Bernard Fisher revolutionized the understanding of breast cancer—but 28 years ago this week, NCI jettisoned him from his position as chair of the National Surgical Adjuvant Breast and Bowel Project.
Fisher’s landmark clinical trials demonstrated that, for treatment of breast cancer, the less invasive lumpectomy plus radiation provides the same surgical benefit as the radical, disfiguring Halsted mastectomy or modified radical mastectomy.
In 1994 his practice-changing research was questioned when it was reported that a Montreal surgeon—one of about 5,000 doctors to join Fisher’s study group—had falsified the paperwork of some of the patients he enrolled in several studies.
Congress became involved, and the Washington scandal took on a life of its own. Fisher fought back, emerging with his dignity intact. Nearly three decades later, his scientific legacy is more brilliant than ever, and his decision to stand by his science is an inspiration to every scientific leader who has stood up in defiance of political attacks.
Remembering Bernie Fisher
- Bernard Fisher, pioneering breast cancer researcher, dies at 101
By The Cancer Letter | Oct. 25, 2019
Bernard Fisher, a surgeon and clinical trialist who revolutionized the field of breast cancer research and all but eliminated reliance on disfiguring surgeries, died Oct. 16 at the age of 101.
At the time of his death, Fisher was the Distinguished Service Professor at the University of Pittsburgh School of Medicine.
“The world has lost a great man. Dr. Bernard Fisher, a courageous surgeon who almost single-handedly, over great resistance, changed the paradigm of breast cancer treatment from brutish to the more compassionate and successful treatment of today leading to reduction in mortality and morbidity,” Vincent DeVita, a former NCI Director and the Amy and Joseph Perella Professor of Medicine and Professor of Epidemiology and Public Health at the Yale School of Medicine, wrote on Facebook. “And I have lost a great friend. Rest well Bernie. There is a very large chorus of angels waiting for you.”
Anatomy of a scandal
- When Bernie Fisher refused to grovel
By The Cancer Letter | Nov. 01, 2019
Bernard Fisher had been in many a fight. He was, after all, an iconoclastic surgeon who had famously infuriated his colleagues by demonstrating that heroic surgeries in breast cancer do more harm than good.
However, nothing in his life prepared him for the ordeal that befell him in March 1994.
In a matter of days, everything Fisher had accomplished vanished in the midst of a political brawl sparked by Rep. John Dingell (D-MI) and his squad of investigators. Dingell et al. had learned about scientific fraud in a small number of cases in massive clinical trials Fisher directed.
Fisher knew about that, too, but didn’t think it was a big problem, and didn’t move fast to reanalyze the data. In fact, The Cancer Letter’s first story about this brewing scandal appeared on page 6 (The Cancer Letter, March 18, 1994).
Initial appearance notwithstanding, the story rapidly acquired hurricane force, and feeling the pressure from the intensely feared Dingell committee, NCI Director Samuel Broder fired Fisher from his position as chairman of the National Surgical Adjuvant Breast & Bowel Project, the cooperative group the surgeon co-founded and ran. The University of Pittsburgh, too, threw Fisher under the bus. Ultimately, the databases run by NCI and the National Library of Medicine—including all NSABP publications and Fisher’s Karnofski Lecture at ASCO—were libelously labeled “SCIENTIFIC MISCONDUCT.” The surgeon, who was 75 at the time, was never accused of scientific fraud.
The NSABP scandal became the single biggest story in oncology in 1994. People Fisher contemptuously called BAPs—bureaucrats, administrators and politicians—were on the attack, media coverage was intensive and not always correct, academic warlords were contemplating carving up NSABP, and patients were terrified about having relied on NSABP data in their treatment decisions.
- Anatomy of a Scandal
By Pittsburgh Post-Gazette | republished in The Cancer Letter Nov. 1, 2019
A series on the events of Bernie Fisher’s time with the NSABP and subsequent falling out, —Anatomy of a Scandal—appeared in the Post-Gazette in December 1994.
It’s unlikely that you saw it in print unless you were interested in oncology and lived in Pittsburgh at the time. Even today, a quarter-century later, the series allows us to observe Fisher and the people around him as they try to orient themselves in the midst of a cataclysmic disturbance.
Anatomy of a Scandal is being printed in its entirety with permission from Pittsburgh Post-Gazette.
Fisher’s and NSABP’s research milestones
Source: University of Pittsburgh
Founds and directs Pitt’s Laboratory of Surgical Research as the first full-time faculty member in the Department of Surgery.
