Spotlight On: Mitchell H. Gail, MD, PhD

Issue 26 Winter/Spring 2016

Mitchell H. Gail, MD, PhD

Mitchell H. Gail, MD, PhD
Senior Investigator
Biostatistics Branch
Division of Cancer Epidemiology & Genetics
U.S. National Cancer Institute
Bethesda, MD

Whether applied to an individual or a nation, assessments of whether a particular intervention might help prevent cancer – and to what extent it might do so – are crucial to the decision-making process. In this context, any statistical tool that helps clarify the risks and benefits of a chemopreventive measure becomes vital.

Over the course of his career, Dr. Mitchell Gail has pioneered the development of these types of risk assessment tools, some of which have now been in use for decades.

For this and other achievements, the American Academy for Cancer Research and the American Cancer Society selected Dr. Gail this year as the recipient of its Award for Excellence in Cancer Epidemiology and Prevention.

Gail may be best known for the widely used statistical tool that bears his name – the aptly named “Gail model.” First developed and described in 1989, the model attempts to answer a vital question for any woman: What is my risk of getting breast cancer?

The Gail model uses several risk factors – the woman’s age, her age at first live birth, age at onset of menses, number of first-degree relatives with breast cancer, and the number of prior breast biopsies – to come up with her risk of developing breast cancer, either in absolute terms or relative to other women.

This was the first model for assessing breast cancer risk that could be used in a general population. Soon after, the U.S. National Cancer Institute adapted the Gail model to develop its Breast Cancer Risk Assessment Tool (BCRAT), which remains in broad use in doctors’ offices today. BCRAT has also been updated to improve estimates of breast cancer risk for minority populations.

The Gail model has other applications, as well – for example, the U.S. Food and Drug Administration used it to define indications for the chemopreventive drug tamoxifen in women aged 35 and older.

Dr. Gail’s work extends beyond breast cancer, however. Over the years, he has been involved in designing studies that look at interventions to fight lung cancer and prevent gastric cancer, for example. His work today focuses on how to improve statistical modeling in epidemiological studies, including studies focused on a myriad of genetic factors linked to disease.

In the end, Gail believes that the accurate assessment of the risks and benefits of chemo-preventive interventions is vital to saving lives. This is as true for the individual patient as it is for populations as a whole.

In a lecture delivered at the time he received his award, Gail described the risk models he and others have developed as, “useful for counseling, providing a general perspective, and weighing risks and benefits … They are also useful for designing clinical trials and for assessing the population impact of an intervention.”

These statistical tools point to the need for safer interventions that might then be utilized by more people – maximizing the potential for cancer prevention.

Gail has received numerous other awards throughout his career, including a Lifetime Achievement award from |the American Statistical Association, the PHS Distinguished Service Medal, the Distinguished Achievement Award from the American Society of Preventive Oncology, and the National Institute of Health’s Merit Award.

He received his medical degree from Harvard Medical School, and his mathematics doctorate from George Washington University in Washington DC. Gail joined the NCI in 1969.