It is with mixed feelings that we advise that Professor Graham Giles AM is retiring this year, after 40 years of exemplary service to Cancer Council Victoria, cancer epidemiology research and the broader community in general. In this article we summarise his research career and role as Chief Investigator of Health 2020.
Following his move to Australia in 1976 from the United Kingdom via the United States, Graham began his career in epidemiology and population-based studies as a doctoral student at the University of Tasmania, where he received a PhD in medical geography in 1980. His post-doctoral research in Tasmania centred on a population- based case-control study of blood cancers, which whetted his appetite for cancer epidemiology and impressed upon him the value of cancer registries to research.
Victorian Cancer Registry (VCR) Beginnings
In 1983, Graham moved to Melbourne to take on the newly created role of Director of the Victorian Cancer Registry (VCR). He arrived at an opportune time, as cancer registration had recently been mandated by legislation. He quickly grasped the VCR’s untapped potential for cancer research in Victoria. His vision was “for an accurate, unbiased, population-based collection of cancer-data that would be useful for identifying and framing research questions and for facilitating population research”. Graham realised that registries needed to be seen and to be used if they were to survive; he therefore began a program of VCR data analysis and publication, initially through a series of 4-page pamphlets called Canstat. In 1984, he published the first volume of Cancer in Victoria containing population incidence and mortality rates for 1982.
In 1985, Cancer Council Victoria CEO, Dr Nigel Gray’s long held ambition to promote epidemiological research on cancer was revitalised by the VCR’s increased functionality and he asked Graham to develop a 5-year proposal for epidemiological research that would utilise the registry as a resource. The proposal was accepted, and in 1986 Graham was appointed to head the Cancer Epidemiology Centre, incorporating the VCR.
The Melbourne Collaborative Cohort Study (Health 2020)
In preparing his 5-year plan, Graham drew upon his analysis of VCR data that showed cancer differences across varied migrant and cultural communities following WWII, migrants from Southern European countries having lower rates of common cancers of the breast, bowel, and prostate than their Australian-born counterparts. His hypothesis was that at least some of the difference might be due to lifestyle factors, particularly diet. He also understood that to obtain high-quality evidence to inform cancer prevention would require a large prospective study where such exposures were measured before diagnosis not afterwards.
Due to the projected scale and breadth of the research, Graham recruited a handful of key collaborators (Professors Hopper, Larkins, Powles, and O’Dea), chosen for their complementary skills and interests. They spent much of 1986-9 drafting a scientific rationale, performing pilot studies, and developing procedure manuals for what they dubbed the Melbourne Collaborative Cohort Study (MCCS). Conditional upon obtaining part funding from VicHealth, Council agreed to fund MCCS recruitment and long-term follow up. Importantly, Council considered the MCCS needed a more user-friendly name and, given the initial plan was to follow up participants for 20 years, it was called Health 2000. This was revisited in 2000 when its name was changed to Health 2020.
One of Graham’s and the Cancer Epidemiology Centre’s greatest achievements was the recruitment of 41,000 Melburnians to the MCCS over 1990-94. Participants included migrants from Italy and Greece, who were deliberately over-sampled to increase the study’s diversity of lifestyle exposures. This enabled the MCCS team to investigate whether diet/ lifestyle contributed to incidence of cancer, with earlier research results indicating that a Mediterranean diet is associated with lower risk of several cancers and cardiovascular disease.
Since 1990, Health 2020 has produced over 1,000 publications with widespread findings, and to this day provides critical research infrastructure to the national and international cancer research community. It remains one of Australia’s largest prospective cohort studies but has also spurred successive longitudinal cohort studies of not just cancer but also other non-communicable diseases (such as diabetes) in the Australian population, the most notable being the Australian Breakthrough Cancer (ABC) Study, of which Graham was also the founding investigator.
Awards, impact, and conclusion
Graham’s wide-reaching contributions to international cancer research have been recognised in many ways, including honorary professional appointments at Melbourne and Monash Universities, and culminating in his award as a Member of the Order of Australia (AM) in 2014 for significant service to medicine, particularly through cancer epidemiology and public health research organisations, and as
a mentor. Over the course of his career, he has served on a variety of national and international committees, most notably the Scientific Council of the World Health Organisation’s International Agency for Research on Cancer in Lyon, France. One of Australia’s most cited researchers, in 2023 Graham was ranked by Research. com as 15th in Australia for his contribution to medical research.
Always a strategic thinker and a keen adherent to the long game, Graham carefully planned for the continuing success of the key individuals and institutions to which he had devoted his working life. In 2011 he stepped down as Director of the VCR but continued to work closely with his successor, Helen Farrugia. In 2016 he stepped down as Head of what had become the Cancer Epidemiology Division (independent of the VCR), and bought a house to settle in Tasmania, but remained as Head of Research and continued to support Prof Roger Milne in his new role. In 2019 Graham changed to part-time and began handing over the reins for his major projects to Roger and other long-term collaborators such as Prof Melissa Southey. In August 2023 he will retire but plans to stay on in an honorary capacity.
We are sure that you will join us in wishing Graham all the best for his retirement and once again thank you for your generous, ongoing participation in Health 2020.