Bernard Fisher, 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. He was 101.
His daughter Beth Fisher, who is also a medical doctor, confirmed his death but did not cite a specific cause.
Bernard Fisher, an eminent breast cancer surgeon and researcher, died Oct. 16. University of Pittsburgh
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 decades-old 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.”
“For most of the 20th century, and certainly in 1971 when we started the study, the concept was that more surgery was more likely to cure people with breast cancer,” he told the publication Oncology Times in 2002.
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.
Such was the resistance to his ideas, Fisher told the Pittsburgh Post-Gazette, that at one early conference a colleague grabbed him by the lapels and excoriated him. Fisher, however, remained unswayed. “In God we trust,” he once remarked. “All others [must] have data.”
In time, Fisher’s research received wider 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. The award, which recognized his research on the benefits of chemotherapy as well as his findings about mastectomies, honored him as having “done more than any other single individual to advance the understanding of the clinical biology of breast cancer.”
Fisher also investigated the benefits of hormone therapy such as tamoxifen, which is used to prevent the recurrence or even, in some cases, the onset of estrogen-sensitive breast cancer.
“Our 1998 report indicating, for the first time, that breast cancer could be prevented with tamoxifen was probably the capstone of my career,” he told a publication of the University of Pittsburgh’s medical school on the occasion of his 100th birthday. “Certainly, in 1958, when I began this journey, the idea of using an agent to try to prevent breast cancer was . . . science fiction.”
Bernard Fisher was born Aug. 23, 1918, in Pittsburgh, where his father ran a produce operation. Both his parents emphasized the importance of education – to the extent, Fisher told the Post-Gazette, that his father banned Bernard and Edwin from setting foot in the family business.
Fisher enrolled at the University of Pittsburgh, where he received a bachelor’s degree in chemistry in 1940 and a medical degree in 1943, then joined the faculty.
In the early years of his surgical career, he performed a kidney transplant as well as research on liver regeneration. He said he had no interest in breast cancer until 1958, when a mentor, a military doctor who had operated on President Dwight D. Eisenhower, invited him to a National Institutes of Health conference on the matter.
“You don’t turn down a two-star general,” Fisher told the medical school publication.
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 hearings by a congressional subcommittee led by U.S. Rep. John Dingell.
Investigations continued until 1997, when the federal Office of Research Integrity cleared Fisher of allegations of scientific misconduct.
“My life was ruined,” he told the Times. “My reputation was ruined. I lived through the McCarthy era, and I saw what that was all about. Now I have lived through it in science and fear that it could happen again to others.”
But “the great tragedy of this, beside my personal harm, is that women in this country thought that the work I did all of these years was not credible,” he said. “They questioned their therapeutic decisions and suffered anxiety needlessly.”
Later that year, the University of Pittsburgh apologized to Fisher and agreed to pay him $2.75 million, with the National Cancer Institute contributing $300,000 for his legal fees, in a settlement in which Fisher agreed to drop a lawsuit he had filed.
Fisher’s brother died in 2008, and his wife of 69 years, bacteriologist Shirley Kruman Fisher, died in 2016.
Survivors include three children, Beth Fisher of New York City, Joseph Fisher of Scottsdale, Arizona, and Louisa Fisher Rudolph of Pittsburgh; five grandchildren; and two great-grandchildren.
Throughout his career, Fisher sought to recognize the physicians who joined his studies and their patients, whom he described as the “real heroes of our efforts.”
“By consenting to participate in our clinical trials,” he said when he accepted the Lasker, they “gave of themselves in an unselfish noble fashion so that future generations might benefit. Every woman owes those brave women a perpetual debt of gratitude.”
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