International Society for Preventive Oncology

In memoriam · Herbert Eguda Nieburgs, M.D. · 1913 - 2013

• pioneer in the early detection of cancer
• ISPO founder
• Cancer Detection and Prevention founding editor

Dr. Herbert Eguda Nieburgs passed away in the hundredth year of a remarkable life leaving a legacy of impressive accomplishments in the pursuit of early cancer detection — in the realms of diagnostic cell pathology, clinical and laboratory research, continuing medical education as well as authoring, editing, and publishing. He was a physician known for his great honesty and integrity, extraordinary work ethic, clear intellect, keen mind, and insight.

Dr. Nieburgs’ seminal contribution, the discovery and characterization of cellular “markers” presenting malignancy associated changes (MAC) in ostensibly benign cells throughout the body, was made in 1959 — with the aid of the light microscope — before progress in molecular biology transformed biological sciences. His observations of MAC indicated the clinical presence of a suspected tumor and of unsuspected tumors in early asymptomatic stages. MAC was confirmed by independent investigators and also found to be valid for spontaneous cancer in animals. With other investigators, he determined that circulating nucleic acid peptides were the basis responsible for the development of these cellular “markers”. The prospect of being able to diagnose cancer, without performing invasive testing, sparked continuing interest in the medical research community over the next decades. Independent investigators have successfully quantified the MAC principles and criteria and coupled the algorithms of MAC morphology with evolving computer technologies in digital cytophotometric image analysis — integrating them in today’s automated and semiautomatic cytometry systems for cancer screening.

Dr. Nieburgs was a pioneer in clinical cytology and the study of differences between cells from covert invasive carcinoma and preinvasive carcinoma (carcinoma-in-situ) of the cervix uteri. In 1946, he became involved with ground-breaking clinical research on endocrinology and cytology that was blossoming at the Medical College of Georgia (Augusta) under the direction of endocrinologist Robert Greenblatt and pathologist Edgar Pund. In 1949, Drs. Nieburgs and Pund reported that preinvasive carcinoma could remain localized for as long as 10 years in younger women based on an investigation of 10,000 cases utilizing the Papanicolaou Method (Pap smear). This landmark finding justified wide-scale screening programs for early detection of incipient carcinoma that were funded by the National Cancer Institute (Bethesda) between 1950 and 1954.

Dr. Nieburgs directed the first mass-screening project in the United States, undertaken in Georgia’s Floyd County, for detection of uterine cancer in women — the milestone study was published in JAMA 1957;164:1546-51. In 1950, Dr. Nieburgs was appointed a Professor of Clinical Cytology at the Medical College of Georgia where he created the College’s Department of Clinical Cytology. In October 1953, Dr. Nieburgs became the Director of the Cytology Center, Beth El Hospital (Brooklyn, New York). He joined New York’s Mount Sinai School of Medicine Department of Pathology in 1955 working with the renowned pathologists Paul Klemperer and Hans Popper, the father of modern hepatology, and the eminent gastroenterologist, Fenton Schaffner.

Dr. Nieburgs was appointed consultant, Division of Cancer Control and Research, New York City Department of Health (1956–1967). In cooperation with Abe Oppenheim, Commissioner of Health, he conducted a screening project for detection of early stomach cancer. Dr. Nieburgs founded Mount Sinai’s Laboratory for Cell Pathology in 1957 and served as the laboratory Director for 27 years. Innovation was a hallmark in Dr. Nieburgs’ laboratory. He held a number of U.S. patents for devices to facilitate the collection of cell specimens. He published a textbook on techniques for cytological examination, collection methods and fixation. In the reporting of diagnostic information he introduced the practice of always showing both the characteristic cytology of the exfoliated cells and the histopathology of the tissues from which they were derived. To improve visualization of the chromatin distribution within the cell nuclei and the morphology of the fine nuclear cell structures that occur in carcinogenesis, he modified the formula of the Papanicolaou Stain. Leitz Wetzlar optics technicians collaborated with Dr. Nieburgs in engineering light microscope ocular eye pieces and viewers for multiple users. Dr. Nieburgs himself constructed a system to image 20-fold enlargements of single cell structures within various histopathologic alterations, observed at the highest magnifications of a light microscope attached to closed-circuit television.