Becomes a founding member of the National Surgical Adjuvant Breast and Bowel Project. The group starts its first clinical trial, called B-01, to test the ability of the drug thiotepa to reduce early recurrence rates in breast cancer patients. The trial was a proof of principle that encouraged the group to continue this type of research.
A four-year lab study by Fisher and his brother Edwin Fisher, MD, a Pitt pathologist and 1947 Pitt School of Medicine graduate with expertise in cancer, demonstrates that cancer cells can lie dormant for years before developing into detectable metastatic disease.
Fisher performs the first kidney transplant in Pittsburgh. It is one of his many contributions to the field of transplantation, which will also include the establishment of Pittsburgh’s organ-sharing network and research into skin transplantation.
The first official publication from clinical trial B-04 reports that radical mastectomy provided no survival advantage for breast cancer patients when compared with simple mastectomy. With this evidence, the public begins to question the necessity of traditional radical cancer surgery.
Initial results from the B-06 trial are published, reporting that breast cancer patients with tumors of 4 centimeters or smaller do as well with lumpectomy and radiation as they do with total mastectomy. The results support Fisher’s hypothesis of cancer as a systemic disease that can be treated with less extensive surgery.
Fisher and the NSABP publish the results of the Breast Cancer Prevention Trial. It shows that the anti-estrogen drug tamoxifen can reduce the occurrence of breast cancer by almost half in women at increased risk for the disease.
Quote of the week
I am glad to be alive to see this vindication. I feel that I am still in a position to continue to make contributions, and I want to go forward in the best way I can: to write, and to complete data that needs to be put out.
Bernie Fisher (The Cancer Letter, Sept. 5, 1997)
Bernie Fisher in The Cancer Letter archives
A search in the Cancer History Project archive for “Fisher” or “NSABP” garners the following highlights:
- NSABP Researcher Falsified Data, Federal Inquiry Finds
By The Cancer Letter | March 18, 1994 - Freireich and Holland On Bernard Fisher
By The Cancer Letter | April 15, 1994
Emil J Freireich: I know that I express both personal feelings and objective scientific and intellectual facts when I state that I can think of no physician-scientist who has contributed more to our understanding of the basic biology of cancer, to its management, and to the benefit of the literally millions of individuals with cancer and their families than Dr. Bernard Fisher.
- Highlights of Dingell Hearing: Statements Of Visco, Testimony By Broder On Fisher, Uterine Cancer Deaths
By The Cancer Letter | April 22, 1994 - NCI Objects To Fisher As Scientific Director Of NSABP, Threatens To Cut Off Funding
By The Cancer Letter | May 6, 1994 - Results of NSABP Studies Unchanged When Falsified Data is Excluded: Fisher
By The Cancer Letter | May 27, 1994 - NSABP Investigator Recounts Loyalty To Fisher, “Betrayal”
By The Cancer Letter | June 3, 1994 - A Transcript: what Fisher Knew, When Did He Know
By The Cancer Letter | June 24, 1994 - “I Can’t Permit Destruction of NSABP,” Fisher Writes
By The Cancer Letter | Sept. 9, 1994 - As NCI Sets Deadline For B-06 Reanalysis, Fisher Lawyer Says Demand Is Illegal
By The Cancer Letter | Feb. 3, 1995 - Court Orders NIH To Retract Electronic Annotations On Fisher Publications
By The Cancer Letter | March 24, 1995 - Professional Societies: Three Groups To File brief In Fisher’s Appeal
By The Cancer Letter | Oct. 11, 1996 - Bernard Fisher Settles Suit For $2.7M, Retains title, University Apologizes
By The Cancer Letter | Sept. 5, 1997
This column features the latest posts to the Cancer History Project by our growing list of contributors.
The Cancer History Project is a free, web-based, collaborative resource intended to mark the 50th anniversary of the National Cancer Act and designed to continue in perpetuity. The objective is to assemble a robust collection of historical documents and make them freely available.
Access to the Cancer History Project is open to the public at CancerHistoryProject.com. You can also follow us on Twitter at @CancerHistProj, or follow our podcast.
Is your institution a contributor to the Cancer History Project? Eligible institutions include cancer centers, advocacy groups, professional societies, pharmaceutical companies, and key organizations in oncology.
To apply to become a contributor, please contact admin@cancerhistoryproject.com.
