Elizabeth Stern was a pathologist whose research was crucial in the understanding and prevention of cervical cancer, and whose work focused on communities disadvantaged by sex, race and class prejudice.
A Canadian, Stern completed a medical degree from the University of Toronto in 1939 at the age of 24. The following year, she moved to the United States, where she continued her training in pathology at the University of Pennsylvania School of Medicine, and then at the Good Samaritan and Cedars of Lebanon hospitals in Los Angeles.
In LA, she married fellow Canadian Solomon Shankman, a chemist with whom she went on to have three children and spend the rest of her life. Following her marriage, in 1943 Stern became a naturalised American citizen.
Stern was one of the first scientists to specialise in cytopathology – the study of diseased cells which is fundamental in the understanding of cancer. She started her career at Los Angeles’ Cancer Detection Center, where she was a Director of Laboratories and Research. By 1961, she was working for the Medical Schools of the University of Southern California as a research coordinator, and at The University of California, teaching classes in the pathology department.
Stern’s research focused on the study of cancerous cells in the cervix.
At the time, dramatic progress was being made in this field thanks to the development of a screening test that is today known as Pap smear, after Dr Papanicolau, who devised it. The test detected the presence of abnormal cells and cell growth (dysplasia) in the cervix.
Stern set out to determine whether there was a connection between the presence of these cells, which can be a symptom of the herpes virus, or HPV, and the development of cervical cancer. For two years, she studied over 10,000 women in Los Angles County, testing them for dysplastic growths and, a year later, checking whether they had developed cancer.
In a study published in 1963, she concluded that dysplasia almost always led to the development of cervical cancer, which implied that the detection of HPV should be followed by measures aimed at preventing the progress of these cells into a malign tumour. These measures included the excision of dysplastic tissue, a procedure which today is often carried out with laser surgery and is effective in preventing the development of cervical cancer.
Also in 1963, Stern became an associate researcher at the University of California’s School of Public Health, and in 1965 she was promoted to professor of epidemiology.
In subsequent research, Stern drew on her knowledge of both cytopathology and epidemiology to understand what factors encouraged women to access gynaecological healthcare, or prevented them from doing so. Being especially interested in the approach to healthcare among poorer women, and having surveyed that cervical cancer was more common among black and Hispanic women, Stern directed her team’s research effort to determine the causes for this, and possible solutions. She coordinated the opening of special free clinics where women could be tested for cervical abnormalities. Her studies revealed that women were more likely to put themselves forward for tests if childcare, transportation and flexible hours were offered. Another determining factor was the reassurance that a female nurse or doctor would carry out the tests.
In another groundbreaking study, Stern tried to determine whether the regular use of the oral contraceptive was linked with the development of cervical cancer. Again, she surveyed thousands of women, this time for a period of seven years and in a study published in 1977, she concluded that women who regularly took the pill were six times more likely to develop cervical cancer. This eventually led to the removal of Enovid from the pharmaceutical market – the contraceptive which contained about ten times the amount of oestrogen in contemporary oral contraceptives.
Stern was diagnosed with stomach cancer in the 1970s. She underwent several cycles of chemotherapy but eventually died in 1980. Her studies were crucial in preventing thousands of women from dying of cervical cancer. Thanks to her discoveries in preventing, diagnosing and stopping the disease, cervical cancer went from being one of the biggest killers of American women in the 1950s to having its fatality rate drastically reduced by the end of the century.