Bernard Fisher, MD MDAC, FACS, (born August 23, 1918) is an American surgeon and pioneer in the biology and treatment of breast cancer. He is from Pittsburgh. She is the Chairman of the National Breast Enlargement Project Surgery at the University of Pittsburgh School of Medicine. His work definitively determines that early-stage breast cancer can be more effectively treated with lumpectomy, in combination with radiation therapy, chemotherapy, and/or hormonal therapy, than with a radical mastectomy.
The oncology journal and the OncLive website describes Fisher's research as "launching the breast cancer community into the modern era" and honoring it with the Giants of Cancer Care award for his work that ultimately ends the standard practice of performing Halsted radical mastectomy, has been around for more than 75 years. Thanks to Fisher, noted another major oncology journal, breast cancer survival rates have increased worldwide.
Fisher faces constant attacks from within the medical ranks as he works to prove the efficacy of the old status quo treatment, eventually described as an "iconoclastic figure" that brings "a distant change... in the understanding of cancer and its treatment." The Atlantic Monthly has called him a "medical hero. " He was awarded the Albert Lasker Award for Clinical Medical Research in 1985 "for his pioneering studies which has led to a dramatic increase in the survival and quality of life of women with breast cancer."
Video Bernard Fisher (scientist)
Early life and education
Fisher graduated from Taylor Allderdice High School in 1936 and was elected in the hall of their alumni fame in 2009.
He graduated from medical school at the University of Pittsburgh in 1943, then completed a surgical residence.
Maps Bernard Fisher (scientist)
Careers
Initial surgery, research, and postgraduate study
Fisher was appointed an assistant professor at the University of Pittsburgh and established a surgical research laboratory at the institution, where he became director. Among his research interests are liver regeneration in mice, physiological effects of hypothermia, and transplant rejection. While involved in the research, he also performed general and vascular surgery. He was one of the first surgeons to perform kidney transplants.
From 1950 to 1952, he was a colleague in an experimental operation at the University of Pennsylvania. In 1955, he was a researcher at the London Postgraduate Medical School at Hammersmith Hospital, where he sought to improve his knowledge of transplantation.
NSABP
In the spring of 1957, after returning to the University of Pittsburgh, Fisher received a request from I.S. Ravdin, M.D., who was his mentor at the University of Pennsylvania, and who at the time was Chairman of the Clinical Study Panel of the National Cancer Chemotherapy Service Center at the National Institutes of Health (NIH). Ravdin asked Fisher to join 22 other surgeons at a NIH meeting to discuss the establishment of the Adjuvant Chemotherapy Surgery Project, which came to be known as the National Adjuvant Breeding and Adjuvant Swelling Project (NSABP).
"I'm not at all interested in breast cancer," Fisher later said. "But since Dr. Ravdin was an army general who had operated on President Eisenhower when he ordered me to attend meetings, I did so." At the first meeting in 1956, the idea of ​​using clinical trials to obtain information, and of course the idea of ​​providing therapy after surgery, is a new approach to treatment. "Fisher was initially reluctant to release his research on liver regeneration and transplantation and to take the study of breast cancer and other malignant diseases, but he became interested in tumor metastasis subjects. Indeed, he was "captivated," he later said, both by "metastatic mystery" and by "a new concept of clinical trials."
Fisher later said that after the NIH meeting, "I discovered just how little information related to breast cancer biology and a lack of interest in understanding the disease, I learned about the need for randomized clinical trials and the use of biostatistics to obtain credible information from trials "Submitting liver regeneration and transplant research where he was involved, he began, along with his brother Edwin, a member of the University of Pittsburgh pathology department, to study the biology of tumor metastasis. She will spend the next 4 decades to learn about breast cancer.
In 1958, Fisher took part in the first randomized clinical trial that examined the results of systemic therapy after a radical mastectomy for breast cancer. This study of more than 800 women, who was the first project to emerge from the NIH meeting, concluded that while chemotherapy involving thiotepa drugs positively affects the survival rate of premenopausal women, doctors are hesitant to start using systemic adjuvant therapy.
