In a recent issue of Scientific American, Dr. Elizabeth Stern was identified as “probably one of the most significant physician-scientists who worked at the interface of epidemiology and cancer in the mid-20th century … her groundbreaking research led the way to our modern understanding of the prevention, diagnosis and treatment of cervical cancer.” 1

Dr. Elizabeth Stern (1915-1980) was an important contributor to the fields of cytopathology and epidemiology, two emerging fields of research toward the mid- twentieth century.

• Cytopathology refers to the diagnosis or detection of disease at the cellular level, such as through the use of tissue biopsies or analyzing individual cells. These studies can be used to determine the stage of disease, assign appropriate treatment, and monitor patient progress over time.

• Epidemiology is the study of disease distribution within and across populations to discover patterns related to socioeconomic status, age, sex, geographic location, and other factors. The results of epidemiological research help guide public health policy.

Dr. Stern was a careful, thorough and meticulous observer applying techniques from both cytopathology and epidemiology, publishing over 45 papers. She developed cytological criteria that enabled detection of early-stage cervical cancer, allowing earlier treatments and reducing patient deaths.

Dr. Stern’s research defined the earliest stage of cervical cancer development, known as cervical dysplasia
2, and demonstrated the systematic progression of cells from this stage to invasive cancer [1]. Although not widely recognized at the time, dysplasia is now a conventional pre-cervical cancer indicator, and patients with cervical dysplasia are closely monitored for signs of progression to cancer.

Dr. Stern’s work on cervical cancer and dysplasia is tied to her studies on birth control pills. Original forms of birth control pills contained 10 to 100 times more estrogen than safe, leading to harmful side effects largely neglected by the medical profession at that time. Dr. Stern found that high-dose birth control pills were linked to increased risk of dysplasia and cervical cancer [2]. This finding coincided with the growing consumer advocacy movement regarding birth control pills and together these led to reformulation of pills with lower and safer estrogen levels.

In terms of cancer epidemiology, Dr. Stern was well aware that rates of cervical cancer were substantially higher in poor as opposed to middle- and upper-income neighborhoods. She worked closely with public health researchers to establish guidelines for successful community cervical cancer screening clinics in underserved areas. Many of her suggestions such as offering childcare and/or transportation remain relevant today. Her focus on empathy and clear communication were years ahead of her time [3-5]. (continue reading...)