Anne Marie Szarewski
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Obituary 1090 www.thelancet.com Vol 382 September 28, 2013 Anne Marie Szarewski Clinician researcher whose work shaped the use of human papillomavirus tests in cervical screening. Born in London, UK, on Sept 1, 1959, she died there on Aug 24, 2013, aged 53 years. The two research studies for which Anne Szarewski will be best remembered were both on testing for the human papillomavirus (HPV). The first showed its potential in detecting cervical cancer; the second explored some of the practicalities of using it in a screening programme. But to limit an appreciation of Szarewski’s career to her research would be to diminish the breadth of her contributions. She was equally effective as a clinician with a routine workload, as a teacher, and as a communicator with a talent for reaching lay audiences. Szarewski graduated from London’s Middlesex Hospital Medical School in 1982 and soon established what were to be the essential themes of her career: gynaecological oncology and women’s reproductive health, the latter pursued at the Margaret Pyke Centre in London which she joined in 1986 and with which she continued to be associated for the rest of her life. Peter Sasieni, Professor of Biostatistics and Cancer Epidemiology at London’s Wolfson Institute of Preventive Medicine, first met Szarewski more than 20 years ago. “She wanted to help women”, he says. “She liked being involved with well-woman issues—disease prevention, family planning, and sexual health.” But given that she delighted in clinical work, why the urge to do research? And why this field in particular? It had a natural attraction for her, says Diana Mansour, a consultant in community gynaecology and reproductive health care in Newcastle upon Tyne who knew Szarewski as a colleague and a friend. “She was one of these people who are very questioning about issues that come up in everyday contact with patients. Why don’t we do this? Would doing that be more effective?” Szarewski’s PhD, completed in 1997, was on the effects of smoking in relation to cervical cancer. “By encouraging lifestyle changes you started to see regression of CIN”, says Mansour. “She could see it was making a really positive impact.” The HPV studies began in the early 1990s when Szarewski joined the Imperial Cancer Research Fund, now Cancer Research UK, working with Professor Jack Cuzick. The first of the two key papers, both published in The Lancet, appeared in 1995. It described a study of HPV DNA testing in women attending cervical screening at the Margaret Pyke Centre. “It brought home that it might be possible to improve on the then screening test, the Pap test. Rather than trying to tweak the Pap test, which is what other people were doing, her work showed that molecular testing could provide something that was better and more robust”, explains Sasieni. As the lead clinician, Szarewski’s rapport with patients proved invaluable. “Anne was much better at recruiting patients than anyone else”, says Sasieni. A further and larger study called HART (HPV in Addition to Routine Testing) was published in 2003. Through its closer resemblance to real world screening it could explore the use of HPV testing in relation to conventional cytology, and it helped to lay the foundations of what became in the UK the National Health Service Cervical Screening Programme. Although not concerned in the development of an HPV vaccine, Szarewski was involved in one of the phase 3 trials of the contending agents. She became a keen advocate of HPV vaccination Szarewski was a great communicator, and it was a task she seemed to relish. “Definitely”, says Sasieni. “I think she saw herself as a lobbyist on behalf of women’s health issues. She had messages she wanted to convey whether it was on HPV vaccination or contraception or HRT. There were times when she would be nervous about an interview, but generally she looked forward to them.” Researchers often don’t consider how best to explain their work, Sasieni adds. “They haven’t thought about speaking to a lay audience, and they don’t show any enthusiasm for what they’ve done. Anne was completely the opposite. She probably saw doing this as part of the research work.” As Mansour comments, “If Anne had a cause she would really keep fighting for it.” Szarewski was popular with patients and colleagues. “Although very hardworking, she always had time for you”, says Mansour. “Someone you could always rely on.” Sasieni points to a paradox embedded in the trust that Szarewski’s patients placed in her. It meant that they were willing to do whatever she recommended—yet she herself was opposed to medical paternalism and eager to encourage patients to make their own choices. She leaves a husband, Lester. Geoff Watts For the HPV testing in primary cervical screening paper see The Lancet 1995; 345: 1533–36 For the HART study see The Lancet 2003; 362: 1871–76
Transcript of Anne Marie Szarewski
Obituary
1090 www.thelancet.com Vol 382 September 28, 2013
Anne Marie SzarewskiClinician researcher whose work shaped the use of human papillomavirus tests in cervical screening. Born in London, UK, on Sept 1, 1959, she died there on Aug 24, 2013, aged 53 years.