Chairman of NSABP
On March 20, 1967, the letter, Dr. Rudolf J. Noer suggested that Fisher apply for the position of NSABP chairman. He was officially appointed to the post on 9 May of that year. Over the next few decades he will lead clinical trials that will result in transformative changes in the treatment of breast cancer.
Throughout the 1960s and 1970s, Fisher studied the biology of cancer and conducted a randomized clinical study comparing the relative effectiveness of lumpectomy, total mastectomy, and lumpectomy followed by chemotherapy or radiation.
Fisher's impact on breast cancer treatment is the subject of an August 2013 article on the Atlantic Monthly due to his 95th birthday. "Before 1971, if you had breast cancer, chances are you have to cut your breasts," the article said. "The surgeons have been taught one thing: a life-saving radical operation.That is Bernard Fisher who changed their minds."
"For more than the first half of the 20th century," Fisher later explained, "surgery is the only treatment for breast cancer.At that time, there is a uniform agreement on breast cancer treatment.The disagreements associated with surgery or not should be more radical Improvement in anesthesia and blood transfusions allow the surgeon to perform a wider operation. "That was the situation when Fisher started working on breast cancer. At that time, more than that, "the researchers theorize that women die from breast cancer despite radical surgery because tumor cells dislocate during surgery, it is believed that the spread of these cells results in metastases and subsequent deaths."
Since the late 19th century, breast cancer has been treated with Halsted's radical mastectomy, named for its originator, William Stewart Halsted (1852-1922), a renowned surgeon at Johns Hopkins Hospital. This procedure involves the removal of not only the entire breast but also the underarm lymph nodes and chest wall muscles. Such operations make women with gaping holes in their chests. The argument for this approach is "that cancer cells, originating from the breast, always pass through the lymph nodes before spreading metastases and, therefore, radical surgery is required to lift the entire breast, underlying the chest muscles, and the axillary lymph nodes to stop metastasis. "
For more than ten years, Fisher and his research team conducted "numerous investigations into the biology of tumor metastasis." Their findings led them to question the theories on which Halsted was based, and led them to formulate alternative hypotheses. It is "that breast cancer is a systemic disease in tumor cells that may have been disseminated throughout the body at the time of diagnosis and that more expensive lokoregional therapy is unlikely to improve survival." In other words, they believe that cancer cells spread through the blood and lymph system and it enters this system at an early stage than previously thought. This means that the best way to fight breast cancer is not to widen the local area network. Instead, a lumpectomy, in which only the tumor itself and a small amount of surrounding tissue is cut, will likely be just as effective and will have an added advantage as it does not cause damage.
What Fisher introduced, in a nutshell, is an entirely new theory about the spread of breast cancer: while Halsted argues that it is spreading by penetrating the surrounding tissue, Fisher argues that it spreads through the blood and lymph system.
By the late 1960s, Fisher's research had determined that radical mastectomy was "no more effective than total mastectomy," and that the total mastectomy, in turn, "was no more effective than lumpectomy in treating breast cancer." Thus, Fisher urged his colleagues breast cancer surgeons to change their approach to the disease. Most of them refused, and continued to radical mastectomy, and many accused Fisher and his supporters of putting women's lives in jeopardy by not performing radical operations. Fisher then described the widespread resistance to his approach by medical institutions as "extensive and often unpleasant." "For 50 years," she later recalled, "surgeons have been trained to perform radical surgery, they feel that doing lumpectomy is completely inappropriate." Therefore, "my colleagues are my antagonists.... It's hard to get doctors to put doctors into the trial, and, as might have been anticipated, it's even more difficult to persuade women to be randomized into a study where some of them will undergo a mastectomy and the other will retain their breasts. "
Fisher's argument, however, received positive attention in the 1970s, from many women's rights activists. According to women's health activist Cynthia Pearson, "the women's health movement began talking about mastectomy as an example of sexism in medical care in the United States." Fisher's ideas won the support of the movement and became a political issue as well as a medical question.
In the end, her recommendations for breast cancer treatment won the approval of medical institutions. "In 1985," reported Atlantic, "the New England Journal of Medicine published two Fisher studies that were definitively proven" to their previous findings. The recommended approach to treat breast cancer subsequently gained universal acceptance.
