Making the pap smear into the 'right tool' for the job: Cervical cancer screening in the USA, circa 1940-95

Despite being a rather recalcitrant tool, the 'Pap smear' is today the major cancer screening technology in the world. This paper examines how and why heterogeneous actors chose to advocate the Pap smear as a screen for cervical cancer in the late 1940s, and to tinker both in and far beyond the diagnostic laboratory for over 50 years to make the Pap smear 'fit' as a screening and clinical technology. Tinkerings included gendering the division of labour, attempting to automate reading of smears, juggling costs, exploring alternative screening technologies, pushing for regulation of laboratories, and settling for locally-negotiated orders of clinical accuracy instead of global standardization, still elusive today.