Professor Kazumasa Masubuchi was a gifted educator and brilliant surgeon who devoted his professional life to the development of early cancer detection methods and to the care of his patients at the Cancer Institute Hospital in Tokyo.¹

He graduated in 1937 from the Medical School of Tohoku and was appointed director of the Cancer Institute Hospital in 1949.

In his article “Today’s Problems in Cytodiagnosis” of 1967,² he reports that the first studies on cytodiagnosis realized by Professor George Papanicolaou were presented in Japan only a few years after the publication of the 1943 monograph on the diagnosis of cancer cells by vaginal smears. Cytodiagnosis expanded to other pathology fields, and the following colleagues deserve special mention: Dr. Amaki, University of Kamamoto; Professor Ayaba, University of Tottori; and Professor Ishikawa, Academy of Gynecology of Japan.

In Professor Masubuchi’s opinion, the precursor of cytologic diagnosis was no doubt Professor George Papanicolaou. Masubuchi visited him at the Cornell Medical School of New York in 1956, where Papanicolaou, although retired, carried out research as Professor Emeritus. They discussed the impending foundation of the International Academy of Cytology (IAC).¹

He underscored that cytodiagnosis is a large field of pathology and requires very specific education and training of technicians and cytopathologists to achieve precise cytologic diagnosis. Equipment, instruments and specific infrastructure are also needed. He stated that much must be dedicated to expand this technique to every corner of his country to fight cancer and that this reality must be known so as to ensure the achievement of this goal.²

With the continuously expanding use of cervical cytology, Dr. Masubuchi realized the need for regulated and well-administered training courses in the area for cytotechnologists. In 1968, Masubuchi established the First School of Cytotechnology in Japan, at the Cancer Institute Hospital of Tokyo.¹

In “The Detection of Cervical Cancer at the Cancer Institute Hospital, in Tokyo from 1952 to 1963,” the authors report having used, since 1952, the smear test as the screening strategy and applying it to all outpatients.³ An earlier publication from 1953, “On the Test Examination for Female Genital Cancer in Small Villages,” reveals that Dr. Masubuchi had already used the cytologic vaginal smear as a screening test.⁴ As a consequence of these studies the vaginal smears were adopted in 1961 in 92 hospitals in Japan as routine practice.³

In this article, he also describes the specimen collection technique and staining method selected. Since 1957, the authors used a combination of specimen collection as proposed originally by Papanicolaou and Marchetti in 1943, even when few or no changes were observed in the cervix. They collected cells by vaginal aspiration smears, scrape smear of the surface of the ectocervix and endocervical smear, which was considered of great importance in the postmenopausal women. The staining method was preceded by a rapid wet fixation of smears in alcohol ether, followed by staining with the Papanicolaou technique EA 36. This fixation and staining resulted in exquisite cytologic detail that was optimal for microscopic evaluation.

A variation of the 5-class Papanicolaou Classification was used. Class IV–V was considered as cancer, Class I–II as not cancer and Class III as false positive.

Cytologic correlation with the histologic diagnosis by biopsy was included as a quality control approach for expertise in cytology.

The results from this 1952–1963 study showed very high correlation of cytologic diagnosis with cancer and noncancer cases, reaching almost 90% efficiency. They also reported a 4% of false negatives.³

In the paper “Follow up Studies by Cytology on Cancer of the Cervix Uteri after Treatment, 1969,” emphasis is placed on the importance of carrying out a periodic follow-up examination by cytology after treatment of cancer of the cervix uteri with the purpose of the earliest possible diagnosis of recurrent cancer. Dr. Masubuchi was aware, as Ruth Graham had already described in 1955, of the effects of radiation, radiation response, on normal and cancer cells and the importance of their recognition in the differential diagnosis with truly recurrent or persistent cancer cells.⁵

The main conclusions of “Epidemiologic Studies on Uterine Cancer at Cancer Institute Hospital, Tokyo, Japan 1972” related to cervical cancer were early age at first intercourse, sexual intercourse, increased parity, syphilis and the possibility of a genetic background, because cervical cancer was seen in mothers and daughters. As reported since 1950, early age at first intercourse is very important in squamous cell carcinoma and may have a relationship to the high sensitivity of biologically immature sexual organs to carcinogenetic factors. Early marriage, early first delivery and multiparity are all related to first intercourse. This epidemiologic study used analytical methods based on case-control studies that involved 572 cancer cases and 200 noncancer cases, individually interviewed. The statistical level of significance was established at 0.05.⁶

