Our story begins exactly fifty years ago. On a fall weekend in late September 1974, a former dancer from Michigan and a young surgeon from Pittsburgh met just outside Washington, DC. The treatment of breast cancer would never be the same.

Less Radical is the story of Dr. Bernie Fisher, the surgeon-scientist who not only revolutionized breast cancer treatment, but also fundamentally changed the way we understand all cancers. He was an unlikely hero—a Jewish kid from Pittsburgh who had to make it past antisemitic quotas to get into med school. And the thanks he received for his discoveries? A performative, misguided Congressional hearing that destroyed his reputation and haunted him until his death.

Over six episodes, radiation oncologist Dr. Stacy Wentworth will take you into operating rooms, through the halls of Congress, and into the labs where breakthrough cancer treatments were not only developed, but discovered.

If you or someone you know has had breast cancer, Bernie is a part of your story—and you’re a part of his.

For photos, recommended readings, and show notes, visit Dr. Wentworth’s Substack, Cancer Culture.

Transcript

[MUSIC]

STACY WENTWORTH: August 1974. Richard Nixon is facing impeachment, and very likely removal from office over Watergate. He resigns. Gerald and Betty Ford move into the White House. Less than a month later, Ford pardons Nixon.

PRESIDENT GERALD FORD: Theirs is an American tragedy in which we have all played a part…[fades]

STACY WENTWORTH: President Ford hoped the pardon would help the country move on from Watergate and focus on other pressing issues. And there were plenty—the Vietnam War was winding down, inflation and gas shortages were pushing the U.S. toward an economic crisis. After all the secrecy and corruption of the Nixon White House, Ford was determined to lead candidly, with transparency.

PRESIDENT GERALD FORD: My conscience tells me it is my duty not merely to proclaim domestic tranquility, but to use every means that I have to ensure it.

[MUSIC] 

STACY WENTWORTH: By his side was Betty, a former dancer and a friendly fixture in D.C. She’d been married to Gerald for a quarter-century. And she was sometimes a little too candid for the President and his staff. 

BETTY FORD: I told my husband, if we have to go to the White House, okay, I will go. But, I’m going as myself, and it’s too late to change my pattern, and if they don’t like it, then they’ll just have to throw me out.

STACY WENTWORTH: She openly supported the Equal Rights Amendment and certain abortion rights. She spoke with candor about sex. When the press reported that she had once been married and divorced, she treated it matter-of-factly. She was funny, friendly, real.

In September, not long after the Nixon pardon, Betty Ford did something no other First Lady had done. It was something most women didn’t do—she spoke publicly about having breast cancer.

BETTY FORD: The malignancy was something my husband never expected, and he couldn’t believe it was happening to me. The whole family was so depressed. I think their surprise was a very natural reaction because one day I appeared to be fine, and the next day, the very next day, I was in the hospital for a mastectomy. 

STACY WENTWORTH: That’s a clip from a year later, of Betty Ford reflecting on her cancer diagnosis. Women of her generation and before didn’t really talk about breast cancer, not openly, and often not even with their doctors. Today, most breast cancers are found through a mammogram even before a patient notices a lump. But in 1974, screening mammograms were still a decade away. When a woman felt a mass, or when her doctor found one, she went straight into surgery. 

BERNIE FISHER: Surgery was the only treatment. 

STACY WENTWORTH: This is Dr. Bernard Fisher—Bernie, as he was known by friends, family, and colleagues. He was the nation’s leading breast cancer researcher in the early ‘70s. Really, he was one of the only breast cancer researchers in the world. 

At the time, doctors practiced what they called a “one step” procedure for breast cancer. Women went under anesthesia, the doctors biopsied the lump, and if it turned out to be cancer, the mastectomy began. There was no consultation. It all happened while the woman was under. Here’s Dr. Susan Love, a surgeon, author, and breast cancer survivor, in the PBS documentary, The Emperor of All Maladies. 

SUSAN LOVE: So you would go into the operating room and you wouldn’t know whether you were going to wake up with a breast or not. And you know how you found out? You looked at the clock. [HEART RATE MONITOR BEEPING] If it was three hours, it was cancer. And if it was an hour, you were benign.

[MUSIC]

STACY WENTWORTH: The type of mastectomy that women got in these cases wasn’t like the mastectomies women get today. It was called a Halsted Radical Mastectomy. It’s named for Dr. William Halsted, who developed it in the late 19th century. We’ll get more into Halsted the man later, but for the moment, let’s focus on the “radical” part.

