Bernard Fisher (scientist)

Bernard Fisher died in Pittsburgh on October 16, 2019 at the age of 101.

Fisher's "wife of 69 years, Shirley Kruman Fisher, died in 2016." She was a medical researcher who worked in bacteriology. Both she and Fisher's brother, the pathologist Edwin Fisher, worked with him in his early research and experiments. Bernard and Shirley had three children.

Fisher's impact on breast-cancer treatment was the subject of an August 2013 article in the Atlantic Monthly that was occasioned by his 95th birthday. "Before 1971, if you had breast cancer, chances are you'd have to get your breast cut off", the article recalled. "Surgeons had been taught one thing: radical surgery saves lives. It was Bernard Fisher who changed their minds".

In 2006, Fisher was awarded the American Association for Cancer Research Award for Lifetime Achievement in Cancer Research. "Dr. Fisher's important work not only helped those who fight the disease, but has also helped prevent breast cancer in women who are at high risk", said Dr. Margaret Foti, chief executive officer of the AACR.

To honor Fisher's career, the University of Pittsburgh created the Bernard Fisher Lecture in 2005. In January 2006, the University of Pittsburgh School of Medicine named David L. Bartlett, M.D., professor of surgery and chief of the division of surgical oncology at the school, as its inaugural Dr. Bernard Fisher Professor of Surgery.

In 1997, after a three-year investigation the Office of Research Integrity ruled that Fisher was innocent of any scientific misconduct.

In autumn 1997, six weeks before his case was set to go to trial, Fisher accepted an apology from the university and a cash settlement from the defendants and agreed to withdraw his lawsuit. Fisher reportedly received $2.75 million in damages, plus $300,000 from the NCI to cover his legal expenses. After the settlement was announced, Fisher said that the lawsuit had not been about money, which, he indicated, “could hardly compensate for the 3½ years lost from his work,” but about “truth and justice.” He hoped that the settlement would “act as a deterrent to those who would disregard due process and the First Amendment right to freedom of speech.” Responding to the charge “that he had not properly audited the data submitted by other researchers, had published papers knowing that some data had been falsified, and had been slow to publish corrections,” Fisher pointed out “that it was NSABP investigators who first uncovered the data falsification and it was the NSABP that told authorities about the problem.”

When Fisher began to perform research on breast cancer, "it was widely believed," he later wrote, “that patients with tumors in the inner quadrants of the breast had a poorer prognosis than those with lesions in the outer quadrants". Fisher's research led him to conclude, on the contrary, "that the location of a tumor was unrelated to its prognosis" and "that there was no justification for selecting specific surgical or radiation approaches based upon tumor location". He would stay in that position until 1994, excepting an interlude during which he was removed from the position.

The national media reported in 1994 that Poisson had falsified data in 99 cases and that both Fisher and the NCI, under whose auspices the research was being done, had kept this information from the public. One journalist's interpretation of the episode was that "the same self-assured and pugnacious attitude that had helped him triumph over surgical conservatism” had “landed him in hot water".

Fisher served as President of the American Society of Clinical Oncology from 1992 to 1993 and on the board of directors of the American Association for Cancer Research from 1988 to 1991.

He was elected a Fellow of the American Association for the Advancement of Science in 1991, was named a fellow of American Association for Cancer Research in 2013, and was a fellow of American College of Surgeons, from which he also was awarded the prestigious Jacobson Innovation Award in 2009.

In 1990, one of the statisticians on Fisher's research team "noticed a discrepancy on the chart of one breast cancer patient being treated by a researcher in a hospital in Montreal." Upon being questioned by Fisher, the researcher, Dr. Roger Poisson at St. Luc Hospital, "admitted that he had falsified data for years to get unqualified patients into trials." To ensure that Poisson's bad data had not "affected the outcome of the lumpectomy trial, Fisher reanalyzed the study" and found that the results were still valid. "He notified the federal officials at his granting agency, the National Cancer Institute, of the problem with the errant researcher", and continued his work. But federal investigators stepped in, and eventually a congressional subcommittee called a hearing. "They found problems with Fisher's auditing system, potential problems with misconduct at another site, sloppy paperwork at a few more of the 500 centers that Fisher had been relying upon for data."

In 1986, he was appointed Distinguished Service Professor of Surgery. In 1994 he left the position of chairman of the NSABP.

Fisher faced constant attacks from within medical ranks as he worked to disprove the efficacy of the old status quo treatment, eventually being described as "an iconoclastic figure" who brought about "far reaching changes...in the understanding of cancer and its treatment". The Atlantic called him "a medical hero". He was awarded the Albert Lasker Award for Clinical Medical Research in 1985 "for his pioneering studies that have led to a dramatic improvement in survival and in the quality of life for women with breast cancer."

Ultimately, his recommendations for breast-cancer treatment won the approval of the medical establishment. "In 1985," reported the Atlantic, "the New England Journal of Medicine published two of Fisher's studies that definitively proved" his earlier findings. His recommended approach to treating breast cancer thereafter gained universal acceptance.

Fisher had been a member of the Institute of Medicine of the National Academy of Sciences since 1985. He served on a number of scientific advisory committees and was appointed by the White House to serve on the National Cancer Advisory Board and the President's Cancer Panel. He was a member of many editorial boards and belonged to most of the important academic, medical, surgical, and scientific societies.

