Bernard Fisher (scientist) facts for kids

Quick facts for kids Bernard Fisher
Born	(1918-08-23)August 23, 1918 Pittsburgh, Pennsylvania, U.S.
Died	October 16, 2019(2019-10-16) (aged 101) Pittsburgh, Pennsylvania, U.S.
Education	University of Pittsburgh
Medical career
Profession	Physician
Institutions	University of Pittsburgh School of Medicine

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.

The oncology journal and website OncLive described Fisher's research as "launching the breast cancer community into the modern era" and honored him with a Giants of Cancer Care award for his work that ultimately ended the standard practice of performing the Halsted radical mastectomy, a treatment that had been in place for more than 75 years. Thanks to Fisher, notes another major oncology journal, breast-cancer survival rates have improved worldwide.

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."

Early life and education

Fisher was born in Pittsburgh, Pennsylvania, the son of Anna (Miller) and Reuben Fisher. His family was Jewish. His brother, Edwin, would eventually become a pathologist, and the brothers conducted cancer research together, particularly in their early years.

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

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

Career

Early surgery, research, and postgraduate study

Fisher was named assistant professor at the University of Pittsburgh and established the laboratory of surgical research at that institution, of which he was director. Among his research interests were liver regeneration in rats, the physiologic effects of hypothermia, and transplant rejection. While engaged in research, he also performed general and vascular surgery. He was one of the first surgeons to perform kidney transplants.

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.

NSABP

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".

Fisher later said that after that NIH meeting, "I discovered how little information there was related to the biology of breast cancer and what a lack of interest there was in understanding the disease. At the meeting, I learned about the need for randomized clinical trials and the use of biostatistics to obtain credible information from those trials". Giving up the liver regeneration and transplantation research in which he had been engaged, he began, along with his brother Edwin, a member of the University of Pittsburgh's pathology department, to study the biology of tumor metastasis. He would spend the next four decades studying breast cancer.

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.

Chairman of NSABP

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.

Achievements

Fisher's work fundamentally changed the understanding of breast cancer and improved and extended the lives of thousands of women. To quote the citation of his Albert Lasker Award, Fisher "demonstrated that the regional lymph nodes were not a barrier to the dissemination of tumor cells, as postulated earlier, but were routes traversed by tumor cells to gain access to the circulating bloodstream and lymphatic system. Out of this basic work on cancer metastasis came a new model for the management of breast cancer based on the premise that the disease is systemic from its inception."

Fisher was "the first to show that less-invasive lumpectomy surgery treated breast cancer just as effectively as did disfiguring radical mastectomies." He also demonstrated that postoperative systemic chemotherapy and hormonal therapy could be efficacious elements of postoperative treatments, and that it was possible to prevent breast cancer in women who are at high risk for the disease.

Aside from utterly transforming the treatment of breast cancer, Fisher's pioneering of "the multicenter randomized clinical trial set a standard for the scientific evaluation of therapy for many other diseases". His early work on tumor metastasis, moreover, has been described as "pav[ing] the way for later hypotheses about the spread" of breast cancer.

Later career and legacy

After the Poisson scandal was put to rest and Fisher's reputation restored, Fisher again took up his position at the NSABP, where he resumed his efforts to establish the efficacy of tamoxifen in lowering breast cancer risk in high-risk women.

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

Fisher said that the greatest contribution of his career "was carrying out laboratory investigations...which have altered our understanding and treatment of breast cancer". The Atlantic magazine observed, "Today, medicine relies almost exclusively on randomized controlled trials and their more sophisticated cousins, meta-analyses, to guide treatment decisions. Bernard Fisher's story reminds us of the consequences patients faced in a time before such trials were the gold standard". As remarkable as Fisher's scientific contributions, one colleague has written, "is that some 60 years into his career as a surgeon scientist he remains actively involved not just with accepting awards (which alone would keep him busy) but with adding to his bibliography of over 600 papers and with continuing to analyze and review the broad implications of his studies in the treatment of human disease".

Into at least his nineties, Fisher was a Distinguished Service Professor in the Department of Surgery at the University of Pittsburgh.

Memberships

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 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.

Honors and awards

Early in his career, Fisher won a Markle Scholarship.

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".

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.

Additional awards Fisher won:

• Fulbright Fellowship
• General Motors Cancer Research Foundation's Kettering Prize (1993)
• Medallion for Scientific Achievement of the American Surgical Association (2003)
• Bristol-Myers Squibb Award for Distinguished Achievement in Cancer Research
• American Cancer Society Medal of Honor (1986)
• Memorial Sloan–Kettering Cancer Center’s C. Chester Stock Award
• James Ewing Award of the Society of Surgical Oncology
• Sheen Lifetime Achievement Award of the American College of Surgeons
• Distinguished Service Award from the Friends of the National Library of Medicine
• AACR-Joseph H. Burchenal Clinical Research Award (1998)
• AstraZeneca Historical Milestones Excellence in Clinical Research Award (2003)
• Komen Brinker Award for Scientific Distinction (1988) from the Susan G. Komen Foundation
• Distinguished Service Award for Scientific Achievement of the American Society of Clinical Oncology (1999)
• Pittsburgh's Man of the Year Award
• Jacobson Innovation Award, the highest research award given by the American College of Surgeons

Honorary doctorates from:

• Yale University (2004)
• Carlow University
• Mount Sinai School of Medicine of the City University of New York
• University of Pittsburgh

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.

Personal life

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.

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

Dr. Gabriel Hortobagyi described Fisher as "a very, very complex man" who "could charm you off your feet in no time" but who also had "a reputation for arrogance".

See also

• History of cancer