STACY WENTWORTH: Over several hours of surgery, a doctor performing a Halsted radical mastectomy removed not only the tumor, but the entire breast, as well as chest muscle beneath the breast, and forty to fifty lymph nodes from the armpit. The open wound was so large that surgeons had to bring the woman back to the operating room a few days later to cover it with a hand-sized piece of skin from her leg. The goal of a Halsted mastectomy was to get all the cancer cells out at one time because doctors thought cancer spread directly out from a tumor, and that lymph nodes collected cancer cells like filters. They thought removing everything a tumor touched would cure cancer. Here’s Bernie Fisher again.

BERNIE FISHER: And the hope was that if you could only do a bigger and better operation, you were going to cure more people by eliminating one more cancer cell. And that was the science of the time.

STACY WENTWORTH: Even Halsted’s peers thought this was a long, brutal surgery. Will Mayo, one of the founders of the Mayo Clinic, left the operating room in shock after he watched Halsted operate. In a biography of Halsted, Dr. Gerald Imber wrote, quote: “the apocryphal dark joke in the hospital was of the orderly asking Dr. Halsted which part of the patient was to be returned to the ward.” 

STACY WENTWORTH: But brutal as it was, the radical mastectomy was the standard of care in the treatment of breast cancer. By the 1970s, a less severe surgery was available. It was called the modified radical mastectomy. This procedure left the chest muscles intact. But most surgeons steered their patients away from this less radical procedure. The Halsted Radical Mastectomy was the default even though it left many women disfigured and unable to fully move their arms. Marvella Bayh, wife of Senator Birch Bayh of Indiana, had a modified radical mastectomy in 1971. Here she is on the MacNeil/Lehrer Report to talk about her experience and her volunteer work with other breast cancer survivors.

MARVELLA BAYH: I meet women who’ve had the radical mastectomy, the old Halsted radical, who can’t, for example, wear dresses like I’m wearing tonight with the arm showing. They suffer from the swollen arm. Sometimes they can’t wear the V-neck dress because of the extensive surgery. 

STACY WENTWORTH: The prospect of being disfigured only added to the agony of a breast cancer diagnosis. Survival rates at the time were much lower than they are now. In 1974, of ninety thousand women diagnosed with breast cancer, more than a third would die of the disease. Many women suffered in silence—they didn’t examine their breasts, and they didn’t talk to their doctors about the risks of breast cancer. Before Betty Ford went public with her story, the average time between a woman finding a lump and going to the doctor was two-and-a-half months. 

 

[MUSIC]

BETTY FORD: This made me realize how many women in this country could be in exactly the same situation. That realization made me decide to discuss my breast cancer operation openly, because I thought of all of the many lives in jeopardy.

STACY WENTWORTH: By talking about her diagnosis, and by being in the public eye throughout her recovery, Betty Ford inspired countless women to check themselves for lumps, to talk to their doctors, to end the silence around breast cancer, and to give themselves the best possible chance to survive. 

BETTY FORD: My experience and frank discussion of breast cancer did prompt many women to learn about self-examination, regular checkups and such detection techniques as mammography, and the things that are so important. I just cannot stress enough how necessary it is for women to take the time out of their active lives and take an interest in their own health and their own body.

STACY WENTWORTH: Later, Betty Ford told Gloria Steinem in an interview that her openness was in part inspired by the secrecy of the Nixon White House. Her speaking up was about transparency, and serving the public good. 

Betty Ford had her radical mastectomy on September 28th, 1974, at the National Naval Medical Center in Bethesda, Maryland. It’s just outside of Washington, D.C., and now it’s part of Walter Reed Hospital. The press at the hospital was on “Betty Watch.” They camped out, waiting for updates. 

While the First Lady was recuperating, word got out to the press that there was a talk on breast cancer happening just down the street, at the National Institutes of Health. Titled “A Report to the Profession from the Breast Cancer Task Force,” it was an update for the National Cancer Institute on the latest breast cancer research. It wasn’t supposed to be a big event, and there wasn’t supposed to be any press at all. The National Cancer Institute’s philosophy was that science spoke for itself. At the moment, the research was by doctors, for doctors. 

Bernie Fisher was one of the doctors speaking at the conference.

[MUSIC]

Even though he was the leading breast cancer researcher at the time, he was still an obscure figure outside of medicine. But he wouldn’t be unknown for long.

