Surgeon’s studies changed treatment of breast cancer
Bernard Fisher, 101, a surgeon and scientist who revolutionized the standard treatment for breast cancer by demonstrating that the disfiguring procedure known as a radical mastectomy was often unnecessary, and that chemotherapy and hormone therapy could prolong women’s lives, died Oct. 16 in Pittsburgh.
His daughter Beth Fisher, who is also a medical doctor, confirmed his death but did not cite a cause.
Fisher was recognized as one of the most significant cancer researchers of his era — “the bold field marshal of hundreds of staunchly independent surgeons, thousands of dedicated patients (and) millions of research dollars,” as the Philadelphia Inquirer once described him, who “rallied legions to his crusade: to stop breast cancer.”
He began his cancer research in the 1950s at the University of Pittsburgh, where he would spend his entire career. At the time, routine treatment for breast cancer included the “radical mastectomy,” introduced by American surgeon William Stewart Halsted in the late 19th century, in which the breasts were removed along with nearby lymph nodes and the muscle tissue beneath the breasts.
The procedure, which left patients disfigured if not debilitated, was based on the then-prevailing belief that breast cancer spread directly from the original tumor. The more surrounding tissue was removed, went the theory, the greater the chance of stopping the cancer.
Working with his brother, pathologist Edwin Fisher, Bernard Fisher determined that breast cancer did not, in fact, spread in such an organized way, and that it could instead move throughout the body by entering the lymph system. That premise, one of the first fundamental ways that Fisher upended decadesold medical dogma, inspired the sprawling studies that he went on to lead.
From 1967 to 1994, he headed the National Surgical Adjuvant Breast and Bowel Project, a consortium based in Pittsburgh and funded by the National Cancer Institute that during his tenure ran clinical trials involving 500 institutions, 5,000 medical professionals and nearly 50,000 patients, according to figures cited by The Washington Post in 1994.
Among the project’s first studies was one testing the efficacy of the radical mastectomy — a line of inquiry that at the time, Fisher said, was “tantamount to heresy.”
The studies Fisher led compared survival rates among women who had undergone radical mastectomies, simple mastectomies in which only the breast was removed and lumpectomies in which only the tumor was excised. The research revealed no advantage to the radical mastectomy.
In time, Fisher’s research received wide acceptance. By 1979, the Post reported that physicians had “all but abandoned the radical mastectomy in the treatment of breast cancer.”
In 1985, Fisher received the Albert Lasker Clinical Medical Research Award, an honor often considered a precursor to the Nobel.
Fisher also investigated the benefits of hormone therapy such as tamoxifen, which is used to prevent the recurrence or, in some cases, the onset of estrogen-sensitive breast cancer.
Fisher endured a painful chapter in his career beginning in 1994, when it was revealed that a Canadian researcher involved in one of his studies had falsified data to allow the participation of patients who did not meet the established criteria. The revelations sparked widespread panic among breast cancer patients whose treatment plans had relied on that study, which showed lumpectomies followed by radiation to be as effective as full mastectomies.
Fisher, who emphasized that the results of the study remained valid, was not accused of falsifying data but was criticized for failing to immediately report the falsifications when they were discovered. He was removed from his role at the National Surgical Adjuvant Breast and Bowel Project, and his actions were scrutinized in congressional hearings.
Investigations continued until 1997, when the federal Office of Research Integrity cleared Fisher of allegations of scientific misconduct. Later that year, the University of Pittsburgh apologized to Fisher and agreed to pay him $2.75 million in a settlement in which Fisher agreed to drop a lawsuit he had filed.