Dr. Masubuchi states in his paper “Significance of the Role of Cytology in Population Screening of Cancers” (1975), “I have reviewed the present status of cytodiagnosis in the population screening of epidemiologically important cancers in Japan, as cancer of the uterus, gastrointestinal tract, lung, breast and urinary bladder, in order to establish this method of cytology, which is without any hazard. Some remarks have been made of its future, mixed with my own dreams about it. I wish to propose here that we should all examine the means for developing cytology as a method for population screening of cancers.” In this paper he highlights the needle aspiration method by Zajicek for diagnosis of palpable mammary lesions and discusses future problems of their detection.⁷

Other fields of Dr. Masubuchi’s interest and research, for example, were endometrial, vulvar and fallopian tube cancers; adjuvant therapies for advanced ovarian cancer; second cancer after radiation therapy for cancer of the uterine cervix; stump recurrence after radical hysterectomy for cervical cancer; and effects of laser therapy for cervical lesions.

Important Events in Professor Masubuchi’s Life

In 1957, during the foundation of the IAC, he was appointed its First Honorary Member. In 1958, he was a founding member of the Academy of Clinical Cytology. In 1961 he became founding member of the Japanese Society of Clinical Cytology. In 1969, he received a Public Health Award for his contribution to improvements in the cure rate of female genital cancer. In 1973, he presided over the Third International Tutorial on Clinical Cytology in Tokyo. In 1974, he was appointed President of Cancer Institute Hospital. In 1977, he was President of the Sixth International Congress of Cytology, Tokyo. In 1980, he was appointed President of the IAC for the period 1980–1983 in Munich, at the Seventh International Congress of Cytology. In 1982, he was President of the 20th meeting of the Japan Society for Cancer Therapy.

In 1983, as President of IAC, Dr. Masubuchi gave a presidential address at the Eighth IAC Congress in Montreal in which he pointed out “ the benefits of the early detection and treatment of many diseases, including cancer as a result of the development and spread of clinical cytology, suggesting that all countries should establish their own National Society of Cytology and stressing the importance of having educated IAC-registered cytopathologists and cytotechnologists of excellence, which will contribute to the welfare of people.

Words from Friends of Professor Masubuchi

“He was a generous man and treated each individual on an equal basis. He thought of every detail about his friends to make them comfortable. He had great respect for cytotechnologists in the field of cancer detection and for all of his co-workers. His interest in the education of the cytotechnologists led him to invite the International Academy of Cytology to give the first CT (IAC) examination for cytotechnologists in Tokyo, in 1973. Prior to the examination, an educational program was held for the cytotechnologists who were accepted for the examination. Dr. Masubuchi and his colleagues made a great national effort to organize this event. His efforts were appreciated by all who knew him.”

The IAC Editorial Office,¹ in his obituary of 1993, stated “Dr. Masubuchi was practically personally responsible for the development of cytologic cancer detection, for the organization of the national licensure examinations for cytotechnologists and the promotion of IAC registration and certification in his country, to such an extent that the Japanese section of the IAC is now one of the largest national groups of the IAC. One of his last generous deeds was the establishment of The Kazumasa Masubuchi Lifetime Achievement Award in Diagnostic Cytology to be given every 3 years at the International Cytology Congresses. Japan and the rest of the world have in this personality one of the most important educators on early cancer detection and the IAC, one of their best friends.”

References

1. In Memoriam. Acta Cytol 1993;37:1–2
2. Masubuchi K: Today’s problems in cytodiagnosis. Clin Cancer 1967;10:736–737
3. Masubuchi K, TenjinY, Fujii JI: The detection of cervical cancer at the Cancer Institute Hospital in Tokyo from 1952 to 1963. Acta Cytol 1967;11:32–34
4. Masubuchi K, Matsuo K: On the test examination for female genital cancer in small villages. Gan 1953;44:393–394
5. Masubuchi K, Kubo H, Tenjin Y, Ono M, Yamazaki M: Follow-up studies by cytology on cancer of the cervix uteri after treatment. Acta Cytol 1969;18:323–326
6. Masubuchi K, Nemoto H: Epidemiologic studies on uterine cancer at Cancer Institute Hospital, Tokyo, Japan. Cancer 1972;30:268–275
7. Masubuchi K: Significance of the role of cytology in population screening of cancers. Acta Cytol 1975;19:334–336

Keywords: cancer; International Academy of Cytology; Masubuchi, Kazumasa; Papanicolaou.