That weekend in September 1974, Bernie was announcing the findings of a study called “NSABP B-04.” It’s a dry title, but it piqued the interest of the press. Maybe they were bored waiting around for news on the First Lady’s recovery and wanted a different story. Maybe all the recent headlines about breast cancer made this—the first randomized clinical trial on treatment of the disease—more newsworthy in their eyes. Or, maybe the press heard rumors about what Bernie had discovered—the radical mastectomy was all wrong. Women didn’t need to sacrifice so much of their body to treat cancer. Instead, a simpler surgery offered the same chance for survival. And there was promising evidence that following up the surgery with chemotherapy would save more lives without the disfigurement and pain.

Here he is on TV discussing the findings a few years later.

BERNIE FISHER: From a statistical point of view in terms of treatment failure, in terms of survival, there is at the present time—and I continually reiterate that—at the present time, no evidence that there is a difference in the treatments. I think that most of us who are doing breast cancer surgery, based upon these statistics and others from throughout the world, have tended to see the need for radical as being almost extinct.

STACY WENTWORTH: The press ran with it. They asked the White House doctor if the First Lady would benefit from this new research. After his talk, Bernie went down the street and recommended that Ford take chemotherapy—which she did. 

Bernie’s fellow doctors, however, reacted differently. When presented with data that could save lives and end a brutal, disfiguring surgery, they rejected it. They called Bernie a traitor to his profession—“Bloody Bernie.” That clip we just heard was from 1977. Three years after Bernie presented his findings, doctors were still defending the more severe surgery. Here’s another guest on that same show, Columbia University breast surgeon, Dr. Cushman Haagensen.

CUSHMAN HAAGENSEN:​​ No operation is good enough, no good operation is thorough enough to suit me. We do the best we can, and still we don’t succeed as often as we wish. We spend about five or five and a half hours doing our operation. We don’t penalize the patient much more with it, but we do a much more thorough removal. And our chances with this kind of surgery of getting every cell out are a great deal better.

STACY WENTWORTH: But now we know that Bernie Fisher wasn’t wrong. NSABP B-04 was the first step toward the treatments that we have today. If you know anyone who has had surgery or chemotherapy for breast cancer, it’s because of Bernie Fisher. He’s in the room with everyone who is diagnosed and treated.

And he’s with me every day. I’m Dr. Stacy Wentworth. I’m a board-certified radiation oncologist, cancer survivorship expert, and award-winning author. I’ve helped thousands of people living with and through cancer. And I’ve relied on Bernie’s discoveries. 

His work was monumental. But he’s not a household name like Jonas Salk, Sanjay Gupta, Anthony Fauci, Sidney Farber, or the Mayo brothers.

Well, there was one time when a lot of Americans knew the name Bernie Fisher—but it wasn’t because of his life-saving work. 

FORREST SAWYER: Other health news, there are new questions tonight about a major breast cancer study that helps determine how doctors treat the disease. Last month, it was revealed that one part of the study used falsified data. That led officials to a full review, which has uncovered another problem.

JACKIE JUDD: The latest case of fraudulent science involving breast cancer research took place here at St. Mary’s Hospital in Montreal. Investigators from the National Cancer Institute probed the hospital’s records yesterday. They found that the history of one breast cancer patient had been altered, and nine other cases are still being looked into. The falsified data exposed earlier this month at another Canadian hospital involved one hundred women. 

[THEME MUSIC IN]

This scandal has now cost Dr. Bernard Fisher of the University of Pittsburgh his position as the manager and principal investigator on NCI’s huge study on breast cancer. 

STACY WENTWORTH: Bernie reinvented cancer treatment, but time and time again, nobody listened. They didn’t believe him. Doctors were slow to adopt his findings. Women were shut out of conversations—conversations that might have saved them from unnecessary, debilitating, and painful surgery. Still Bernie persisted, and changed the minds of tens of thousands of surgeons on how they should treat breast cancer—even cancer in general. 

But after all he did, how did we thank him? With misguided congressional hearings that put his research, and his practices, in question. He lost his job. He lost everything. Even though we now know he was right. 

This is the story of Dr. Bernie Fisher. It’s a story I tell my patients when they’re diagnosed with breast cancer. It’s a story about how our thinking about breast cancer, about surgery, about medicine in general, has changed. 

This is…Less Radical.

