John HaywardBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2751 (Published 29 April 2013) Cite this as: BMJ 2013;346:f2751
- Anne Gulland, London
John Hayward became a breast cancer surgeon at a time when the most common treatment for the disease was mastectomy. This operation came at a high physical and psychological price for patients, and Hayward began to think that such radical treatment was, for many women, unnecessary. With Sir Hedley Atkins, a senior surgical colleague at Guy’s Hospital in London, he ran the first trial to compare mastectomy with breast conserving surgery.
Atkins, after whom the cancer unit is named at Guy’s, introduced the randomised control trial to medicine in the UK, and Hayward was a keen proponent of it. Together they showed that not all patients needed a mastectomy and that breast conserving surgery would suit some women.
Hayward’s first research was on hormones, which had long been known to have a role in the development of cancer, and, at the time of his first research in the 1950s, women often faced removal of their adrenal and pituitary glands. This treatment was not successful for all women, and Hayward began to study which patients would benefit and which would not.
At a conference in 1957 he met Richard Bulbrook (known as Mick), a biochemist at the Imperial Cancer Research Fund. Hayward took blood and urine samples from patients for Bulbrook to analyse, and they came up with a discriminant function test to determine which patients should undergo removal of the pituitary and adrenal glands.
According to Robert Rubens, professor of clinical oncology, who worked with Hayward at Guy’s, the two formed a most successful partnership and would eventually go on to found the British Breast Group, to promote research into breast disease. Colleagues described the pair as great fun and very sociable.
Hayward grew up in Essex, and as a boy he dreamed of becoming an actor until his architect father told him to choose a more sensible career. Hayward’s wife, Jill, believes that he was finally able to give vent to his talent for performance in the lecture theatre.
He studied medicine at the University of London and at the end of the second world war was one of a group of medical students who travelled to the German concentration camp Belsen, shortly after it was liberated, to carry out relief work. What he witnessed there was so shocking that he rarely spoke about it. He graduated in 1947 and, after serving in the Royal Air Force and a brief stint at Selly Oak Hospital in Birmingham, he was appointed a surgical assistant at Guy’s Hospital in 1953 and remained there for the rest of his career.
One of his most notable achievements was the Guernsey study, an extension of his work on steroid hormones with Richard Bulbrook. The pair wanted to look at a large group of women over time and chose Guernsey as it had a stable and well defined population, with the general practitioners and surgeons on the island keen to collaborate. Ian Fentiman, professor of surgical oncology at Guy’s and one of the young researchers on the study, says that the Guernsey study was unique in its scale. Its major finding was that exposure to high levels of oestrogen determined women’s likelihood of developing breast cancer. Today women in the study are still being followed up.
“The object of the study was to look at risk factors for development of breast cancer. Hayward was concerned with trying to identify women who would respond to treatment and also with finding those who were at increased risk,” says Fentiman.
In the early 1960s a breast cancer unit was established at New Cross Hospital, part of Guy’s, and Hayward became its director. Then the Imperial Cancer Research Fund increased its financial contribution to Guy’s and set up the breast cancer unit, which combined laboratory and clinical research. Hayward became its first director and from there carried out much international work, including the Anglo-Japanese and Anglo-Egyptian breast cancer studies, which looked at the differences in the incidence and pathology of the disease between the countries.
Hayward also promoted multidisciplinary working and appointed a pathologist to the unit, Rosemary Millis, as well as Rubens as clinical oncologist. Millis says that at the time multidisciplinary teams were unusual: “He foresaw the multidisciplinary approach that was to become standard practice. Up until his time most patients with breast cancer were treated by general surgeons, and few were specialists. He was one of the first to be entirely focused on looking at breast diseases and dedicated to finding the best form of treatment.”
Hayward—described as affable, gregarious, and fun—loved to travel, and his knowledge and expertise were recognised internationally. He had strong links with colleagues all over the world and often hosted international students and researchers. In the 1980s he was asked by Italian breast cancer expert Umberto Veronesi to go to Milan to undertake a mastectomy that would be filmed and then used as a training video. Murid Chaudary, the surgical assistant who accompanied him, believes that hundreds of surgeons must have watched Hayward’s surgical skills.
When Hayward retired he bought a pub near his home in East Sussex, serving behind the bar one day a week. He had a stroke and then developed dementia, which gradually overtook him in the last 10 years of his life. He leaves his wife, Jill, and two sons.
Cite this as: BMJ 2013;346:f2751
John Langford Hayward, consultant surgeon (b 1923; q 1947 University of London), died from dementia on 24 February 2013.