often been linked with developments in late nineteenth century: the rise of histology and cellular theory of malignancy that favored the definition of cancer as a local pathology, then the development of radical surgical techniques that transformed malignant tumors into a potentially curable condition. This text seeks to nuance this view. It points out important continuities in the understanding of the natural history of uterine cancers. At its center, the wish, already present in early nineteenth century, is to detect "early," that is, small and localized malignant lesions, then to extirpate or destroy these lesions before they become fully blown cancer. The long history of this particular regime of hope helps demonstrate why it is so difficult today to promote more nuanced views of the efficacy of early detection of malignant tumors.

The quasi-totality of social scientists who studied screening for cervical tumours identified such screening with a single method: the Pap smear (exfoliative cytology). This article explains that this method was not valid everywhere. The history of screening for cervical cancer in Brazil displays an alternative method for detecting cervical malignancies: a direct observation of the cervix with a specific instrument--the colposcope. The development of this method in Brazil in the 1940s and 1950s reflected a complex mixture of professional interests, government policies, and regional, local and charitable initiatives. While the use of colposcopy for cervical tumour screening was phased out in the 1970s and 1980s, the long lifespan and widespread diffusion of this method illuminates the irreducible contingency of specific developments in science, technology and medicine. Seen from the vantage point of Brazil, the Western model for preventing cervical malignancies no longer appears self-evident Alternative choices might have led to the development of different material and visual cultures of medicine, stimulated different patterns of medical specialization and division of medical labour, produced different links between malignancies, women, gynaecologists, epidemiologists and public health experts, and shaped different health policies.

The expectation of participation in cervical screening programs has become a ubiquitous feature of women's lives; but despite the obvious importance of trying to prevent cervical cancer, both the expression and fulfilment of that expectation are far from straightforward. This is because the actors involved are not always consistent in their interpretation of the risks involved and safety sought. The history of cervical screening in Australia illustrates how the implementation of medical surveillance can be shaped by such interpretations. We argue in particular that conflict in Australia over screening frequency requires an explanation of this kind, and more broadly that we have entered an era of preventive medicine that can be described as one of 'contested surveillance'.

Background: It has been claimed that publicity surrounding popular celebrity Jade Goody's experience of cervical cancer will raise awareness about the disease. This study examines the content of newspaper articles covering her illness to consider whether 'mobilising information' which could encourage women to adopt risk-reducing and health promoting behaviours has been included., Methods: Content analysis of 15 national newspapers published between August 2008 and April 2009, Findings: In the extensive coverage of Goody's illness (527 articles in the 7 months of study) few newspaper articles included information that might make women more aware of the signs and symptoms or risk factors for the disease, or discussed the role of the human papilloma virus (HPV) and the recently introduced HPV vaccination programme to reduce the future incidence of cervical cancer. For example, less than 5% of articles mentioned well-known risk-factors for cervical cancer and less than 8% gave any information about HPV. The 'human interest' aspects of Goody's illness (her treatment, the spread of her disease in later months, her wedding, and her preparations for her children's future) were more extensively covered., Conclusions: Newspaper coverage of Goody's illness has tended not to include factual or educational information that could mobilise or inform women, or help them to recognise early symptoms. However, the focus on personal tragedy may encourage women to be receptive to HPV vaccination or screening if her story acts as a reminder that cervical cancer can be a devastating and fatal disease in the longer term.

The history on the relationship of VPH infection and cervical cancer was examined. Findings were initially reported in Maracaibo(1971), later in Mexico(1973) and thereafter several studies on the ultrastructure and immunohistochemistry of VPH infection and its role on cervical cancer were described. The ultrastructural findings of viral particles of HPV and their proteins, as well as their role in the incorporation of the viral genome to the human cervical cells were also described. Glycoproteins on the surface of cervical cells were reviewed and their importance on HPV infection was related to p16, blood group antigens and early genetic changes in the cell cycle with loss of heterozigocity, all of which, stimulated by the high risk HPV infection lead to cervical cancer.

Fifty years after Henrietta Lacks died of aggressive glandular cervical cancer, the first cell line - HeLa cell line - is the workhorse of laboratories everywhere. It helped to produce drugs for numerous diseases, including poliomyelitis, Parkinson's, leukemias. But they are so outrageously robust that they contaminated hundred of other cell lines, as far away as Russia. For decades, biologists worked with contaminated cell lines and today, the problem is not yet solved. But the story of HeLa cells is also a moving reflection of racial and ethical issues in medicine in the late half-twentieth century in the USA.

Henrietta Lacks died in 1951 of an aggressive adenocarcinoma of the cervix. A tissue biopsy obtained for diagnostic evaluation yielded additional tissue for Dr George O. Gey's tissue culture laboratory at Johns Hopkins (Baltimore, Maryland). The cancer cells, now called HeLa cells, grew rapidly in cell culture and became the first human cell line. HeLa cells were used by researchers around the world. However, 20 years after Henrietta Lacks' death, mounting evidence suggested that HeLa cells contaminated and overgrew other cell lines. Cultures, supposedly of tissues such as breast cancer or mouse, proved to be HeLa cells. We describe the history behind the development of HeLa cells, including the first published description of Ms Lacks' autopsy, and the cell culture contamination that resulted. The debate over cell culture contamination began in the 1970s and was not harmonious. Ultimately, the problem was not resolved and it continues today. Finally, we discuss the philosophical implications of the immortal HeLa cell line.