In 1970, Valerie Beral was a young doctor working in a London family planning clinic. The pill had been licensed in the UK for nearly a decade, but evidence on its use was far from complete and when patients asked about its effects she reluctantly had to say: “We don’t know.”
This frustrating experience prompted Beral, who has died aged 76 after a year-long illness, to leave clinical medicine and study epidemiology to find the answers she felt women deserved. A gifted mathematician and exceptionally focused, she became one of the pre-eminent epidemiologists of her generation.
She specialised in cancer and women’s health, but also studied Hiroshima survivors, diet, dementia, smoking, HIV and Aids, blood clots and more, with the British Medical Journal describing her work as “a checklist of the epidemiological cause celebres of the past three decades”.
Beral was also a gifted tutor and took a particular interest in mentoring women, encouraging them to fulfil their potential and take up senior positions in science.
Beral trained and then worked at the London School of Hygiene & Tropical Medicine (LSHTM), heading the epidemiological monitoring unit. After a year at the Centers for Disease Control and Prevention in Atlanta, in 1989 she moved to Oxford, where she would remain for the rest of her career, taking over from Richard Doll as head of the Cancer Epidemiology unit (now part of Oxford Population Health).
In the early 1990s, scare stories about the pill and breast cancer frequently filled the newspapers, and there was little academic consensus. To settle the matter, in 1992 Beral set up the collaborative group on hormonal factors in breast cancer in Oxford.
She and her team brought together and reanalysed all the data from studies around the world, concluding in 1996 that the pill gave long-term protection against womb and endometrial cancer, and, although it slightly elevated breast cancer risk, the effect was only temporary. Resolving that the pill is safe to take has brought reassurance to millions of women around the world.
Turning her attention to HRT and other issues, Beral believed there needed to be a definitive large-scale study, and set up the Million Women Study. It was the largest of its kind anywhere in the world, with 1.3 million women aged 50-64 (a quarter of all British women in that age group). Participants, who were recruited via NHS breast-screening centres, filled in questionnaires about their lives, which, with data from their medical records, created a unique databank on women’s health.
In 2003, Beral published results from the study showing that one form of HRT gave a significant increase in the risk of breast cancer. On the back of this, regulatory bodies changed their advice to recommend taking HRT for the shortest time possible. It was unwelcome news for some, and Beral repeatedly had to refute claims there were flaws in her methodology.
A key finding was that childbearing is the most significant factor in breast cancer: for each pregnancy, a woman’s lifetime risk of getting the disease drops by 10%. Beral said preventing breast cancer by having extra children was clearly absurd, but theorised that, in future, science might invent a “vaccine” for young women that mimicked the protective effects of pregnancy hormones.
The data from the Million Women Study has cast light on numerous age-related conditions, including dementia. Not engaging in social and cognitive activities is often thought to be a cause, but Beral’s team turned the theory on its head, proving that it is actually a consequence of the disease’s onset.
Beral, who was made a dame in 2010 for services to medicine and women’s health, served on many international committees and was chair of the government’s advisory committee on breast cancer screening. In this role, in 2009 she helped set up the AgeX Trial, which will determine whether it is beneficial to extend the screening age range from 50-70 to 47-73.
Born in Sydney, she was the daughter Ilse (nee Rubel) and Herbert Beral who had relocated to Australia from Bucovina (an area now split between Romania and Ukraine) in 1939. Her father had an egg farm in the suburb of Glenfield and later worked in a packaging company, while her mother took care of Valerie and her older sister, Margaret.
Beral attended Strathfield and North Sydney girls high schools, where she shone at mathematics and science. She also loved chess, saying she practised constantly, even keeping a board on her lap under her desk. She became the junior female chess champion of Australia as a teenager, and later taught her children and grandchildren.
In 1969 Beral graduated in medicine with a first-class degree (sometimes even helping her tutors out with their maths), and after a year working at the Royal Prince Alfred hospital in Sydney had an enjoyable time making her way overland to the UK. After briefly working at the Brook family planning centre, she went to the Hammersmith hospital in London to work for the epidemiologist Charles Fletcher. He recognised her talents and suggested she train at the LSHTM.
In early 1972 Beral met Paul Fine, who became her partner, in the LSHTM canteen. Originally from the US, he is now professor of communicable disease epidemiology. Their two sons, Richard, born in 1979 and Stephen, born in 1981, were the couple’s witnesses when they married in 2004.
Work could be all-consuming (Beral was one of the last to get email in case it distracted her), but her family, both in the UK and in Australia, also gave her great joy, as did tending her garden in Oxford.
She is survived by Paul, Richard and Stephen, two grandchildren and her sister, Margaret.