Direct Inspection

Cancer of the cervix is one of the commonest forms of malignant disease. It is also one of the most certainly cur able, provided it is detected early. Thanks to the famed "Pap smear" test for early detection, developed by Cornell University's late Dr. George N. Papanicolaou, the lives of an estimated 15,000 women are now being saved each year in the U.S. But gynecologists believe that almost as many women who develop cervical cancer each year will eventually die of it, and needlessly -- because it is not being detected soon enough.

Today's best hope for improving the cure rate lies not in more sophisticated technology but in a return to the use of the human eye, aided by magnifying lenses, for direct examination of tissues in which disease may be developing. The technique is called colposcopy (pronounced col-poss-cuppy), and its most ardent proponent is the University of Mississippi's Dr. Karl A. Bolten, who learned it from its inventor in Bolten's native Germany.

When Hans Hinselmann (1884-1959), a professor of gynecology who was educated at Bonn and later taught there, sat down in 1924 to write about uterine cancer, he postulated that cancer in its first stages must produce ulcers or tumors too small to be seen by the naked eye. He worked with the Leitz optical firm to produce the first colposcope--essentially a pair of binoculars with a light source, mounted on a pedestal. Though the device has been improved, the principle remains the same today. A choice of lenses gives magnifications from six to 25 diameters, and most models of the colposcope carry a camera to provide a color record of the findings. The entire examination, including photography, takes about seven minutes. A doctor can learn the technique, and how to identify the tissue changes that he sees, in less than, a week.

Endangered Fertility. When Dr. Bolten arrived in the U.S. in 1952, he concluded that colposcopy was undeservedly neglected by American doctors. At a series of seminars, the most recent at Los Angeles' Queen of Angels Hospital, he demonstrated the method and taught its niceties to scores of gynecologists. In his lectures. Dr. Bolten points out the advantages of the doctors' ability to see a tissue change in its earliest precancerous stages and to determine just where it is. Cervical cancer, he notes, is found not only in older women but in young women, who may, as a result, lose their chance of motherhood. He cites the case of a woman in her early 20s, soon to be married. The Pap smear taken at a premarital examination discloses some suspicious cells. Since their source is not precisely pinpointed, standard practice would demand removal of sizable cone-shaped sections of tissue from the cervix and perhaps its entire lip, with the danger of forming scar tissue that could close off the uterus and leave the woman infertile.

In some cases, says Dr. Bolten, colposcopy makes conization unnecessary. Careful examination of the vagina, the cervical opening, and even of the cervical canal itself will reveal suspicious spots, and only these small areas may need to be removed. With experience, the viewing doctor can usually tell which changes are malignant and which benign. In most cases, suspicious areas of either type can be removed precisely enough to avoid endangering fertility. And in a few cases of slowly developing cancer, it may be possible to postpone a hysterectomy until a woman has had one or two more babies.

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