Achievements
Fisher's work fundamentally changed the understanding of breast cancer and improved and prolonged the lives of thousands of women. To quote his Albert Lasker Award, Fisher "suggests that regional lymph nodes are not a barrier to the spread of tumor cells, as postulated, but are the route through which the tumor cells get access to the circulation of blood and lymphatic systems. This base on metastatic cancer comes new models for breast cancer management based on the premise that the disease is systemic since its inception. "
Fisher was "the first person to suggest that a less invasive lumpectomy surgery treats breast cancer equally effectively as it does by staining a radical mastectomy." He also pointed out that post-operative systemic chemotherapy and hormonal therapy can be a potent element of postoperative care, and it is possible to prevent breast cancer in women at high risk for this disease.
When Fisher began doing research on breast cancer, "widely believed," he later wrote, "that patients with tumors in the breast quadrants have a worse prognosis than those with lesions in the outer quadrant." Fisher's research led him to conclude, on the contrary, "that the location of the tumor is unrelated to its prognosis" and "that there is no justification for choosing a surgical or radiation-specific approach based on the location of the tumor." He will remain in that position until 1994, except for interludes as long as he is removed from his position.
Fisher found "that breast cancer metastasis is not solely determined by anatomical considerations, but also influenced by the biological activity of tumors and hosts." Furthermore, 20 years of follow-up from one of his studies proves that "lumpectomy preserves the breast without damaging effects either on disease-free survival or overall survival." In addition, his work "provides [proof] that breast cancer can be treated and prevented."
He is the first scientist to reject the idea that cancer is "autonomous from its host," and argues that "solid tumors such as breast cancer tend to be systemic at the time of diagnosis and represent potential metastases during the life of the host."
In addition, Fisher conducted "the first female health test in the United States to evaluate the use of tamoxifen preventive agents, which ultimately proved to reduce nearly 50% of the incidence of illness in women at risk." This drug is now taken by millions of women who have undergone breast cancer surgery.
In addition to completely changing the treatment of breast cancer, Fisher's pioneering "multicenter randomized clinical trial set the standard for scientific evaluation of therapy for many other diseases." The initial work on tumor metastasis, moreover, has been described as a "pav [ing] path for later hypotheses about the spread of" breast cancer.
Poisson case
In 1990, one statistician at Fisher's research team "saw a difference in the graph of one breast cancer patient treated by a researcher at a hospital in Montreal." After being asked by Fisher, the researcher, Dr. Roger Poisson at St. Hospital Luc, "claimed to have faked data for years to get unqualified patients in the experiment." To ensure that poor Poisson's data did not "affect the results of the lumpectomy test, Fisher re-analyzed the study" and found that the results were still valid. "He told federal officials at his agency, the National Cancer Institute, about the problem with the evil researcher," and continued his work. But federal investigators stepped in, and eventually the congressional subcommittee was called the trial. "They found problems with Fisher's audit system, potential problems with errors on other sites, unkempt documents in some of the more than 500 centers that Fisher has relied on for data."
The national media reported in 1994 that Poisson had falsified the data in 99 cases and that both Fisher and NCI, under whose supervision research is underway, have kept this information from the public. One of the journalists' interpretations of the episode was that "the same selfless and confident attitude that had helped him win over surgical conservatism" had "landed him in hot water."
In a Philadelphia Inquirer article about Fisher's appearance before the subcommittee, Fisher, once an "autocratic and magnetic genius," is described as "tired, abstract, unprepared", with "no trace left of the courage he leads." landmark clinical trials, no trace of malignant pragmatism that makes it a heroine of the women's health movement. "According to the article," its reputation is ruined. It's hard to believe that this humble man, for decades, became a brave marshal of hundreds of independent surgeons, thousands of dedicated patients, millions of dollars in research..... It's hard to believe that the vast clinic network he built and run from the bustling headquarters of Pittsburgh University has been out of control. That Bernard Fisher has been violated by other scientists' scams and his own blindness. or arrogance. "
The article notes, to be sure, that some members of the scientific community "strongly refuse to believe that Bernard Fisher can do bad science," cites cancer researcher Dr. New York. James Holland as asked: "Do you think... The Pope took the money from the collection box?"