Dr. Nieburgs regularly lectured on aspects of the cell morphology in the biology and diagnosis of tumors to medical groups around the world. His command of German and Italian permitted him to address his audience in these languages. Medical schools invited him to organize workshops. He continually conducted diagnostic cytology courses for Mount Sinai’s Page and Black Post-graduate School of Medicine, the International Academy of Cytology, the American Society of Cytology and the Society for Detection and Prevention of Cancer (later known as the International Society for Preventive Oncology – ISPO).

Dr. Nieburgs effectively fostered global approaches to cancer recognition and prevention founding both the ISPO and the internationally peer-refereed bi-monthly journal, Cancer Detection and Prevention. The journal became an authoritative and important voice in the mechanisms of cancer development as well as its many causes and cofactorial aspects of detection and prevention. Under Dr. Nieburgs’ leadership, as editor-in-chief from 1976 to 2009, the publication brought to world attention articles about the lifestyle practices that were responsible for particular types of cancers or the presence of local factors in the environment that lead to cancer, including many studies on diet and cancer, the establishment of basic services in screening programs and development of national tumor registries, the implications of specific types of cancer in migrant populations, and on public health and psychosocial issues.

As ISPO’s Secretary-General, Dr. Nieburgs advanced continuing medical education on interacting etiologic factors in cancer development and their impact on prevention, detection and management of neoplastic diseases. Dr. Nieburgs’ energy, commitment and ingenuity were instrumental in convening two-dozen major international symposia held between 1973 and 2004 for appraisal of advances in predictive and preventive oncology at the individual, community and national level. The 4-5 day scientific programs involved the organization of thousands of research reports into cohesive schedules of presentations proffered by leading clinicians and researchers worldwide engaged in various fields of cancer medicine and biotechnology

Major international cancer control agencies endorsed the ISPO symposia including the International Union Against Cancer (UICC), Geneva; International Agency for Research on Cancer (IARC), Lyon; and World Health Organization (WHO), Geneva. The symposia were convened in venues around the world including the cities of Boston, New York, London, Sao Paulo, Paris and numerous other European locations. As ISPO’s Secretary-General, Dr. Nieburgs involved national, regional, and local cancer control agencies, university institutes and medical centers in cosponsoring the symposia scientific programs.

Dr. Nieburgs undertook the massive task of reviewing and editing the papers presented at the ISPO symposia in collaboration with well-known physicians and medical researchers, including Philip Strax, Murray M. Copeland, Robert A. Good, I. Bernard Weinstein, Guy de Thé, Anthony B. Miller, and Leonardo Santi to mention but a few. The ISPO publications included Prevention and Detection of Cancer (4 volumes, 1977–1979), Tumor Markers in Cancer Control (1985), Immunobiology of Cancer and AIDS (1987), and Developments in Preventive Oncology (2 volumes, 1987) by way of example. Thereafter, symposia papers were selected to appear in special issues of the print and online versions of the journal, Cancer Detection and Prevention.

Between 1987 and 2012, Dr. Nieburgs was affiliated with the University of Massachusetts Medical School (Worcester). He was appointed Professor of Pathology in the Department of Pathology initially chaired by the world-renowned pathologist Guido Majno. Medical School faculty members including the prominent educator and Chancellor Aaron Lazare, lent their expertise to ISPO’s programs in primary and secondary cancer prevention complementing the School’s continuing medical education. In 1989, the editorial functions for Cancer Detection and Prevention were established at the University of Massachusetts Medical School. The journal’s editorial responsibilities were passed to the publisher, Elsevier Science (Oxford, England) in 2009, at which time Dr. Nieburgs stepped down after 33 years as editor-in-chief.