The two research studies for which Anne Szarewski will be best remembered were both on testing for the human papillomavirus (HPV). The fi rst showed its potential in detecting cervical cancer; the second explored some of the practicalities of using it in a screening programme. But to limit an appreciation of Szarewski’s career to her research would be to diminish the breadth of her contributions. She was equally eff ective as a clinician with a routine workload, as a teacher, and as a communicator with a talent for reaching lay audiences.
Szarewski graduated from London’s Middlesex Hospital Medical School in 1982 and soon established what were to be the essential themes of her career: gynaecological oncology and women’s reproductive health, the latter pursued at the Margaret Pyke Centre in London which she joined in 1986 and with which she continued to be associated for the rest of her life. Peter Sasieni, Professor of Biostatistics and Cancer Epidemiology at London’s Wolfson Institute of Preventive Medicine, fi rst met Szarewski more than 20 years ago. “She wanted to help women”, he says. “She liked being involved with well-woman issues—disease prevention, family planning, and sexual health.” But given that she delighted in clinical work, why the urge to do research? And why this fi eld in particular? It had a natural attraction for her, says Diana Mansour, a consultant in community gynaecology and reproductive health care in Newcastle upon Tyne who
knew Szarewski as a colleague and a friend. “She was one of these people who are very questioning about issues that come up in everyday contact with patients. Why don’t we do this? Would doing that be more eff ective?” Szarewski’s PhD, completed in 1997, was on the eff ects of smoking in relation to cervical cancer. “By encouraging lifestyle changes you started to see regression of CIN”, says Mansour. “She could see it was making a really positive impact.”
The HPV studies began in the early 1990s when Szarewski joined the Imperial Cancer Research Fund, now Cancer Research UK, working with Professor Jack Cuzick. The fi rst of the two key papers, both published in The Lancet, appeared in 1995. It described a study of HPV DNA testing in women attending cervical screening at the Margaret Pyke Centre. “It brought home that it might be possible to improve on the then screening test, the Pap test. Rather than trying to tweak the Pap test, which is what other people were doing, her work showed that molecular testing could provide something that was better and more robust”, explains Sasieni. As the lead clinician, Szarewski’s rapport with patients proved invaluable. “Anne was much better at recruiting patients than anyone else”, says Sasieni. A further and larger study called HART (HPV in Addition to Routine Testing) was published in 2003. Through its closer resemblance to real world screening it could explore the use of HPV testing in relation to conventional cytology, and it helped to lay the foundations of what became in the UK the National Health Service Cervical Screening Programme. Although not concerned in the development of an HPV vaccine, Szarewski was involved in one of the phase 3 trials of the contending agents. She became a keen advocate of HPV vaccination
Szarewski was a great communicator, and it was a task she seemed to relish. “Defi nitely”, says Sasieni. “I think she saw herself as a lobbyist on behalf of women’s health issues. She had messages she wanted to convey whether it was on HPV vaccination or contraception or HRT. There were times when she would be nervous about an interview, but generally she looked forward to them.” Researchers often don’t consider how best to explain their work, Sasieni adds. “They haven’t thought about speaking to a lay audience, and they don’t show any enthusiasm for what they’ve done. Anne was completely the opposite. She probably saw doing this as part of the research work.” As Mansour comments, “If Anne had a cause she would really keep fi ghting for it.”
Szarewski was popular with patients and colleagues. “Although very hardworking, she always had time for you”, says Mansour. “Someone you could always rely on.” Sasieni points to a paradox embedded in the trust that Szarewski’s patients placed in her. It meant that they were willing to do whatever she recommended—yet she herself was opposed to medical paternalism and eager to encourage patients to make their own choices. She leaves a husband, Lester.
Geoff Watts
For the HPV testing in primary cervical screening paper see
The Lancet 1995; 345: 1533–36
For the HART study see The Lancet 2003; 362: 1871–76
