--An Inspiration and Mentor to a Generation of Cancer Prevention Researchers--
Steven D. Stellman, PhD, MPH
Professor
Department of Epidemiology
Mailman School of Public Health
Columbia University
New York, New York
The death of Sir Richard Doll this year at the age of 92 brings to a close an era spanning six decades in which cancer epidemiology was born, grew up, and attained its maturity. The year 1950 was an especially important one for this new discipline, in that it saw the publication of five papers that, for the first time, established powerful statistical links between cigarette smoking and lung cancer.(1-5) History has conferred on only two of these papers the distinction of becoming classics: that of a young Washington University (St. Louis) physician named Ernst Wynder, and that of a slightly older British doctor named Richard Doll. These two papers stand out above the others due to the personalities and unique accomplishments of their senior authors.
As one who knew both men (Sir Richard only slightly), I have often reflected on how much their careers both paralleled each other yet were also drastically divergent. Both men parlayed initial observations on smoking and cancer into long and distinguished careers in cancer epidemiology that continue to exert a far-reaching impact on human health throughout the world. Sir Richard built his career largely through observational studies, including the British Doctors Study,(6) which has become a classic both for its elegant prospective design (later adopted by E. Cuyler Hammond for the American Cancer Society's million-person Cancer Prevention Study(7) and by Larry Garfinkel and myself in the even larger Cancer Prevention Study(8)) and for its sheer longevity - the final 50-year follow-up was published just this year.(9) His long-running collaboration with Sir Richard Peto, produced, among many noteworthy achievements, the classic 1981 treatise that quantified the contributions of various environmental and lifestyle factors to cancer.(10,11) Doll's lasting influence in studies of tobacco-related cancers sometimes overshadowed contributions to the epidemiology of occupational, environmental, and lifestyle related cancers. Doll was not shy about facing the limits of epidemiology in controversial areas such as whether saccharin caused bladder cancer,(12) the effects of living near nuclear power plants,(13) and fluoridation.(14)
By contrast, Wynder, whom I knew as an employer, mentor, and later as a colleague, was more than an epidemiologist - he was a preventive medicine entrepreneur who left Memorial Sloan-Kettering Cancer Center in the 1960s to found a unique institution, the American Health Foundation (AHF), which became the only National Cancer Institute (NCI)-funded basic sciences cancer center dedicated to cancer prevention. Not content with observational studies on humans, Ernst gathered around him chemists, biochemists, specialists in in vitro studies and animal bioassays, and behavioral scientists to carry out a many-faceted approach to cancer prevention. He used the Foundation both as a sounding board for his own ideas and as a gathering spot for distinguished scientists - including many with points of view different from his own - all of whom he listened to carefully. Wynder died in 1999.
The accompanying photograph was taken at a 1979 gathering at AHF that included (top row, from the left) myself, Wynder, Lester Breslow (then Dean of the UCLA School of Public Health and a pioneer in community health trials), biostatistician Jerome Cornfield (a designer of MRFIT - the Multiple Risk Factor Intervention Trial, a sweeping test of a three-pronged approach to prevent coronary death in high-risk men), and AHF staff biostatistician Harland Austin, now a Professor of Epidemiology at the Rollins School of Public Health, Emory University. Seated beside Sir Richard is Dr. Arthur Upton, an authority on health effects of radiation who was then Director of the NCI.
- Wynder EL, Graham EA. Tobacco smoking as a possible etiologic factor in bronchogenic carcinoma: a study of six hundred and eighty-four proved cases. JAMA. 1950;143:329-336.
- Doll R, Hill AB. Smoking and carcinoma of the lung: preliminary report. BMJ. 1950;2:739-748.
- Levin M, Goldstein H, Gerhardt P. Cancer and tobacco smoking: a preliminary report. JAMA. 1950;143:336-338.
- Schrek R, Baker L, Ballard G, et al. Tobacco smoking as an etiologic factor in disease. I. Cancer. Cancer Res. 1950;10:49-58.
- Mills C, Porter M. Tobacco smoking habits, and cancer of the mouth and respiratory system. Cancer Res.1950;10:539-542.
- Doll R, Hill AB. Study of aetiology of carcinoma of the lung. BMJ. 1952;2:1271-1286.
- Hammond EC. Smoking in relation to death rates of one million men and women. Natl Cancer Inst. Monogr.1966;19:127-204.
- Stellman SD, Garfinkel L. Smoking habits and tar levels in a new American Cancer Society prospective study of 1,200,000 men and women. JNCI. 1986;76:1057-1063.
- Doll R, Peto R, Boreham J, Sutherland I. Mortality from cancer in relation to smoking: 50 years observations on British doctors. Br J Cancer. 2005;34:426-429.
- Doll R, Peto R. The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today. JNCI. 1981;66:1191-1308.
- Doll R, Peto R. The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today. Oxford University Press. Oxford: 1981.
- Armstrong B, Doll R. Bladder cancer mortality in diabetics in relation to saccharin consumption and smoking habits. Br J Prev Soc Med. 1975;29:73-81.
- Cook-Mozaffari P, Darby S, Doll R. Cancer near potential sites of nuclear installations. Lancet. 1989;2:1145-1147.
- Doll R, Kinlen L. Fluoridation of water and cancer mortality in the U.S.A. Lancet. 1977;1:1300-1302.
