Thursday, September 28, 2023

A Tribute to the Epidemiologist Who Predicted and Documented Cancer’s 30-Year Decline


The U.S. National Cancer Institute recently launched a public relations campaign to increase its funding in fiscal year 2025, from $10 billion to $11.5 billion.  Arguing for the increase, NCI director Dr. Monica M. Bertagnolli notes that there are “two million new cases of cancer diagnosed each year” in the U.S., even as she acknowledges that “there are more than 18 million cancer survivors” living today.  As shown in the chart at left, cancer kills far fewer Americans now than it did in 1990, the peak year for U.S. cancer mortality.  In fact, the decline has been virtually continuous for over 30 years. 

This extraordinary trend was first brought to light by University of Alabama at Birmingham epidemiologist and professor Dr. Philip Cole.  In his 1996 article in the American Cancer Society’s flagship journal, Cancer, Dr. Cole attributed the decline in cancer deaths primarily to reductions in smoking that had begun in 1965, and to improvements in diagnosis and treatment.  He predicted that “the decline…is likely to continue for at least 20 years and may accelerate.” (my emphasis)

Dr. Cole and I published a follow-up study in the Journal of Clinical Oncology in 2001, demonstrating that if lung cancer had never existed, the death rate in the U.S. from all other forms of cancer would have declined continuously, starting in 1950. 

Dr. Cole was a world-renowned epidemiologist whose insightful analysis three decades ago has proven prescient.  He passed away on September 6.

I met Dr. Cole in 1993 when I asked the director of the UAB Comprehensive Cancer Center to comment on my draft medical article laying out the scientific foundation for smokeless tobacco as a substitute for cigarettes (a public health strategy unheard-of then, now called tobacco harm reduction). He told me to contact Dr. Cole, the chairman of epidemiology at UAB who was revered in the cancer epidemiology field as an exceptional data-driven scientist.  I’m sure the director suspected that Dr. Cole would quickly eviscerate my thesis.  When I delivered the draft to Dr. Cole, I included a red pen and told him to feel free to “bleed” all over the text.  

Three weeks later, having dissected my piece every which way, he called to say that he had rarely had another faculty member bring him a completely novel idea in epidemiology.  He offered to help me, and that support – which required me to produce more than 20 additional drafts – not only contributed immeasurably to getting my article published in the American Journal of the Medical Sciences, but it continued for a remarkable 30 years and resulted in coauthoring 36 publications in medical/scientific journals and book chapters with him. 

I acknowledged Dr. Cole’s invaluable assistance in my book, For Smokers Only: How Smokeless Tobacco Can Save Your Life, which was published in 1995.  As I wrote, by that time, he had “served as a collaborator on projects related to this idea for the past two years. In this short period he has challenged me to write — even more fundamentally to think — with precision, clarity and refinement about many important facets of the tobacco issue.”  Dr. Cole wrote a foreword for my book in 1995, which illustrates his literary talent.    

Dr. Cole’s authoritative voice articulating the causes of cancer has gone silent.  I dedicate this post to Dr. Cole, his extraordinary life, his incredibly productive career, and his personal guidance and friendship.


  Dr. Philip Cole, 1938-2023