Fisher won the Albert Lasker Clinical Medical Research Award for 1985, which was given in recognition of "his profound influence in shaping the character of modern breast cancer treatment, thus lengthening and enriching the lives of women suffering from this dread disease". The citation noted that Fisher had "done more than any other single individual to advance the understanding of the clinical biology of breast cancer" and "conceptually reshaped and improved the treatment of breast cancer, extending and enriching the lives of women suffering from this dread disease....From 1972 to 1981, the use of radical mastectomies has declined progressively from 46.8 percent to 4.5 percent. Each year from 55,000 to 60,000 women in the U.S. have breast cancer of 4 centimetres (1.6 in) or less and are eligible for this breast-preserving therapy".

Fisher's arguments received considerable positive attention in the 1970s, however, from many women's rights activists. According to women's health activist Cynthia Pearson, the “women's health movement began talking about mastectomy as one of the examples of sexism in medical care in the United States.” Fisher's ideas won the movement's support and became a political issue as well as a medical question.

In a March 20, 1967, letter, Dr. Rudolf J. Noer suggested that Fisher apply for the position of chairman of the NSABP. He was officially appointed to that post on May 9 of that year. During the succeeding decades he would lead clinical trials that would result in transformative changes in the treatment of breast cancer.

Throughout the 1960s and 1970s, Fisher studied cancer biology and performed randomized clinical studies comparing the relative effectiveness of lumpectomy, total mastectomy, and lumpectomy followed by chemotherapy or radiation.

By the late 1960s, Fisher's research had established that radical mastectomy was indeed "no more effective than total mastectomy", and that a total mastectomy, in turn, was “no more effective than lumpectomy in treating breast cancer.” Fisher consequently urged his fellow breast-cancer surgeons to change their approach to the disease. Most of them resisted, however, and continued to perform radical mastectomies, and many accused Fisher and his supporters of placing women's lives at risk by not performing the radical surgery. Fisher later described the widespread resistance to his approach by the medical establishment as “extensive and often unpleasant". "For 50 years", he later recalled, “surgeons had been trained to do radical surgery. They felt that performing the lumpectomy was totally inappropriate". Hence, "my peers were my antagonists....It was difficult to get doctors to put doctors into the trials, and, as might have been anticipated, it was even more difficult to persuade women to be randomized to a study in which some of them would undergo mastectomy and others would have their breasts preserved".

In 1958, Fisher took part in the first randomized clinical trial examining the results of systemic therapy following radical mastectomy for breast cancer. This study of more than 800 women, which was the first project to emerge from the NIH meeting, concluded that while chemotherapy involving the drug thiotepa positively affected the survival rates of premenopausal women, physicians were hesitant to begin using systemic adjuvant therapy.

In the spring of 1957, having returned to the University of Pittsburgh, Fisher received a request from I.S. Ravdin, M.D., who had been his mentor at the University of Pennsylvania, and who at the time was Chairman of the Clinical Studies Panel of the Cancer Chemotherapy National Service Center at the National Institutes of Health (NIH). Ravdin asked Fisher to join 22 other surgeons in attending an NIH meeting to discuss the establishment of the Surgical Adjuvant Chemotherapy Breast Project, later known as the National Surgical Adjuvant Breast and Bowel Project (NSABP).

"I wasn’t the least bit interested in breast cancer", Fisher later said. "But since Dr. Ravdin was an army general who had operated on President Eisenhower, when he commanded me to attend the meeting, I did so. At the time of that first meeting in 1956, the idea of using clinical trials to obtain information, and certainly the idea of giving therapy following surgery, were novel approaches to treatment". Fisher was initially reluctant to relinquish his research on liver regeneration and transplantation and to take up the study of breast cancer and other malignant diseases, but he became intrigued by the subject of tumor metastasis. Indeed, he "was captivated", he later said, both by "the mystery of metastasis" and by "the new concept of the clinical trial".

From 1950 through 1952, he was a fellow in experimental surgery at the University of Pennsylvania. In 1955, he was a research fellow at the London Postgraduate Medical School at Hammersmith Hospital, where he sought to increase his knowledge about transplantation.

He graduated from the medical school at the University of Pittsburgh in 1943, then completed a surgical residency.

He graduated from Taylor Allderdice High School in 1936 and was inducted in their alumni hall of fame in 2009.

Bernard Fisher (August 23, 1918 – October 16, 2019) was an American surgeon and a pioneer in the biology and treatment of breast cancer. He was a native of Pittsburgh. He was Chairman of the National Surgical Adjuvant Breast Project at the University of Pittsburgh School of Medicine. His work established definitively that early-stage breast cancer could be more effectively treated by lumpectomy, in combination with radiation therapy, chemotherapy, and/or hormonal therapy, than by radical mastectomy.

Since the late 19th century, breast cancer had been treated with the Halsted radical mastectomy, named for its originator, Dr. William Stewart Halsted (1852–1922), a famous surgeon at Johns Hopkins Hospital. This procedure involved the removal not only of the entire breast but also the underarm lymph nodes and chest wall muscles. Such operations left women with gaping holes in their chests. The argument for this approach was "that cancer cells, originating from the breast, always passed through the lymph nodes prior to metastatic spread and, therefore, required radical surgery to remove the entire breast, underlying chest muscle, and axillary lymph nodes to halt metastasis".