Surgeon who revolutionized breast cancer treatment

Surgeon who revolutionized breast cancer treatment dies at age 101

Women's Health,

Up until the 1970s, a woman diagnosed with breast cancer—of any size—would most always be subjected to a radical mastectomy. Developed in the late 1800s and persisting as the standard of care for over 75 years, it consists of removal of the entire breast, underlying chest muscles, overlying skin, and extended removal of lymph nodes in the armpit. Sometimes the underlying ribs were removed.

This surgery cured many women, but caused severe disability and disfigurement. There was pain and limitation of arm motion due to the muscle removal.  If skin was removed, large skin defects often took months to heal. And due to the radical removal of lymph nodes, all the women suffered from post-operative lymphedema—a swollen and painful arm due to congested lymph. 

One brave surgeon

It took one brave surgeon, Dr. Bernard Fisher—who died last week at age 101—to challenge the medical establishment and prove the radical mastectomy was, in almost all cases, unnecessary. Dr. Fisher showed that much less radical operations were just as effective.

Dr. Fisher’s was scorned

Dr. Fisher’s theory that lesser surgery would be just as effective was almost universally scorned by the medical profession. Few surgeons were willing to even consider changing what they believed was the only way to cure the disease. Dr. Fisher was even called a “murderer” for suggesting lesser surgeries.

An early randomized study

Through his dogged persistence, Dr. Fisher was able to start a clinical study to test his theory. His research was a randomized clinical trial, a new concept at the time. He recruited 1765 women from Canada and the US with early-stage breast cancer and divided them randomly into 3 groups. One group received the traditional radical mastectomy; another group had a simple mastectomy (only removing breast); and the third group had simple mastectomy followed by radiation therapy.


The results confirmed Dr. Fisher’s theory. The women who underwent the more limited surgery survived just as well as the women who underwent the radical surgery, and without the massive disability. 

Hailed as a hero

By 1979, due to Dr. Fisher’s work, simple mastectomy had replaced radical mastectomy as the treatment of choice. He was hailed as a hero by the same people who had rejected him a few years earlier. He was mentioned for the Nobel prize. While he did not receive the Nobel, he received the Albert Lasker Clinical Medical Research Award as the person who had “done more than any other single individual to advance the understanding of the clinical biology of breast cancer.”

Later research

Dr. Fisher and his research group also made another fantastic finding—that the estrogen modulator tamoxifen could prevent recurrences in many women after surgery. 

When he won the Lasker award, Dr. Fisher thanked the women who participated in his original research, “By consenting to participate in our clinical trials, 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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See also in ProcuraMed:

Postmenopausal weight loss lowers risk of breast cancer

Low dose aspirin lowers risk of breast cancer

Esta postagem também está disponível em: Portuguese (Brazil)

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