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Dr. Evarts Graham and the History of Cardiothoracic Medicine and Research at Washington University

The Department of Surgery at Washington University School of Medicine has been conducting renowned healthcare and research for over a century. Evarts Graham, MD, established and led the Division of Cardiothoracic Surgery from its inception in 1933 to 1951. After its establishment, the program has consistently excelled as a clinical, teaching and research center. Dr. Graham’s contributions included work in lung surgery and lung cancer epidemiology, and the department continues to treat and conduct research to advance pulmonary medicine.

Dr. Evarts Ambrose Graham

Surgeons and physicians of distinction have supported Washington University’s various clinical programs since its inception. One such individual was Dr. Evarts Ambrose Graham, one of the most impactful, respected physicians of his era nationwide. From 1919 to 1951, Dr. Graham served as the first full-time chairman of the department of surgery at Washington University School of Medicine and the chief of surgery at what is now Barnes-Jewish Hospital.

Dr. Graham’s career was characterized by a variety of clinical achievements. Following a period of military service, Dr. Graham was recruited as the Bixby Professor of Surgery at Washington University. Soon after, he established the “chest service” program for thoracic surgery. Dr. Graham was an expert thoracic surgeon. One of his most notable achievements was a collaboration with Drs. Jacob J. Singer, Kenneth Bell and William Adams in 1933. This team performed the first successful removal of a lung (pneumonectomy) to treat lung cancer (bronchogenic carcinoma).

Dr. Graham was also a productive physician outside of the operating room. He was instrumental in forming the American Board of Surgery in 1937. It was the first and still one of the most prestigious surgical boards, supporting standardized and ethical practices by surgeons nationwide through rigorous testing and certification. Dr. Graham was the first “Board Certified” surgeon of the ABS. He was further active as a medical editor and author, acting as Editor-in-Chief for the Yearbook of Surgery & the Journal of Thoracic Surgery as well as the Co-Editor-in-Chief of the Annals of Surgery journals. Dr. Graham’s work as a surgeon and academic was further advanced through his involvement in research. His work contributed to clinical understanding of lung health and the carcinogenic consequences of smoking.

Research on Smoking and Lung Cancer

In his most renowned research project, Dr. Graham worked with Dr. Ernst Wynder to conduct the first large-scale, systematic survey on the carcinogenic effects of cigarette smoking, a project known as the 1950 Wynder and Graham Study.

Between the 1920s and 1950, deaths from lung cancer had quadrupled, becoming the primary cancer detected in male patients. Before the project began, Dr. Graham was not initially convinced that smoking increased risk of lung cancer, but he sought to better understand the disease process and improve the health of his patients. He supported Wynder’s research design to conduct interviews on patients he treated for lung cancer. Drs. Wynder and Graham compared the smoking habits of 684 patients with bronchogenic carcinoma, comparing them to those without the condition. The study concluded that long-term cigarette smoking contributed to the onset of lung cancer. 96.5% of the men with lung cancer were classified as long-term moderate to heavy smokers, a significantly higher proportion than the general hospital population control group.

Drs. Graham and Wynder published their results in a 1950 paper in the Journal of the American Medical Association (JAMA). Theirs was one of the earliest publications to link cigarette smoking and lung cancer, and it helped pioneer later studies that would encourage the Surgeon General to release a warning in 1964 about the risks of cigarette smoking. Unfortunately, Dr. Graham had been a long-time cigarette smoker before his research supported the correlation between smoking and disease. He himself died from lung cancer in 1957.

A Lasting Impact and Continued Pursuits in Pulmonary Medicine

Modern trends in smoking cessation can be in part attributed to the social impact of Dr. Graham’s research. Since its publication, further scientific and clinical research has supported his conclusion that smoking causes lung cancer, heart disease and lung disease among many other debilitating and deadly conditions. As these studies have proliferated, public understanding of smoking’s impact has shifted. Nearly half of Americans smoked when Dr. Graham’s results were first made public. Since 1950, research, programs for smoking cessation and social understanding of smoking have reduced the number of smokers nationally to near 14% in the United States.

Smoking cessation has improved the pulmonary health of Americans. Avoiding cigarettes reduces the risk of developing cancer, lung disease, heart disease, stroke, high blood pressure, emphysema and other smoking-related symptoms like headaches. It helps prevent the incidence of pneumonia and bronchitis and promotes overall better health. Outside of personal health, abandoning cigarettes reduces the health problems caused by second-hand smoke.

Current research focuses on vaping and its effects, a continued concern for lung health. Research and cessation programs are now turning towards vaping products, which have seen a huge surge in use and uptake especially from young adults, an audience previously targeted by cigarette companies. Vaping products are marketed towards a younger audience using a variety of flavors and stylish designs that promote usage in social environments, much like high-end cigarettes in the past. According to different polls in recent years, 5-10% of Americans are regular users of vaping products, but somewhere between 20-27% of high school students have or currently use vaping devices. This disproportionate fraction demonstrates the higher concern for young adults developing health problems from vaping.

In the tradition of Dr. Graham’s pursuits in the cardiothoracic and pulmonary fields, the Division of Cardiothoracic Surgery continues to treat and conduct research to best understand the health of its patients.

Surgeons and researchers in this division lead NIH-funded research studying lung allograft rejection to understand and prevent organ rejection after transplantation. The Lung Transplant Program at Washington University School of Medicine in St. Louis, which has performed over 1,900 lung transplants, continues to lead the nation in clinical volume and patient outcomes.

In partnership with the Veterans Affairs St. Louis Health Care System, a recent study from the division found that Veterans who receive care for early-stage lung cancer through the VA receive exceptional care with favorable outcomes, including significantly longer overall survival, in comparison to the general population. The division also contributes to the advancement of cardiothoracic research by leading many of the major journals in the field, including the Journal of Thoracic and Cardiovascular Surgery.

Continuing Dr. Graham’s Tradition of Excellence at Washington University

The precedent set by Dr. Graham established excellence at Washington University early in its operation. Graham stressed the importance of applying sciences to the clinical training of surgeons and believed that the study surgical medicine should be an integral part of preparing for a career in a surgery. His legacy of scientific research and clinical care has been upheld by later chairmen and a cardiothoracic program strong in both exploration and medicine.

Today, under the leadership of renowned cardiac surgeon, Ralph J. Damiano, Jr., MD, the division continues to be a pioneer in developing treatments for heart and lung disease in adults and children. It has maintained a branch of cutting-edge research on lung cancer and disease that will lead the department to even more innovative pursuits of pulmonary medicine, as surgeons adapt to the changing needs of patients.

To learn more about the Lung Cancer Screening Program at Siteman Cancer Center, please call 314-747-3046 or visit the Siteman Cancer Center website.

To make an appointment with a Washington University lung surgeon or refer a patient, please call 314-362-7260 or visit the Cardiothoracic Surgery website.