Year: 2023
Type: other
Abstract: Few people loved epidemiology with the depth and passion that Janet Daling did. Naturally gifted with numbers, she completed a Bachelor of Arts degree in mathematics at Washington State University in 1957. After graduating, she got married and started a family on a cattle ranch in eastern Washington. In 1967, seeking a way to apply her mathematical skills to real-world problems, she became a research analyst in the Washington State Department of Social and Health Services. During her 10 years in this role, she discovered the fields of biostatistics and epidemiology, which motivated her to continue her education. She completed a Master of Science degree in biostatistics in 1973 and a PhD in epidemiology in 1977 from the University of Washington, all the while continuing her work for the State of Washington. In 1978 she joined the faculties of the University of Washington and the Fred Hutchinson Cancer Center. Janet’s earliest work focused on women’s reproductive health and birth outcomes. These topics were understudied at the time, and she was a pioneer in leveraging administrative data from birth certificates to characterize risk factors for adverse pregnancy outcomes. Examples of this type of research that had direct clinical impact include the following: Demonstrating the impact of chlamydia infections on risk of premature birth and perinatal mortality (1). Characterizing potentially modifiable risk factors for neonatal sepsis (2). Documenting the increased risk of ectopic pregnancy in relation to use of some intrauterine devices (3) and from douching (4). Quantifying the risk of infertility in relation to use of intrauterine devices, which contributed to the removal of the Dalkon Shield (A.H. Robins Company, Richmond, Virginia) from the market (5). Appreciating the invaluable experience epidemiologists gain from analyzing real-world data, she created a new (and unique for its time) course that became highly replicated as a structured way for students to apply their nascent epidemiology data analysis skills. To this day, this required course continues to follow the core sequence of epidemiologic theory and methods classes in the University of Washington Department of Epidemiology. For decades, this project-based class put Washington State birth records into the hands of small groups of students who were asked to design a study with a specific hypothesis and then analyze and present their data. This class has spawned hundreds of publications, many of which resulted from Janet’s initiation of innovative vital, hospital discharge, and cancer registry record linkages. Janet was a trailblazer in developing these rich databases, which were further used outside of class, launching dozens of careers. Examples include studies exploring the topics of differences in twins (6); maternal and perinatal risk factors for longer-term outcomes among offspring, including cancer (7–9) or death (10); a woman’s risk of repeating adverse pregnancy outcomes in subsequent deliveries (11–13); sisters’ shared risks of pregnancy complications (14); intergenerational aspects of pregnancy conditions (15); pregnancy outcomes (16, 17); and long-term morbidity among cancer survivors (18, 19). One of Janet’s hallmark characteristics as an epidemiologist was her keen aptitude for hypothesizing novel connections between exposures and outcomes, and innovative approaches to testing them. For example, Janet was inspired by a conversation with her hair stylist to investigate whether the risk of cancer was associated with potential correlates of sexual behavior for men who have sex with men (20) by linking cancer and sexually transmitted disease registries. She observed 2 associations that confirmed her hypothesis: The incidence of anal cancer was particularly increased among men with a history of sexually transmitted disease and among men, but not women, who had never married. She also noticed that anogenital cancer pathology reports frequently described tumors that arose in a condyloma, and she subsequently conducted a study that showed condylomas are more frequent among women with vulvar cancer (21). By 1986, she began a series of population-based studies of human papillomavirus (HPV) in cervical cancer and other anogenital cancers, characterizing and comparing their epidemiology across sites. Janet was always driven by where the data took her, and in these studies she never held back from asking study participants questions that others perceived would be difficult or uncomfortable to ask. This led to strong evidence that multiple forms of anogenital cancer are related to HPV infections (22), certain features of sexual history (23), and cigarette smoking (24). Janet’s landmark paper on anal cancer (25) showed that oncogenic HPV is a necessary cause of anal cancer, similar to cervical cancer. These studies were continuously funded by the National Cancer Institute for 25 years, and included studies of oral (26), cervical (27), vaginal (28), vulvar (29), anal (25), and penile (30) cancers. The ramifications of Janet’s conversation with her hairdresser were substantial! Janet is also well-known for her contributions to studying cancer in women, with research spanning breast, ovary, endometrial, and thyroid cancers and a primary interest in hormonal exposures. With respect to ovarian cancer, she characterized how both exogenous hormones (31, 32) and some forms of infertility treatment (33) increased the risk of this aggressive cancer. For breast cancer, having observed a large