Dr. Nieburgs’ own publications were many and varied. He authored an Armed Forces Institute of Pathology syllabus Morphogenesis of Uterine Cervix Carcinoma (1964), textbooks on subjects such as Hormones in Clinical Practice (1949), Cytologic Techniques for Office and Clinic (1957), Diagnostic Cell Pathology in Tissue and Smears (1967), chapters in textbooks and reference compendia like the 5th edition of Bocus Gastroenterology (1995), numerous audiovisual teaching aids, films, manuals and over 100 refereed journal articles devoted to the identification of cellular markers in cancer, immune deficiencies and AIDS, prognosis and response of cancer patients receiving chemotherapy and radiation treatment, and the relationship between environmental factors and cancer. In addition, Dr. Nieburgs’ command of Russian and German made it possible for him to authoritatively translate a number of books into English, including the Russian language report by the U.S.S.R. Red Army Medical Unit, Treatment of Exposure to Freezing and Frostbite, for use by the British military during wartime (subsequently published by Hutchinson in 1947), and the 2nd edition of the German textbook by Henning and Witte, Atlas of Gastrointestinal Cytodiagnosis, published by G. Thieme (1970).

A native of Latvia, Dr. Nieburgs received his early education in Riga and Berlin in the twenties during years of economic tumult and political instability in Germany and Eastern Europe. His father, a pharmacist, was influential in his decision to attend the German Medical School in Prague, Czechoslovakia. Dr. Nieburgs completed his degree in Italy at the University of Bologna (1938). Post-graduate studies in gynecologic pathology at the Sorbonne, Paris, were interrupted by the threat of imminent war. Dr. Nieburgs was in the Vienna train station on the night of November 9, 1938 — Krystallnacht. He escaped from Nazi soldiers in the course of his arrest and made his way to Italy. In Turin, he turned for help from Count Rossi, the honorary Latvian Consul, who had recently travelled from Estonia to Riga with Dr. Nieburgs serving as his interpreter (Latvian into Italian). The Count arranged with the British Embassy for Dr. Nieburgs’ visa to enter England. Dr. Nieburgs was in London during the Blitz. He was granted a British license and assigned to the surgery and medicine service at the Emergency Hospital, Barking, and West Middlesex Hospital. In May, 1942, he filed to patent his invention of a surgical tourniquet — the first of many patents he was granted throughout his career.

From 1942 to 1946, Dr. Nieburgs was affiliated with the Endocrine Clinic, Department of Gynecology and Obstetrics, Westminster Hospital, and the British Post-Graduate Medical School, University of London. His research in cell pathology and experimental endocrinology was associated with some of Britain’s most illustrious scientists. He conducted clinical studies with endocrinologist Raymond Greene, brother of the author Graham Greene, and an alpinist who accompanied Sir Edmund Hillary in the ascent of Mt. Everest. Sir Solly Zuckerman, the influential war operations research pioneer and leading authority on primate behavior, engaged Dr. Nieburgs in cytologic studies of rhesus monkeys. In fact, Dr. Zuckerman was one of the many distinguished researchers participating in the first meeting that Dr. Nieburgs organized — an international symposium on Exfoliative Cytology, Cancer Detection and Diagnosis (Augusta, April 1953).

Dr. Nieburgs accepted appointments as consultant to the Cancer Unit of the World Health Organization, and lived near Geneva, Switzerland for several years after retiring from the Mount Sinai School of Medicine in 1984. He continued to study the cell morphology of malignancy-associated changes imaged digitally at the highest power of the light microscope. Dr. Nieburgs was 97 years of age when he displayed his recent photomicrographs of MAC appearing in cancer stem cell niche architecture. The presentation attracted the enthusiastic attention of junior and senior investigators attending the American Association for Cancer Research 101st annual meeting (Washington DC, April 17-21, 2010).

During his career, Dr. Nieburgs was the recipient of numerous honors and awards recognizing his contributions to continuing medical education and studies of cancer cell morphology. He will be missed by his many friends, students and those he mentored, and colleagues in medical and scientific communities internationally. Dr. Nieburgs passed away on June 8, 2013. He was predeceased by his beloved parents who perished in Auschwitz. He is survived by his second cousin, Aleck Hercbergs M.D., a radiation oncologist at the Cleveland Clinic, and his spouse and devoted partner for the last 41 years of his life, Suzanne Kay Nieburgs, a former science and technology reference librarian at the New York Public Library Research Libraries (42nd Street), who collaborated with him in all aspects of his pursuits of the early detection of cancer.