But news of forged data blackened Fisher's image, at least temporarily. Many breast cancer survivors followed Fisher's advice and chose lumpectomies rather than a very angry radical mastectomy. Sharon Batt accused Fisher in his book, Patient No More: The Politics of Breast Cancer, about "a shocking breach of trust." Amid allegations of scientific misconduct, NCI and the University of Pittsburgh moved him as the head of NSABP. At the time of her appointment, she was involved in clinical trials that studied whether tamoxifen could prevent breast cancer.
Over time, however, it turns out that Fisher and his colleagues have long regarded 99 Poisson cases from their data banks and examined the remaining data, and have found that Poisson forgery did not affect the results of the study. Indeed, the result is almost the same.
Meanwhile, Fisher has taken legal action. After being removed from his position at NSABP, and publicly accused by the University of Pittsburgh and NCI for knowingly publishing false data, Fisher filed a libel suit. The defendants are universities; its law firm, Washington, DC based Hogan & amp; Hartson; Department of Health and Human Services; National Institutes of Health; NCI; and the Office of Research Integrity (ORI). The Fisher lawsuit "alleges that the dismissal came without legal process and that the defendants violated Dr. Fisher's right to free speech by interfering with his right to publish in medical journals."
In 1997, after a three-year investigation, the Federal Integrity Research Office ruled that Fisher was innocent of any scientific error.
In the fall of 1997, six weeks before his case was set for trial, Fisher received 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 NCI to cover his legal expenses. After the settlement was announced, Fisher said that the lawsuit was not about money, which, he points out, "can barely keep up with the 3 1/2 years lost from his job," but about "truth and justice." He hopes that the settlement will "act as a barrier for those who will ignore the legal process and the right of the First Amendment for free speech." Responding to the accusation "that he did not audit precisely the data submitted by other researchers, has published a paper knowing that some data had been falsified, and has been slow to publish corrections," Fisher pointed out "that it was the NSABP researcher who first discovered data forgery and that is the NSABP who notifies the authorities on this issue. "
University's apology reads as follows: "The University of Pittsburgh wants to take this opportunity to apologize to Dr. Fisher and express his sincere remorse for any public hazard or disaster that Dr. Fisher has experienced in any way related to the activity. University of Pittsburgh, and/or its employees.
"The University and Dr. Fisher want to emphasize that there is no time that Dr. Fisher finds himself involved in any scientific or ethical errors related to his work.
"The University approved the decision of the National Cancer Institute in the spring of 1994 to remove Dr. Fisher as Principal Investigator of the NSABP and subsequent developments in completed litigation reaffirmed the need for University's commitment to thoroughly investigate any allegations against faculty members who have the potential to infringe their First Amendment rights or the fundamental rights and freedoms of the academic community.
"The University wishes to express its pride in the many achievements that Dr. Fisher has had with the University Surgical Department and wish him success as he continues in the position of Distinguished Service Professor and NSABP Scientific Director."
In addition to university apology, NCI issued a statement calling Fisher "a force in breast cancer studies over the past 40 years."
"There has never been any falsified data published, and ORI recognizes that now in their reports and also that my actions are completely precise and precise," Fisher said. He told Oncology News International that he was "very pleased and satisfied that the litigation had been completed and I could return to my research in a favorable state."
In a 1997 medical journal article entitled "Dr. Bernard Fisher's Experiment: European Perspective on an American episode," several European doctors protested that although Fisher "is, in normal use of English, quite innocent" from the charge of "Failure of scientific integrity," he and a colleague have been "quickly removed by their university" from their position at NSABP "at the urging of the director" NCI. The authors find this development bothersome and "of general relevance to American medical research."
Later career and legacy
After the Poisson scandal was extinguished and Fisher's reputation restored, Fisher resumed his position at NSABP, where he continued his efforts to establish the efficacy of tamoxifen in lowering the risk of breast cancer in high-risk women.
In 1986, he was appointed as the Distinguished Service Counselor. In 1994 he left the position of chairman of NSABP.
