A tribute to Anne Szarewski

Anne Szarewski

In 1995, many doctors only knew of the human papilliomavirus (HPV) as a virus that caused warts, and were disbelieving of the suggestion that it caused cancer of the cervix.

And although researchers had discovered that the types of virus that caused genital warts were distinct from those associated with cervical cancer, there was little appreciation among clinicians of the potential applications of this research. HPV vaccines were still some way off, and the general view was that cervical cancer was preventable by screening using the Papanicolaou test (often known as the cervical smear test).

All that was to change with the publication of a paper showing that testing for the presence of HPV DNA on cells taken during cervical screening would pick up cases of pre-cancer that were missed by Papanicolaou testing.

The clinician who led that research was Dr Anne Szarewski.

To all who knew her, it came as a great shock to learn that Anne died suddenly and unexpectedly last weekend, just days before what would have been her 54^th birthday.

It is a tragic loss for her husband, friends, colleagues and Cancer Research UK. As the charity’s CEO Harpal Kumar wrote: “Anne was an exceptional researcher who made an outstanding global contribution to the fight against cancer and we are proud to have been associated with her and her work. Anne was a wonderful colleague and we are indebted to her for the support she gave more widely to CRUK – she will be sorely missed.”

Anne was something of an enigma. She professed to have no understanding of statistics, but chose to work in analytic epidemiology. She thought that most mathematicians were on the autistic spectrum, but spent much of her career working closely with them and enjoying their company.

On social issues, such as contraception, feminism and gay rights, Anne was a liberal, but in other respects she was extremely conservative. She believed that certain standards should be maintained always being immaculately dressed which was often at odds with the tendency of academics to wear casual and sometimes scruffy clothes.

Anne’s genius was communicating the results of her research to a wide audience with passion and conviction. Whether lecturing to medical students, or writing for a woman’s magazine, Anne would convey her message with scholarship and an amusing anecdote.

Beyond her research, Anne contributed much to the health of women through her books and articles aimed at a lay audience. A quick search on the internet will reveal that for over 20 years, whenever there has been a news item about hormonal contraception or cervical cancer, Anne was interviewed. Journalists loved her because she imparted her great knowledge clearly and simply.

Most recently she commentated on Michael Douglas’s oral cancer using the link to HPV infection to renew her call for the vaccination of boys. As a lead investigator in some of the clinical trials of the Cervarix HPV vaccine, she was well qualified to comment.

Anne joined the Imperial Cancer Research Fund (one of the two forerunners of Cancer Research UK) in 1992 as a clinical research fellow. She worked with Dr Jack Cuzick on cervical cancer, including on the pioneering work on HPV testing.  Two decades later, HPV testing is used routinely in cervical screening programmes around the world.

In parallel with this work, Anne gained a PhD looking at the effect of smoking on cellular immunity in the cervix. She showed that, in the absence of treatment, early signs of cervical disease picked up on screening in smokers were much more likely to disappear if women gave up smoking.  This study was only successful because of Anne’s personality: she was a caring clinician who loved helping her patients.  It is said that the extremely high rate of smoking cessation achieved in her study was solely due to the counselling and support she gave to each patient.  She was more effective than nicotine patches in helping the women to stop smoking.

After completing her PhD, Anne continued to work for the Imperial Cancer Research Fund / Cancer Research UK, relocating to the Wolfson Institute of Preventive Medicine, Queen Mary University of London in 2002, but still researching for Cancer Research UK. Anne followed her early trial of HPV testing in cervical screening with a larger multi-centre trial using a commercially available HPV test. The HART study was published in 2003 and was pivotal in the decision of the International Agency for Research on Cancer (IARC) a year later to recommend that HPV testing could be used in primary cervical screening.

Anne was also one of the first to study the possibility of HPV testing on self-collected vaginal samples; an approach that is finding increasing attention as a way to increase screening uptake both among those in developed world who find clinician sampling embarrassing, uncomfortable or  simply inconvenient, and in countries with scarce resources.

In 2001, Alma from Coronation Street died suddenly of cervical cancer. The story had a huge impact across the country. It was reported and debated in most national newspapers and women’s magazines. For the first time, attendance at cervical screening increased.  Anne was there for Cancer Research UK. She did so many interviews that the charity’s press team presented her with an Alma award!

People loved to work with Anne because working with her was fun. If they needed advice she would give her opinion clearly and unambiguously and usually in an entertaining way – often regaling her audience with stories about her beloved cat Bertie before turning to more serious matters. She was always willing to do what was needed and never felt that she was too important to roll up her sleeves, even turning up at a Freshers’ Fair to recruit girls to clinical trials.  She did however have to ask what she should wear and for the music to be turned down.

And to many of us, Anne was the cake lady. Every day at 3.00pm she would produce cakes and wander into people’s offices to offer a little ‘pick me up’ and entertaining conversation. It has been said that wherever Anne worked, the team around her felt like they were part of a family, Anne’s family.

Last week Anne was busy as usual, caring for her patients, preparing lectures, and planning future research studies. This week, the Wolfson Institute where she worked is sadly quiet.

Anne will be greatly missed.

Peter & Louise

• Professor Peter Sasieni is Professor of Biostatistics & Cancer Epidemiology and Deputy Director of the Centre for Cancer Prevention at the Wolfson Institute of Preventive Medicine
• Louise Cadman is a Senior Research Nurse at the Centre for Cancer Prevention, based at the Wolfson Institute of Preventative Medicine.