In the late 19th century, women succumbed easily to cervical cancer in Brazil. Without access to medical care, many died without knowing the cause of their illness or how to treat it. Surgery and palliative care were the main approaches used by Brazilian doctors to treat the disease at the time. Regardless of the therapy used, however, the likelihood of curing the disease was very small, except in the case of minor tumors. In the early 20th century, facing an increase in the incidence of the disease, doctors began to pay more attention to the problem. Gradually, they began to take a much more organized approach to tracking this type of tumor, leading to the establishment of institutions to monitor and treat the disease like the Institute of Gynecology in Rio de Janeiro. Opened in March 1947, the Institute was a pioneer in putting into place permanent measures to prevent cervical cancer by using a specific diagnostic approach that became a reference for all of Brazil.
Until the 1930s, cervical cancer garnered attention in Brazil mostly at medical school clinics, where it was part of the specialized curriculum taught in gynecology. It was diagnosed through a simple gynecological exam. In cases where the disease was identified at an advanced stage, the only option was to surgically remove the uterus. Most women did not survive. The widespread stigma associated with this type of cancer implied that victims of the disease had been promiscuous in some way. For this reason, many women avoided talking about their pain publicly, turning to their doctors only when the pain became unbearable.
In 1936, the School of Medicine at the University of Brazil (now the Federal University of Rio de Janeiro), decided to eliminate the clinical surgery chair, replacing it with the chair in gynecology, held by Rio de Janeiro physician Arnaldo de Moraes (1893-1961). Moraes had specialized in gynecology at The Johns Hopkins University in the United States in 1927 on a fellowship from the Rockefeller Foundation. In 1930, he went to Germany, where he worked with gynecologist Hans Hinselmann (1884-1959), the inventor of a binocular magnifying glass adapted to examine the cervix. The device, known as a colposcope, made it easier to diagnose cellular anomalies in the cervix.
Moraes brought the colposcope with him when he returned to Brazil, with the aim of using it as a tool to diagnose cervical cancer alongside other techniques less disseminated outside of Europe and the United States, such as the use of diluted iodide to observe changes in the cervix and the cervical smear test, according to Luiz Antonio Teixeira, a researcher in the history of science at the Oswaldo Cruz Foundation (Fiocruz) in Rio. At the outset of his work at the medical school, Moraes founded the scientific journal Anais Brasileiros de Ginecologia [Brazilian Annals of Gynecology], which was in circulation until the 1960s. In the same year, he launched a practical program of instruction and established a clinic at the Estácio de Sá Hospital, which had ambitions to be a cutting-edge institution that would attract researchers interested in new diagnostic techniques to treat cervical cancer.
In 1942, the clinic was transferred to the Moncorvo Filho Hospital, where it still functions today. In 1947, university officials granted it legal status and it came to be known as the Institute of Gynecology. “The founding of the institute symbolized the institutionalization of all the research in gynecology that had already been conducted by Moraes,” explains Vanessa Lana, a researcher in the history of science in the History Department at the Federal University of Viçosa (UFV) in Minas Gerais, in an article published in the journal História, Ciência, Saúde – Manguinhos [History, Science, Health – Manguinhos]. The institute approached its work from a prevention perspective. “Given the limits of medicine, detecting the tumor at its early stages enhanced the effectiveness of therapeutic interventions, like radiation,” says Lana. As result, any woman who came to the institute, whether she had symptoms of cancer or not, was given an exam.
The institute used an integrated model to detect cervical cancer, involving colposcopy, cytology and biopsy. “The combined use of these methods became the institute’s hallmark and the driving force behind cervical cancer prevention initiatives in Brazil,” says Lana. “The systematic combination of these methods increased the chances of early detection of cervical lesions,” she said. The researcher says that in 15 years, the number of cases detected early increased by 300% compared to the late 1940s, when Moraes began his clinical research in gynecology.
The approach allowed the institute to increase the percentage of early-stage tumors diagnosed and decrease the number of deaths, making it a reference point for treatment for other organizations involved in cancer prevention, like Hospital Aristides Maltez (HAM), founded in 1952 in Salvador by the Cancer Prevention League of Bahia.
In São Paulo, the Department of Obstetrics and Gynecology at the School of Medical Sciences at the University of Campinas (Unicamp), under the leadership of Dr. José Aristodemo Pinotti, launched an important cervical cancer prevention program in 1965 (see Especial Unicamp 50 anos [Unicamp at 50]). Every woman seen was given a pap exam. Later, when the demand for treatment fell, plans began for construction of what came to be known as the Center for the Prevention of Reproductive and Breast Cancer, the forerunner of the Center for Women’s Comprehensive Health Care (CAISM), now the José Aristodemo Pinotti Women’s Hospital.