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Biographical entry Blamey, Roger Wallas (1935 - 2014)

BChir Cambridge 1960; MB 1961; FRCS 1966; MD 1970; Hon FRACS; Hon FRCPS Glasgow.

Born
16 March 1935
London
Died
1 September 2014
Occupation
Breast Surgeon, General surgeon and Transplant surgeon

Details

Roger Blamey was professor of surgical science at Nottingham and a pioneering breast surgeon who developed the world-famous Nottingham prognostic index (NPI). He was born in London on 16 March 1935, the son of John and Cara Blamey. From Highgate School he went to Downing College, Cambridge, where he played rugby and was secretary of the boat club, followed by the Middlesex Hospital Medical School. He graduated BChir in 1960 and MB in 1961, and obtained his FRCS five years later.

He became a research fellow under Pat Forrest in Cardiff and was awarded an MD from Cambridge University in 1970 for his thesis 'Immunological aspects of tumour growth'. He spent two happy years from 1970 to 1972 in Australia as a senior lecturer under Dick Bennett in Melbourne. He subsequently undertook further postgraduate surgical training in Cambridge, where he was involved in both renal transplantation and breast surgery, which stood him in good stead when he was appointed senior lecturer in Nottingham in 1973 in Jack Hardcastle's department. He was appointed professor of surgical science in 1980.

Although he became an internationally-known breast surgeon, an early achievement was the introduction of renal transplantation to Nottingham. In 1974 the regional service for transplant surgery was too busy to cope with demand. Blamey felt that Nottingham patients were dying unnecessarily, so against the Regional Health Authority's wishes and inducing panic in his hospital administrators, he simply went ahead and laid the foundation for Nottingham to become a major renal centre.

Roger Blamey became one of the foremost breast surgeons of his generation and established at the City Hospital the Nottingham Breast Institute, a beacon for teaching and research. His main objective was to find a way to tailor the treatment of patients with breast cancer so that each individual received the most appropriate therapy for them, rather than the broad based standard of the day. To this end he set up in 1973 the Nottingham Tenovus breast cancer study, in collaboration with the Cardiff Tenovus Research Institute. A range of potential prognostic and predictive factors was studied in a large group of closely followed-up patients, leading in 1982 to the Nottingham prognostic index, based on pathological (not clinical) tumour size, histological grade (the Nottingham method evolved by his colleagues Elston and Ellis) and lymph node stage. It proved, with oestrogen receptor status, to be a reproducible tool for the stratification of patients into therapeutic groups. Combined with newer molecular markers, such as HER2, the NPI still remains relevant.

The collaboration with Tenovus was typical of Blamey's approach to research. From small beginnings he built a team of cellular pathologists, research fellows, oncologists, radiologists, plastic surgeons, geneticists and many others. Although clearly the leader of the team, Blamey took pains to develop the potential of every member. He was one of the first surgeons to introduce preoperative diagnosis of breast lesions, using needle core biopsy and fine needle aspiration cytology. This replaced the then standard practice of intraoperative frozen section, after which a woman would awake from surgery not knowing whether or not her breast had been removed. He also pioneered the concept of breast conserving surgery, despite opposition from more traditionally minded colleagues.

Multidisciplinary team working is now standard practice for all patients with cancer and Blamey led the way. His weekly meetings with pathologists evolved into full-blown patient management conferences, including oncologists, radiologists and specialist breast care nurses, especially after the introduction of the National Breast Screening Programme, of which he was a key protagonist as project leader of the UK trial for early breast cancer detection (1980 to 1987) and the UK Coordinating Committee on Cancer Research trial of the frequency of breast cancer screening (1990 to 1996).

Blamey published over 350 articles, 30 book chapters and eight books, and was in considerable demand all over the world as a teacher, lecturer and debater, even after retirement. He established the Nottingham international breast conference in 1990, one of the most important events in the breast research calendar, and it is hardly surprising that Nottingham breast service was selected as a national training centre for the screening programme. Many young surgeons from the UK and abroad trained under his supervision, with no fewer than 25 completing a doctoral thesis. He also had a major influence in establishing standards for the training of breast surgeons and the setting of national targets for the operation of breast units.

At the British Association of Surgical Oncology he was chairman of the breast surgeons group from 1989 to 1996 and president (1998 to 1999). He was chairman of the British Breast Group from 1993 to 1995, and vice president and accreditation co-ordinator of the European Society of Mastology. He was an honorary fellow of the Royal Australasian College of Surgeons.

Roger Blamey was charismatic, a great motivator and possessed of a high intellect, but he was not noted for administrative efficiency and could be intolerant of those not in tune with his ambitions. Once on a lecture tour in the USA he telephoned his long-suffering secretary saying he was in Philadelphia, but where should he be? He was notorious for making extensive revisions to research papers before they were submitted for publication. His research fellows quickly realised that by the third or fourth redraft the paper bore an uncanny resemblance to the original, so they would agree with all his amendments and send off the original version! It is not known if he ever found out. Apparently this also happened when he helped his children with their homework.

He had wide interests outside medicine, including music, theatre, art and sport, particularly cricket. He was a regular attender at the Edinburgh Festival. He had a very happy home life with Norma (née Kelly), his wife for 55 years, and they were very proud of their three children, Eleanor, Sarah and Edmund, and six grandchildren.

Towards the end of his life he was admitted to hospital with acute symptoms, which turned out to be due to a cerebral abscess. This was successfully drained, but he never really recovered and died on 1 September 2014, aged 79.

Christopher W Elston
Douglas Macmillan

Sources used to compile this entry: [BMJ 2014 349 6395 www.bmj.com/content/349/bmj.g6395 - accessed 17 February 2015; The Guardian 11 September 2014 www.theguardian.com/society/2014/sep/11/roger-blamey - accessed 17 February 2015; The Telegraph 21 September 2014 www.telegraph.co.uk/news/obituaries/11111715/Professor-Roger-Blamey-obituary.html - accessed 17 February 2015; The Times 15 October 2014].

The Royal College of Surgeons of England