rise in breast cancer incidence in young women in the early 1980s (34), Janet launched what became the first of a 2-decades–long series of case-control studies of breast cancer. These studies made important contributions toward characterizing the roles of reproductive and hormonal factors in relation to breast cancer risk, such as breastfeeding, pregnancy history, perinatal factors, and oral contraceptive use (35, 36). Janet was also a Principal Investigator and Chair of the Steering Committee for the multi-institutional Women’s Contraceptive and Reproductive Experiences (CARE) Study, funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which enrolled thousands of breast cancer patients, including an oversampling of African-American women, in what at the time was one of the single largest observational studies of breast cancer ever carried out. The CARE Study made numerous contributions, including reports on the absence of any increase in breast cancer risk among middle-aged and older women in relation to oral contraceptive use (37); the presence of an increased risk related to use of combined estrogen-progestin hormone replacement therapy (38), which appeared to be largely confined to the lobular subtype (39, 40); determination of the prevalence and predictors of breast cancer 1 (BRCA1)/breast cancer 2 (BRCA2) gene mutation carriership, including the largest assessment of its time among African-American women (41); and many others. Janet was also an early adopter of population-based research on the determinants of breast cancer recurrence and death and published some of the earliest papers on how reproductive, hormonal, and lifestyle factors may influence the risks of these outcomes (42, 43). There are few things that Janet loved more than meetings with her trainees, staff, et al., when they came bearing fresh data. She would put aside whatever else she was working on to give her full attention to data tables, swiftly generating possible explanations for the results, considering potential sources of bias, and of course quickly rattling off a long list of additional analyses that should be done. What was also remarkable was her ability to identify even the smallest numerical errors in a sea of results, as well as confidence intervals that seemed a bit too wide, concerns about how exposure variables were parameterized, and issues with missing data. The joy she took in reviewing data was rooted in her love of scientific discovery. She made the experience of being the first people in the world to see and consider data from the studies her trainees were working on feel thrilling, because she believed so deeply in the transformative impact of epidemiology. These meetings would frequently end with Janet saying, “Isn’t this fun?”. Related to this, one of the other things that brought Janet tremendous satisfaction was convincing people who were not epidemiology students that they should drop whatever they thought they wanted to do and instead pursue a career in epidemiology. Her passion for epidemiology inspired trainees who were already on the epidemiology path and also those who happened to enter her orbit, from unsuspecting medical students to the children of her friends, to pursue and continue careers in epidemiology. The list of individuals whose careers she affected and inspired is long and includes current and former epidemiology faculty members, department chairs, epidemiologists working in state health departments, and scientists working in health systems and in industry, many of whom have passed along Janet’s inquiring spirit to their trainees. A reflection on Janet’s life would be incomplete without at least a short mention of her second passion, the game of bridge. For decades Janet was one of the nation’s top duplicate bridge players, an interest she pursued even more vigorously in her retirement. Her bridge accomplishments are myriad and included her ranking of 64th in the nation among an estimated 60,000 active North American Contract Bridge League members at the time of her death. She played bridge daily throughout her life and spent one memorable evening playing with Bill Gates at his home when another avid bridge player, Warren Buffet, was in town. Throughout her career, Janet was driven by the power of numbers, as well as the potential for epidemiologic studies to affect human health through discoveries that could directly reduce morbidity and save lives. She had an enormous influence on the field of epidemiology through the body of her work, the methods she employed, her generosity and animation in exchanging ideas with colleagues, and her dedication to her trainees and staff, whom she treated as members of her extended family. For those of us who knew and learned from Janet, the impact of her death is deeply personal, given how her mentorship and guidance changed our lives. Janet Daling was one of a kind, and she is deeply missed. Author affiliations: Epidemiology Program, Fred Hutchinson Cancer Center, Seattle, Washington, United States (Christopher I. Li, Margaret M. Madeleine, Beth A. Mueller, Kathleen E. Malone); and Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States (Noel S. Weiss). Conflict of interest: none declared.
Source: American Journal of Epidemiology
DOI: 10.1093/aje/kwad066
Institutions: Fred Hutch Cancer Center, University of Washington
Language: English
Subfield: History and Philosophy of Science
Field: Arts and Humanities
Domain: Social Sciences
Open Access status: bronze
Funder: University of Washington
OpenAlex ID: W4361190617