Dr Bernard Fisher
Cancer surgeon who challenged the medical wisdom of the day
DR BERNARD FISHER, who has died aged 101, was an American cancer surgeon who challenged prevailing wisdom when he questioned the need for radical mastectomies – the removal of the entire breast and surrounding tissues – on patients in the primary stages of the disease.
From early in his career, Fisher was convinced that the key to devising a successful treatment plan for breast cancer lay in focusing on two previously underexplored areas.
The first was the study of metastasis – the spread of cancer to other parts of the body. The second was the conducting of large-scale clinical studies. During the 1960s and 1970s Fisher did extensive laboratory research and designed a number of such studies. This work led him to conclude that breast cancer is a systemic disease, in which malignant cells spread throughout the body prior to diagnosis.
This being so, then for many patients a disfiguring radical mastectomy could hardly be expected to influence whether or not the cancer spread.
Instead Fisher suggested patients opt for a lumpectomy – a less invasive operation to remove a discrete portion of breast tissue – followed by radiation, drug or hormone therapy. The proposal met with significant resistance from many in the medical community. A few even accused Fisher and others interested in less invasive surgeries of “murdering” the women in their care.
The effectiveness of Fisher’s approach was proved, however, with the publication, in 1985, of two of his studies in the New England Journal of Medicine. These looked at 1,843 women who had undergone one of three treatments: “total” mastectomy, lumpectomy, or lumpectomy followed by radiotherapy. A follow-up study on the same women four years later found that 85 per cent of the lumpectomy patients were still alive, against 76 per cent of those who received total mastectomies. With his theory vindicated, Fisher found himself lauded in the scientific press. There was talk of a Nobel Prize. In the event, he received the 1985 Lasker Award for medical research “shaping the character of modern breast cancer treatment”.
Born on August 23 1918 and trained in medicine at the University of Pittsburgh, Fisher first became interested in cancer research when his former university mentor asked him to help set up a trials group sponsored by the National Cancer Institute. As many as 50,000 patients enrolled in the National Surgical Adjuvant Breast and Bowel Project (as it became known), with Fisher serving as the consortium’s chairman from 1967 to 1994.
He stepped down after a surgeon who had been involved in the research was accused of falsifying data – an accusation that brought Fisher under suspicion of knowingly permitting the bad data to be used.
A subsequent, protracted federal investigation cleared him of any scientific misconduct and allowed him to return to the University of Pittsburgh as a professor. He went on to conduct research into the efficacy of the oestrogenblocking drug tamoxifen at lowering rates of breast cancer in women considered at high risk of developing the disease.
A burly man with something of a reputation for arrogance, Fisher could be scathing about work conducted by colleagues that relied on anecdotal observations and retrospective analysis – an approach he derided as “worthless”. However, he attracted strong support as well as hostility. In 1997, as his campaign to get restitution from those he felt had maligned him drew to a close, 20 European authors collaborated on an article entitled The trials of Dr Bernard Fisher, which dubbed his treatment “Kafkaesque”.
Bernard Fisher’s wife Shirley predeceased him in 2016, and he is survived by three children.