Implementation of a Provincewide Comprehensive Cervical Screening Program in the 1940s
David E. Boyes
University of British Columbia
The Program began in 1949 – 1950, when the late Dr. H.K. Fidler asked Dr. J. McDonaugh and me to
collect some smears, using an Ayers Spatula, from patients attending at the, (then), Vancouver General
Hospital Gynecological O.P.D. I had been influenced by my Professor at Queens University, Dr. R.
Robertson, to think that something could be done for what was a terrible disease, Cancer of the Cervix.
After 3 to 4 years, we decided that a disease could be identified on the cervix, but whether or not it
was related to cervical cancer was not known. We called it insitu cancer and set out to determine its
In order to do this, we thought we should screen as many women as possible and see if by removing in
situ cancer we could influence the incidence and mortality of cervical cancer. In 1955, we decided that
a cone biopsy was the way to investigate suspicious smears and then to review the biopsies with step
serial sections. Dr. Fidler and I examined all the cones. Dr. A.J. Worth joined us in 1965 and was a
great help thereafter. We developed a training program in 1955 and with support from the Canadian Cancer
Society, trained our technicians over two years. Each technician was expected to see about 90 smears per
day. A Senior Technician reviewed the results and abnormal smears were referred to the Medical Staff for
further examination and diagnosis.
By 1960, we saw a drop in the incidence of Invasive Cancer and by 1970, the mortality appeared to be
dropping. In 1971, we decided to start a Colposcopy Program. Dr. Lou Benedet undertook this project.
The main objective was to reduce the emotional trauma of the patients. In the past, Class II and Repeat
Smears might be repeated every 6 months for several years. With Colposcopy, these smears could be
investigated immediately. Twenty Obstetrics and Gynecology Doctors were trained in the Colposcopy
procedure. They were then provided with a Colposcope, Laboratory Support with regard to the biopsies,
quality control and follow-up. We decided to provide a sessional fee for these clinics to make it more
acceptable to the other Gynecologists in the area. This service is provided free to the women of BC
under the Health Ministry Budget.
The Colposcopy and Screening Programs run to this day.