When Valerie Beral was a young family planning doctor, there was no reliable evidence about the health effects of various contraceptive choices. Her uncomfortable inability to answer women’s questions satisfactorily helped lead her to become the epidemiologist who, over several decades, generated much of the world’s best evidence on hormonal factors and female cancers. She re-analysed detailed data from virtually all relevant studies in the world (the largest being her own UK Million Women Study). The overall results showed that some years of oral contraceptive use slightly decreased cancer rates (as it protected against ovarian and endometrial cancer, with little effect on breast cancer), facilitating family planning decisions. They also showed, however, that a few years of menopausal hormone therapy somewhat increased breast cancer rates.
Valerie Beral grew up in Australia and gained a first-class degree in medicine from Sydney University. After a few years of clinical work in Australia, New Guinea and the UK, she turned her attention to public health and spent almost 20 years at the London School of Hygiene & Tropical Medicine working in the Department of Epidemiology and more than 30 years at Oxford University, pursuing her quest for answers to some of the biggest questions in population health – including the causes of cancer.
She succeeded Sir Richard Doll as Director of the Cancer Epidemiology Unit at Oxford University (now part of Oxford Population Health) in 1989, with the aim of understanding the factors that increased or decreased the rates of breast cancer and of other reproductive cancers. Her frustration with the lack of consensus regarding the hypothesised effects of oral contraceptives led her to form worldwide collaborations between all who had undertaken epidemiological studies of hormonal factors and cancers of the breast, ovary, endometrium or cervix, bringing together virtually all the relevant data. Her judicious and painstaking analyses of the data provided definitive evidence that pill use has little effect on a woman’s lifelong risk of breast cancer, but offers significant long-term protection against ovarian and endometrial cancer. This has directly or indirectly given hundreds of millions of women more freedom to choose whether or when to have children, safe in the knowledge that they are not increasing their overall cancer risk.
Using a similar approach, Professor Beral showed that the adverse effects of menopausal hormone therapy (MHT) on cancer had been underestimated, and that some years of MHT had in fact caused an appreciable increase in breast cancer risk. Although her work on the risks and benefits of MHT use over the last two decades has influenced public and medical opinion, preventing many thousands of cases of breast cancer, MHT use is again rising in the UK. As MHT preparations had varied over time, she sought definitive evidence about the effects of contemporary MHT preparations by establishing the Million Women Study, which included about a quarter of all UK women aged 50-64 in the late 1990s and ever since then has used anonymised NHS records to monitor their illnesses. This lasting resource for research into women’s health is still providing definitive evidence about the determinants of many common diseases. It has shown that ‘if women smoke like men they die like men’ (to quote her 2013 press statement), but has also exploded many of the widely publicised but unjustified claims about supposedly healthy or hazardous habits.
The British Medical Journal described her tally of jobs, publications, and committees as reading ‘like a checklist of the epidemiological causes célebres of the past three decades’. (She was also Australia’s junior women’s chess champion when she was a teenager.) She investigated the effects of radiation in the nuclear industry, at Hiroshima and at Chernobyl, undertook early work on HIV/AIDS, and continued to work on a wide range of cancers and on the causes of heart attack, stroke, blood clots, osteoporosis, fractures, and dementia.
While chairing the UK Government’s Advisory Committee on Breast Cancer Screening she and the Director of the NHS Breast Screening Programme undertook the world’s largest randomised trial of breast screening (AgeX), scheduled to yield its findings about breast cancer mortality in 2026.
Dame Valerie was described in an enjoyable BBC ‘Life Scientific’ interview as an icon of epidemiology and brilliant mathematician, and received many honours – Fellowship of the Royal Society, the US National Cancer Institute’s Rosalind E. Franklin Award, Dame Commander of the Order of the British Empire, Companion of the Order of Australia and President of the International Epidemiological Association.
After a year-long illness she died peacefully, but was herself until the end. Throughout her life she was motivated in part by the need for answers, but also by her love of perfect studies, elegant statistical methods, and clear explanations (and winning arguments!). Her scientific integrity and commitment to seeking conclusive answers gained the respect of colleagues around the world. She was, however, not afraid to upset people in the cause of seeking definitive evidence and challenging unfounded perceptions about women’s health. Those who knew her remember her dogged persistence, and her desire to give women simple, reliable information that could help them avoid disease or make appropriate reproductive choices. As well as her devotion to research, she will also be remembered for her warmth and generosity towards junior colleagues (and for her delight in tangled garden flowers). She was an inspiring teacher who took time to instil sound epidemiological principles in everyone who worked with her, and took a special interest in encouraging women in science to fulfil their potential.
Valerie was acutely aware of European history, and donations in her memory can be made to Amnesty International.
Dame Valerie is survived by her husband, Professor Paul Fine, two sons, Richard and Stephen, and two grandchildren.
By Professor Gill Reeves and Emeritus Professor Sir Richard Peto