[SHOW OPEN MONTAGE]

SPEAKER 1: Bernie was changing everything…

DR BERNIE FISHER: Well, at that time, the treatment was draconian to say the least…For fifty years surgeons had been trained to do these radical—really radical—mutilating operations.

SPEAKER 2: I think they really couldn’t change the way they thought. They just…couldn’t do it. (laughs)

DR BERNIE FISHER: The foundations of medical care must be based on science

VINCENT DEVITA: You could see where they hated him because he wouldn’t given in.

[END SHOW MONTAGE]

STACY WENTWORTH: To tell Bernie’s story, we’re going to go into operating rooms, the halls of Congress, and into the labs where breakthrough cancer treatments were not only developed, but discovered. 

[THEME MUSIC OUT]

But first, we’re going to Pittsburgh, Pennsylvania. 

BERNIE FISHER: My mother’s parents came to this country, I guess in 1880. That wave of immigration, they both came. My mother’s father was, they came from Germany…[fades]

STACY WENTWORTH: This recording is from a 1981 oral history project from the National Council of Jewish Women. It’s one of the few personal interviews Bernie gave.

Bernie’s grandparents emigrated from Europe. His mother’s family came from Germany, and his father’s family came from Lithuania. They were part of the waves of Jewish immigrants who came to the U.S. to escape pogroms and violent antisemitism in Europe. They settled in U.S. cities, formed close communities, and built new lives. 

[MUSIC]

In Pittsburgh, Bernie’s mother Anna and his father Ruby, short for Reuben, lived a middle-class life. Ruby sold produce—apples, mostly. Bernard was their first child, born in 1918—the same year as Betty Ford. And two years later, the Fishers moved to 2324 Sherbrook Street, in the neighborhood called Squirrel Hill. This is where Bernie grew up. 

BERNIE FISHER: We spent all of our growing years on that street, which was a rather it’s- it’s a one block street, you probably wouldn’t know where it is. But it was a very nice street, and there were a lot of very good people came from that street. 

STACY WENTWORTH: At the time, nearly eight percent of Pittsburgh’s population was Jewish, and the up-and-coming Jewish families lived in Squirrel Hill. Anna’s parents moved down the street when Edwin, Bernie’s little brother, was born. It was a close-knit community. 

BERNIE FISHER: We didn’t have any other identity because the people that this was not an era as you well know of free comings and goings, Sherbrooke Street and Squirrel Hill and the Manor Theater. This was most of our life. 

STACY WENTWORTH: Ruby left for work at three or four in the morning. He sorted boxcars of apples from Washington State. At one point, the family even considered moving to Washington, but Squirrel Hill remained home. Ruby made a good living, but he didn’t want his sons to follow in his footsteps. Bernie and Eddie were banned from the produce yards. 

BERNIE FISHER: We didn’t really spend much time in the produce yards because there was always the fear that we might become too interested and captivated. 

STACY WENTWORTH: The produce trade had been good to the family, but Ruby and Anna had the fire of immigrants. They imagined their kids doing something more prestigious. And young Bernie was around a lot of doctors—though, not for educational reasons at first. 

BERNIE FISHER: Well, I had all the childhood diseases that you can think of every one of them. I never missed one, like scarlet fever, diphtheria, mumps, measles, whooping cough, this, that. 

STACY WENTWORTH: It was a time when a public health nurse put a quarantine sign on the front door of the house when someone inside was sick. During his time alone, Bernie read puzzle books, a kid’s encyclopedia, Paul de Kruif’s Microbe Hunters.  

Bernie was fond of his family doctor, Julius Goldstein. And his mom’s uncle, Dr. Julius Rogoff would sometimes tell Bernie stories about the physiology experiments he conducted at Case Western Reserve University in Ohio.

BERNIE FISHER: He was sort of the awesome figure of the family, you know, the role model and that kind of thing. And I guess that helped me.

STACY WENTWORTH: Only one thing could deter young Bernie from medicine—sports. When he was in college, he auditioned to be the voice of the Pittsburgh Pirates. One other man tried out—Albert Kennedy “Rosey” Rowswell. And, if you know Pittsburgh sports, you know what happened.

ROSEY ROWSWELL: [crowd cheering] [sound of baseball being hit, soaring] Going…going…and here it comes! [sound of baseball falling, hitting the ground]

STACY WENTWORTH: That’s…not Bernie. Though I got to say, going from medicine to radio is kind of fun. 