Fisher said that the greatest contribution in his career "is to conduct a laboratory investigation... which has changed the understanding and treatment of our breast cancer." The Atlantic magazine commented: "Today, drugs almost exclusively rely on randomized controlled trials and their more sophisticated cousins, meta-analysis, to guide treatment decisions.Table Bernard Fisher reminds us of the consequences facing patients in the time before such trials is the gold standard. "Equally unusual with the scientific contributions Fisher, a colleague has written," is that about 60 years into his career as a surgeon he remains actively involved not only by receiving awards ( which alone will keep him busy) but by adding a bibliography of more than 600 papers and by continuing to analyze and review the widespread implications of his studies in the treatment of human diseases. "
Now in the nineties, Fisher is still a Distinguished Service Professor in the Department of Surgery at the University of Pittsburgh.
Membership
Fisher has been a member of the Institute of Medicine of the National Academy of Sciences since 1985. He has served on a number of scientific advisory committees and was appointed by the White House to serve on the National Cancer Advisory Council and the President's Cancer Panel. He has been a member of many editorial boards and includes most of the important academic, medical, surgical and scientific societies.
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 as a member of the American Association for the Advancement of Science in 1991.
Awards and awards
Fisher won the Albert Lasker Clinical Medicine Research Award for 1985, which was given in recognition of his "profound influence in shaping the character of modern breast cancer treatment, extending and enriching the lives of women with this fear disease." The quote notes that Fisher has "done more than one other individual to advance understanding of clinical biology of breast cancer" and "conceptually re-established and improves breast cancer treatment, extending and enriching the lives of women suffering from this disease.... From 1972 to 1981 , the use of radical mastectomy has decreased progressively from 46.8 percent to 4.5 percent.Each year from 55,000 to 60,000 women in the US have breast cancer 4 cm or less and are eligible to maintain this breast, therapy. "
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 helps those who fight the disease, but also helps prevent breast cancer in women at high risk," said Margaret Foti, Ph.D., M.DD. (h.c.), chief executive officer of AACR.
Fisher has also won the Fulbright Fellowship, Kettering Prize General Motors Cancer Research Foundation (1993), Medallion for Scientific Achievement of the American Surgical Association (2003), Bristol-Myers Squibb Award for Outstanding Achievement in Cancer Research, American Cancer Society Medal of Honor 1986), Memorial Sloan-Kettering Cancer Center, C. Chester Stock Award, James Ewing Award from the Society of Oncology Surgery, Sheen Lifetime Award from the American College of Surgeons, Distinguished Service Award from Friends of the National Library of Medicine, AACR -Joseph H. Burchenal Clinical Research Award (1998), AstraZeneca Excellence History Award in Clinical Research Award (2003), Komen Brinker Award for Scientific Differences from Susan G. Komen Foundation (1988), and Distinguished Service Award for Scientific Achievement from the American Society of Clinical Oncology (1999).
In addition, he has been awarded the Pittsburgh "Man of the Year" Award. He also won the Jacobson Innovation Award, which is the highest research award provided by the American College of Surgeons.
In honor of Fisher's career, the University of Pittsburgh created Bernard Fisher Lecture in 2005. In January 2006, the University of Pittsburgh School of Medicine was named David L. Bartlett, MD, professor of surgery and head of the surgical oncology division at school, as Professor Dr. Fisher Fisher Inaugural surgery.
He has also been awarded honorary doctorates by Yale University (2004), Carlow University, Mount Sinai School of Medicine of the City of New York University, and the University of Pittsburgh.
Early in his career, Fisher won the Markle Scholarship.
Personal life
Dr. Gabriel Hortobagyi describes Fisher as "a very, very complicated man" who "can fascinate you in a short time" but also has a "reputation for arrogance."
See also
Preferred publication
- "Transmigration of lymph nodes by tumor cells", by Bernard Fisher and Edwin R. Fisher, Science , vol. 152, p. 1397-1398, 1966.
- "Barrier function of lymph nodes to tumor cells and erythrocytes I. Normal nodes", by Bernard Fisher, Edwin R. Fisher. Cancer , vol. 20, no. 11, p. 1907-1913, 1967.
- "Postoperative radiotherapy in the treatment of breast cancer: Adjuvant Breast Surgery and Intestinal Clinical Trial", by Bernard Fisher, Nelson H. Slack, Patrick J. Cavanaugh, Bernard Gariner, Robert G. Ravdin, i> Annals of Surgery , vol. 172, no. 4, p. 711-730, 1970.
