The title of this editorial is taken from the heading of a segment for the podcast “Less Radical” (Spotify, Apple Podcasts) that launched a few months ago. In this wonderful five-part discussion, Stacy Wentworth, MD, a radiation oncologist at the Atrium Health Wake Forest Baptist Comprehensive Cancer Center, in Winston-Salem, N.C., describes the life and personal struggles of the late Dr. Bernard Fisher, the champion of the “less radical“ approaches to the surgical management of breast cancer and an advocate for the use of clinical trials in surgical oncology.
Beginning in 1958, along with his mentor I.S. Ravdin at the University of Pennsylvania, Dr. Fisher launched a multi-decade career to understand the metastatic concepts of breast cancer, and, ultimately, to create the modern paradigm of lumpectomy, which was in stark contrast to the Halstedian concepts that were prevalent until the early 1980s.
In listening to the “Less Radical” podcast created and orated by Dr. Wentworth, those of us who knew Dr. Fisher and remember well his contributions will be reminded again of the difficulties one faces in going against surgical dogma. Many of us experienced the same barriers when laparoscopic surgical procedures were introduced! For my younger surgical colleagues who grew up in the era of breast-sparing procedures for mammary cancer, this podcast is a “must listen” that relives the fierce pushback faced by Dr. Fisher and his tenacity in believing that his concepts of eschewing radical extirpation were correct.
The ultimate message in the “Less Radical “podcast comes in the fifth and final segment, in which Dr. Wentworth describes the issues of fraudulent research cast at Dr. Fisher as a result of poor recordkeeping by one of his international contributors to his National Surgical Adjuvant Breast and Bowel Project clinical trial. Although Dr. Fisher reacted appropriately when this issue became known to him, the bureaucratic and political mavens of the time strived to make him a scapegoat. The fact that Dr. Fisher survived the negative devastating forces of his own institution, the University of Pittsburgh, and the power of congressional oversight is a miracle in itself! The details of this malevolent chapter in the history of breast cancer management are beautifully detailed by Dr. Wentworth in her podcast.
In the end, Dr. Fisher was exonerated from any wrongdoing, and his legacy as the force behind modern breast cancer management and the importance of surgical clinical trials remains intact. The good news is that Dr. Fisher, who passed away in 2019 at the age of 101, lived to see the acceptance throughout the world of his breast cancer principles.
The important message that is also conveyed in the “Less Radical” podcast is that many forces are extant in challenging the important principles that govern our current approaches to the scientific practice of medicine and surgery. Those in the scientific world may well face the challenges and extreme oversight during the coming years as faced by Dr. Fisher. We in the medical world must be ready for these challenges and as dogged and tenacious in our steadfastness as Dr. Fisher. I hope we are up to the challenge!
Dr. Greene is the senior medical advisor for General Surgery News.