With his career as a baseball announcer off the table, Bernie stayed focused on medicine. He applied to medical school at the University of Pittsburgh. Staying local meant he could live at home and still afford tuition.

BERNIE FISHER: The thing they can’t believe is that $300 a year was a hell of a lot of money. 

INTERVIEWER: You didn’t get any grants or scholarships?

BERNIE FISHER: No, I never got any scholarships. I wasn’t at the poverty level and nor was I, I guess, smart enough.

STACY WENTWORTH: That last line there about not being smart enough is some of the humor close colleagues told me they loved about Bernie. In reality, peers and mentors found him to be a promising and bright student. But Bernie’s admittance wasn’t assured. The immigrants who fled Europe hadn’t escaped antisemitism when they reached the U.S. Here’s Bernie reflecting on that.

BERNIE FISHER: There were only, you know, the quota system was very strict and stringent. And they only took a certain number of Jewish students into medical school. I think in my class, they went from four, six, the previous couple of years to eight. So I was one of eight Jewish boys who got into medical school. 

STACY WENTWORTH: These quotas were extremely common at the time. In my research, I found a quote from the dean of Yale Medical School directing his staff to admit no more than five Jews, two Italian catholics, and no Black students. At Loyola Medical School, a rejection letter said their quota for Jewish students had been filled. It was widely understood that Jewish students shouldn’t bother to apply to some of the more prestigious programs in the country. After he finished at Pitt, Bernie applied to the surgical training program at the University of Pennsylvania. He was only the second Jewish applicant to get in.

[MUSIC]

Bernie dodged childhood diseases, escaped a move to Washington State to work in the apple business, and got rejected as the voice of the Pirates. Then he got into medical school despite the rampant antisemitism that kept many Jewish students out. 

All these hurdles and circumstances formed the narrow path that Bernie traveled toward a career that would save countless lives. Had anything gone differently, I don’t know what breast cancer treatment might be like today.

BERNIE FISHER: Serendipity has really played a large role in my career. 

STACY WENTWORTH: And there was more serendipity to come. Even after avoiding all the offramps in his path, Bernie still wasn’t set on being a researcher.

BERNIE FISHER: When I graduated medical school in 1943, I decided that becoming a surgeon would be the thing to do because that was where so much of the drama of medicine existed at that time. But I soon learned that most surgeons were more occupied with their feats of skill and daring in the operating room than they were in understanding the biology of the disease that they were treating.

STACY WENTWORTH: Bernie was a competent and confident surgeon-to-be. And he was also curious—the kid who read puzzle books and Microbe Hunters, who admired his great-uncle Julius Rogoff, a medical researcher who had also made it past quotas to get into the field. He’d even worked for a while in Rogoff’s lab during medical school. He wasn’t going to be a swaggering god of the operating theater. He was going to be a scientist, an experimenter, a man who was more inclined to open someone’s mind than cut into their chest cavity. But along the way, he’d encounter many more hurdles, and upset all of those “gods of the O.R.”

In the next episode, we’ll meet the Zeus of surgical gods who preceded Bernie—Dr. William Halsted. We’ll learn how his brutal surgery became the standard treatment for breast cancer, and scarred women for generations.

GERALD IMBER: He had his patients so in his thrall that he would do little procedures of learning about how skin grafts take and things like that, and on a patient that didn’t even need it, and have them come back from another state a month later for him to look at it.

I’m Dr. Stacy Wentworth, and this is Less Radical.

[MUSIC]

Less Radical is produced by me, Stacy Wentworth, and the team at Yellow Armadillo Studios: Melody Rowell, Gabe Bullard, and Sam Gebauer.

Fact checking is by Ryan Alderman. Our artwork is by Arianna Egleston. We get marketing support from Tink Media, and music is from Epidemic Sound.

Special thanks to The Squirrel Hill Historical Society, The Cancer History Project, and the Rauh Jewish Archives at the Heinz History Center.

If you want to bring the conversation about cancer out of the exam room and into your inbox, subscribe to my Substack, Cancer Culture. There, you can also see extensive show notes for Less Radical, including photos and links to read more about Bernie Fisher and the history of breast cancer. It’s at cancerculture.substack.com. And you can follow me on Instagram at drstacywentworth.

And be sure to follow or subscribe to Less Radical in your favorite podcast app so you don’t miss a single chapter of Bernie’s story. While you’re there, please leave us a five star review. 

Thanks for listening.