Nikolai Pavlovich Napalkov
Authors: Boleslav Lichterman
Journal: BMJ (2008)

Nikolai Pavlovich Napalkov was director of the N N Petrov Institute of Oncology in Leningrad (now St Petersburg) and assistant director general of the World Health Organization (WHO). He published extensively on experimental oncology, oncomorphology, the statistics and epidemiology of malignancies, and the fight against cancer and other chronic non-infectious diseases in developing countries.

Napalkov was born in Leningrad. His grandfather, Nikolai Ivanovich Napalkov, and his father, Pavel Nikolaevich Napalkov, were both professors of surgery and leading Soviet surgeons. As a medical student in Leningrad, Napalkov became interested in morphology and started research under Dmitry Zhdanov, professor of anatomy, as well as training in pathology. On graduation he entered the aspirantura (a three year postgraduate research programme) at the laboratory of experimental oncology in the Institute of Oncology in Leningrad (now the N N Petrov Institute of Oncology), which was headed by Leon Shabad, one of the founders of experimental oncology and cancer prophylaxis.

Napalkov’s kandidatskaya dissertation (the Russian equivalent of a PhD thesis) dealt with experimental tumours of the thyroid gland. Noticing that thyroid epithelial cells were histologically and genetically heterogeneous, he proposed a new morphological classification for experimental tumours of the gland. He remained in the laboratory as a junior researcher, and after several months in the United States as visiting scientist, became head of the laboratory of tumour strains, soon renamed the laboratory of experimental tumours. In 1965 (at the age of 33) Napalkov became deputy director of the Institute of Oncology but continued as honorary head of his laboratory. He did pioneer work on blastomogenic effects of antithyroid drugs—the subject of his doctorskaya dissertation in 1969.

During this time Napalkov linked the higher incidence of liver cancer to the herbicide aminotriazole. As a result, its use was prohibited in the United States and severely restricted in the former Soviet Union (USSR). He and his colleagues also investigated the carcinogenic effects of DDT (dichlorodiphenyltrichloroethane).

For many years they studied transplacental cancerogenesis. This phenomenon occurs in all mammals but patterns of susceptibility differ, which was confirmed in 1971 when a higher incidence of vaginal cancer was reported in girls whose mothers took synthetic hormones while pregnant. They also discovered protective anticancer mechanisms in the placenta.

From 1971 to 1974 Napalkov was head of WHO’s cancer unit in Geneva and helped prepare an international histological classification. Returning to Leningrad, he became director of the N N Petrov Institute of Oncology in 1974 at the unusually young age of 42. During the next 15 years Napalkov combined his directorship with research on tumour morphology and morphogenesis. He also became involved in epidemiological studies of and prophylaxis against cancer. During the cold war, cancer statistics in the USSR were classified information. Nevertheless, he was allowed access and to publish his findings in specialised medical journals. He coedited Cancer Control in the Countries of the Council of Mutual Economic Assistance (1982) and Cancer Incidence in the USSR (1983), coauthoring Principles for Evaluating Health Risks to Progeny Associated with Exposure to Chemicals during Pregnancy (1984). All three books were translated into English.

Napalkov and coworkers found that carcinogens increase the risk of tumour development in the next generation as well as increasing susceptibility to tumour promoters. For example, malignancies are more frequent in children whose fathers worked in the atomic industry.

The destruction of the atomic reactor in Chernobyl in April 1986 provided additional impetus to his epidemiological studies. In Belarus (which received more Chernobyl radiation than the Ukraine or Russia) thyroid cancers increased sharply, especially in children from the heavily contaminated Gomel region. During 1986 to 1993, 168 such cancers were diagnosed, compared with six in an equivalent time before then.

In 1989 Napalkov was appointed assistant director general of WHO. He was responsible for several programmes concerned with the impact of the environment on human health, interventions against chronic non-infectious diseases, occupational health, health in elderly people, and promotion of a healthy lifestyle. He also headed an international programme monitoring health sequelae after Chernobyl. In 1998 he returned to St Petersburg as director emeritus of the N N Petrov Oncology Institute.

Napalkov’s scientific career was successful partly because of his social activity. He was secretary of the local komsomol organisation (Young Communist League) at high school and a member of its bureau at medical school, joining the Communist party in 1960. In his later life he was a member of raikom (local district branch of the Communist party) and deputy of the city council of Leningrad, being chairman of the healthcare commission. In 1976 he was elected a delegate to the 25th congress of the Communist party. He wrote in his autobiography, “participation in the work [of this congress], the trust of comrades, left an indelible mark on my soul.” In the years of perestroika he was elected a member of the Soviet parliament, where he joined the commission on health care.

From 1974 to 1989 Napalkov was a president of the All-Union Scientific Society of Oncologists, and for many years he was editor in chief of Voprosy onkologii (“Problems in Oncology”). He was elected to the Academy of Medical Sciences of the USSR (now Russian Academy of Medical Sciences), becoming corresponding member in 1976 and full member in 1986. His international contacts were also many through being consultant to the International Agency for Research on Cancer (IARC) in Lyons and to WHO in Geneva, being a member of the foundation council of the Global Forum for Health Research, and preparing WHO’s framework convention on tobacco control. A globetrotter, he died unexpectedly from a ruptured aortic aneurysm in a Moscow hotel during his tour of duty to the N N Blokhin Russian Oncology Research Centre.

He is survived by his wife, Lilia Anatol’evna Sharai, a histologist; two twin sons, Anatoly, an associate professor of surgery, and Pavel, an epidemiologist; and three grandchildren.