- "L-phenylalanine mustard (L-PAM) in primary breast cancer management: update of previous findings and comparison with those using L-PAM plus 5-fluorouracil (5FU)", by Bernard Fisher, Andrew Glass, Carol Redmond, Edwin R. Fisher, Bruce Barton, Emilyie Such, Paul Carbone, Steven Economou, Roger Foster, Robert Frelick, Harvey Lerner, and Martin Levitt. Cancer , vol. 39, no. 6, p. 2883-2903, 1977.
- "Laboratory and clinical research on breast cancer - personal adventure: David A. Karnofsky warning lecture", by Bernard Fisher, Cancer Research, vol. 40, p. 3863-3874, 1980.
- "Twenty years of follow-up from a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for invasive breast cancer treatment", by Bernard Fisher, Stewart Anderson, John Bryant, Richard G. Margolese, Melvin Deutsch, Edwin R. Fisher, Jong-Hyeon Jeong and Norman Wolmark, Journal of New England Medicine , vol. 347, no. 16, pp. 1233-1241, 2002.
- "Pathobiology of invasive small breast cancer without metastasis" (T1a/b, N0, M0): National Surgical Adjuvant Breast and Bowel Project (NSABP) protocol B21, by Edwin R. Fisher, Joseph P Costantino, Marino E. Leon, Hanna Bandos, Alka S. Palekar, Bernard Fisher, Norman Wolmark. Cancer , vol. 110, no. 9, p. 1929-1936, 2007.
- "Pathological Findings from a National Adjuvant Surgical Breast Project (protocol 4): Discriminant for 15-year survival", by Edwin R. Fisher, Joseph Costantino, Bernard Fisher, Carol Redmond. Cancer , vol. 71, no. S6, pp.Ã, 2141-2150, 2006.
- "Incidence of postoperative lung carcinoma for breast carcinoma with and without postoperative radiotherapy: Results from clinical trials of Surgical Umbrella and National Surgery (NSABP) clinical trials B04 and B06", by Melvin Deutsch, Stephanie R. Land, Mirsada Begovic , H. Samuel Wieand, Norman Wolmark, Bernard Fisher, Cancer , vol. 98, no. 7, p. 1362-1368, 2003.
- "Fifteen-year prognostic discrimination for invasive breast carcinoma: National Surgical Adjuvant Breast and Bowel Project Protocol06", by Edwin R. Fisher, Stewart Anderson, Elizabeth Tan-Chiu, Bernard Fisher, Lamar Eaton, Norman Wolmark. Cancer , vol. 91, no. S8, pp.Ã, 1679-1687, 2001.
- "Prognostic discrimination for fifteen years for invasive breast carcinoma", by Edwin R. Fisher, Stewart Anderson, Bernard Fisher, Lamar Eaton, Norman Wolmark. Cancer , vol. 91, no. S8, pp.Ã, 1679-1687, 2001.
- "Pathological Findings of the National Surgical Adjuvant Breast Project (NSABP) eight-year renewal of B17 Protocol: Intraductal carcinoma", by Edwin R. Fisher, James Dignam, Elizabeth Tan-Chiu, Joseph Costantino, Bernard Fisher, Soonmyung Paik, Norman Wolmark. Cancer , vol. 86, no. 3, p. 429-438, 1999.
- "Prognosis among African-American women and white women with negative breast carcinoma of the lymph nodes: Findings from two randomized clinical trials of the National Surgical Adjuvant Breast and Bowel Project (NSABP)", by James J. Dignam, Carol K Redmond, Bernard Fisher, Joseph P. Costantino, Brenda K. Edwards. Cancer , vol. 80, no. 1, p. 80-90, 1997.
- "Pathological Findings from the National Surgical Adjuvant Breast Project (NSABP) protocol B17: A five-year observation of lobular carcinoma in situ", by Edwin R. Fisher, Joseph Costantino, Bernard Fisher, Alka S. Palekar, SM Paik, CM Suarez, Norman Wolmark. Cancer , vol. 78, no. 7, p. 1403-1416, 1996.
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References
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