Abstract
Dr Joan Austoker was Director of the Cancer Research UK Primary Care Education Research Group, and Reader in Public Health and Primary Health Care at the University of Oxford. Her work underpinned the evidence-based information which accompanies invitations for cancer screening in England. She was also actively involved in developing the public information on cancer screening in general.
Joan founded the Primary Care Education Research Group in 1991, and that year found herself in the eye of the storm around breast self-examination, which trials had shown to be unhelpful in cutting the death rate from breast cancer. Despite ill-health at the time, she briefed ministers and the new Chief Medical Officer on the evidence and worked with the Department of Health in order to ensure that information on breast awareness could be published quickly in the face of heightened public interest. She worked extensively with the breast surgeons in the early days of the Breast Screening Programme, and was a major influence on the first ‘Guidelines for Surgeons in Breast Cancer Screening’. Given only a list of recommendations, Joan organized the document beautifully to make it comprehensible: it was this which led to the Guidelines becoming extremely influential.
She produced information packs for GPs about the breast and cervical screening programmes as they became organised in the late 1980s, and for the new bowel cancer screening programme which began in 2006. She was also responsible for producing an information pack for women at high familial risk of certain cancers; for guides to breast symptoms and cervical screening for GPs; and for the NHS prostate cancer risk management programme for both GPs and patients. Through this, her work reached into millions of people's homes across England and the wider UK, and the current Department of Health focus on an evidence-based National Awareness and Early Detection Initiative is, in many ways, the product of her work over the past two decades.
She was part of the team which originated the Cancer Research UK (CRUK) ‘Cancerstats’ factsheets, which provide professionals with salient information about cancer in an accessible form. They are now on the CRUK website. Author of around 100 scientific papers, her series in the British Medical Journal on cancer prevention in primary care was also published in book form. Her wider research interests included work on the psychological effects of screening and surveillance programmes, and the acceptability of the services provided. Her work was internationally recognized, with contributions to projects at the National Cancer Institute in the USA and in Europe, where she was chief author of the chapters on communication which were published in the breast, cervical and bowel cancer screening guidelines. She was also leading the work on communications for the new supplement under preparation on HPV testing and vaccination.
Joan was born in South Africa in 1947, and originally trained as a biochemist, taking a first class honours degree at the University of the Witwatersrand in 1968. She came from a family of three girls and was taken by her father to all major cricket and rugby matches, which resulted in an encyclopaedic knowledge of both sports. She was a keen sportswoman herself, a fearsome swimmer and walker who played provincial hockey in South Africa and, once in the UK, played county tennis and hockey and was captain of both Aylesbury Vale and North Oxford women's tennis teams at the same time.
She did not feel comfortable in South African society and came here on a one way ticket as soon as she could, without clear plans. Eventually she studied for her PhD in Biochemistry at University College, London in 1972. In 1981 she took an MA in Science and Health Education at Chelsea College. Her special skill was the ability to align scientific method and rigour in the field of health education which, at the time, had not yet developed its own science or methodology. She had a unique combination of skills and expertise and her work was used throughout the world.
Joan was diagnosed with Gaucher's disease during her first pregnancy. Over the next 30 years her illness gradually engulfed her, although she carried on working until the last few hours of her life. In spite of her illness her determined nature survived in her professional practice and in her intellectual rigour. She would argue her point strenuously and even when outvoted would often continue to hold her position. She would demand the same high standards of anyone dealing with her, which pushed many of her research students to great achievements. Her loss has been felt around the world as she was held in high regard wherever informed choice was coming into view. She is survived by her four sons.
Julietta Patnick would like to acknowledge the help of the many friends and colleagues on whose memories of Joan she drew in writing this tribute.