Bernard Fisher, a pioneer in breast cancer research, dies at 101

Bernard Fisher, distinguished service professor at the University of Pittsburgh School of Medicine and a true pioneer in the field of breast cancer research, died Wednesday evening at the age of 101. 

A role model for the surgeon-scientist, Fisher advanced the understanding of the clinical biology of breast cancer and pioneered the design and implementation of large-scale, multi-institutional randomized clinical trials.

Born and raised in Pittsburgh, Fisher earned a Bachelor of Science in 1940 and an MD in 1943, both at Pitt.

Following his training as a surgeon, he joined the faculty at Pitt Medicine as its first full-time member of the Department of Surgery. In 1953, he established the first Laboratory of Surgical Research at the University, based on his firm belief that evidence gathered through scientific inquiry should serve as the basis for advancing patient care.

In this early part of his career, he contributed to the development of both transplantation and vascular surgery, performing the first kidney transplant in Pittsburgh in 1964 and directing surgical research at Pitt in liver regeneration, transplant rejection and hypothermia. 

Fisher’s focus shifted to cancer research in 1958 after he was invited to attend a National Institutes of Health meeting where participants organized groups for conducting clinical trials on breast and colon cancers. Following this meeting, Fisher became a founding member and later served as the chairman of the National Surgical Adjuvant Breast and Bowel Project (NSABP) from 1967-1994.

Based on research conducted in his laboratory at Pitt, he formulated hypotheses that were tested in clinical trials he directed with the NSABP in the 1960s and ’70s. The findings from his initial laboratory studies led him to challenge a breast cancer treatment dogma that had prevailed since the 19th century — that patients were best treated with radical mastectomy (the disfiguring removal of all breast and nearby tissues).

In 1971, Fisher led the NSABP in a landmark clinical trial in women with primary breast cancer comparing radical mastectomy with less extensive total mastectomy. In 1976, he initiated a study comparing total mastectomy with less disfiguring lumpectomy, with or without breast irradiation. Neither study showed a survival advantage from the more extensive procedure. Those studies provided a scientific basis for less extensive surgery.

Findings from other Fisher-led studies showed that the addition of systemic, adjuvant chemotherapy or hormonal therapy provided a survival advantage over surgery alone. Based on these studies, Fisher and the NSABP initiated the first trial to test tamoxifen as a breast cancer prevention agent in 1992. That trial showed that tamoxifen decreased the incidence of breast cancer and was appropriate for many women at increased risk for the disease.

Last year, Fisher remarked to Pitt Med Magazine regarding his tamoxifen studies: “Our 1998 report indicating, for the first time, that breast cancer could be prevented with tamoxifen was probably the capstone of my career. Certainly, in 1958, when I began this journey, the idea of using an agent to try to prevent breast cancer was … science fiction.”

Fisher recognized that the interplay between laboratory research and clinical trials is indispensable to advancement in the fight against cancer. As he told his audience when he accepted the Albert Lasker Clinical Medical Research Award in 1985, “Eventually the concepts and hypotheses formulated from laboratory research require testing in the human by clinical studies. Clinical trial research is not only a necessary adjunct to laboratory investigation but is a source of new concepts and hypotheses in its own right. Giving excessive preference to one at the other’s expense will impede [progress].”

Perhaps Fisher’s most important contribution has been the establishment of a scientific approach to the study of breast cancer. As a result of his pioneering research, women worldwide with breast cancer have a scientific basis to guide treatment that leads to improved quality of life and a greater chance of long-term survival. Moreover, his work resulted in the creation of the paradigm that not only governs the treatment for breast cancer but has shaped the landscape of cancer research more broadly.

“No clinical therapy should be determined by emotion or conviction — the determinant must be the scientific method,” Fisher said in a 2009 video interview shown at that year’s annual Pitt lecture named in his honor.

Fisher received numerous awards and recognitions throughout his career, including the American Association for Cancer Research Award for Lifetime Achievement in Cancer Research and an honorary doctorate from Pitt. A member of the National Academy of Medicine, he was appointed to the President’s Cancer Panel and the National Cancer Advisory Board and was the first surgeon to serve as president of the American Society of Clinical Oncology.

Fisher is survived by three children, Beth Fisher (Harvey Himel), Joseph Fisher (Debra), and Louisa Rudolph (James), five grandchildren and two great-grandchildren.

Pitt leaders regard Fisher

“Bernard Fisher was one of the great medical pioneers of our time. His research at the University of Pittsburgh fundamentally changed how clinicians treat breast cancer — and saved an untold number of lives along the way. On behalf of our extended Pitt community, I would like to extend my deepest condolences to Bernie’s loved ones and his former colleagues, who are continuing his life-changing record of research and care at the UPMC Hillman Cancer Center.”    

— Chancellor Patrick Gallagher

“Dr. Fisher’s pioneering research and visionary clinical trials completely changed the course of treatment for women with breast cancer that still resonates to this day. His advances are among the most important contributions ever made to women’s health.”

— Jeffrey A. Romoff, UPMC president and CEO

“Bernard Fisher was a titan. His research improved and extended the lives of untold numbers of women who suffered the scourge of breast cancer. His work overturned the dominant paradigm of cancer progression and, to the benefit of all, demonstrated the systemic nature of metastasis. This work offered us great insight into the biology of all cancer. He has been part of the University of Pittsburgh since the early 1940s — from undergrad to medical school and beyond — and we are proud to claim him as our own. But Dr. Fisher truly belongs to the world and we are grateful for his incalculable contributions to human health.”

— Arthur S. Levine, senior vice chancellor for the health sciences and John and Gertrude Petersen Dean of the University of Pittsburgh School of Medicine

“Dr. Fisher’s iconic status in breast cancer research and treatment derived from his ability to envision a world not constrained by his surroundings, and current clinical practice at that time. He questioned the status quo, challenged it in the most rigorous scientific fashion, and changed practice for the betterment of women everywhere. He also created a paradigm of clinical research and hypothesis-testing only able to be accomplished across many institutions, demonstrating the power of collaboration. As a surgeon he was trying to reduce surgery — he always put the patient and the data first.”

— Robert Ferris, director of the UPMC Hillman Cancer Center

“All of oncology owes an enormous debt of gratitude to the contributions of Bernard Fisher. He instilled in us the passion for the randomized prospective clinical trial as a vehicle to define optimum therapy in the treatment of breast cancer and other solid tumors applying the scientific method. He delivered us from the age of tyranny when a single individual could dictate the therapy of a particular disease based on his own biased retrospective experience. In the process, Bernard Fisher revolutionized our understanding of the biology of breast cancer. His seminal work has saved countless patient lives and has had an immeasurable effect in allaying suffering. I have lost a mentor, colleague and friend, and the field of oncology has lost its noblest protagonist.”

— Norman Wolmark, director of the National Cancer Institute Cooperative Group on clinical trials and professor of surgery at Pitt Medicine