We return to Washington, D.C. In the fall of 1974, the results of Bernie’s clinical trials promise to change the treatment of breast cancer forever… if only it were that easy.

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

[SOUNDS OF NATURE, BIRDS]

STACY WENTWORTH: For today’s episode, we’re going back to where we began—1974, just outside Washington D.C. Reporters are camped outside what’s now called Walter Reed Medical Center, waiting for news of First Lady Betty Ford’s radical mastectomy. 

[CAMERA SHUTTERS] 

Bernie is just down the street, giving a talk on his research to the National Institutes for Health. 

Looking for a new angle on breast cancer, the reporters waiting for news on Ford got wind of Bernie’s talk and headed over to the NIH. Long-haired, scruffy reporters crowded in with buttoned-up doctors in white coats. 

[CROWD MURMURING]

The audience was so big, the NIH had to set up an overflow room with closed-circuit television streaming the proceedings. The Cancer Letter, a publication that covers cancer news, wrote that what was supposed to be a report to doctors became a report for the nation.

[MUSIC]

Bernie initially planned to announce the results of a study called B-04, which had begun in 1971. It said that a Halsted radical mastectomy and a more conservative mastectomy showed the same survival rates for women. The brutal, disfiguring old procedure was effectively obsolete.

But in the weeks leading up to the talk, Dr. Nathaniel Berlin, an official with the National Cancer Institute who was directing the conference, pushed Bernie to talk about another study, called B-05. It focused on a drug called L-PAM, a chemotherapy agent administered through a pill. Bernie was reluctant to talk about B-05 because it was still in progress. He was confident in the data he’d seen so far, but he hadn’t come to a final conclusion. What if, for example, the cancer returned after women stopped taking L-PAM? What if the drug only delayed cancer coming back and didn’t cure it? 

Berlin’s pressure grew after the First Lady went public with her diagnosis. As he prepared for the conference, Bernie conferred with Dr. Carol Redmond. Redmond was the chief statistician for the NSABP—the breast cancer task force led by Bernie. They spent hours reviewing the data, ensuring they were safe to announce early results. Their findings were huge. Women who had taken the drug had far fewer cancer recurrences than those who had taken a placebo pill. This was news Bernie could share. 

Bernie wasn’t the only presenter that day at the NIH. The day’s agenda included presentations on a few different topics, like the possibility of finding cancer markers in the blood. Even though it was a breast cancer conference, the only woman who presented talked about the virology of breast cancer in mice. But it was Bernie who got the press’s attention. He shared the news on mastectomies and he shared the blockbuster results about L-PAM. 

The news shocked the doctors and the reporters in the audience. No one expected any change in the dismal prognosis of patients with breast cancer. L-PAM was as close to a magic bullet as anyone had ever found. 

That afternoon, when the White House doctor gave the press an update on Betty, they asked him about L-PAM. The doctor told them, “Breast cancer treatment has been controversial for years. I think the best thing to do is take the advice of some eminent specialists to decide the best thing for her or if she needs any treatment.”

The papers reported that Bernie went down the street and talked to the First Lady and her doctors. Even though Betty Ford was slightly older than the patients who benefitted from the drug, Bernie and the other doctors were so convinced by their data, they all agreed Ford should take L-PAM. One of Bernie’s recommendations was now outside of the research lab and in practice—on the most famous breast cancer patient in the world. 

[THEME MUSIC IN]

But it would take a long time for this to become a more frequent occurrence. 

Let’s go back to something the First Lady’s doctor said. Did you catch it? He said “breast cancer treatment has been controversial for years.” Just one year earlier, Barney Crile had published his book What Women Should Know About the Breast Cancer Controversy. At this point, we’re not that far removed from women barely speaking up about finding lumps. And the 1970s were still a time when a cancer diagnosis felt like a death sentence. 

It actually seems like an understatement to say breast cancer treatment was controversial in the early 1970s. And it was about to become even more so.  

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

[SHOW OPEN MONTAGE]

NANCY DAVIDSON: Bernie was changing everything…

JUDY PEARSON: Women were so horrifically being kept down in all ways.

VINCENT DEVITA: There was something offensive about the idea that you could cure cancer.

JEROME URBAN: Sure the person has a free choice, but it’s like a child having a free choice to eat sugar candy or drink some milk.

BERYL MCCORMICK: I think they really couldn’t change the way they thought. They just…couldn’t do it.

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 give in. 

[END SHOW MONTAGE]

[THEME MUSIC OUT]

STACY WENTWORTH: Given what we know now, and what doctors were finding out back then, Betty Ford should’ve been the last woman to have a radical mastectomy. But she wasn’t. And even procedures like the one-step, in which a biopsy and mastectomy were done in one operation, endured for years. 

So what happened? If Bernie Fisher had the science, then why did these out-of-date procedures stick around for so long?

Later, reflecting on the 1974 press conference, Bernie said, “We were flush with success…for twelve hours.” The reporters in the crowd jotted down Bernie’s findings. But many of the doctors dismissed them. The breast cancer advisory committee of the American Cancer Society, which just happened to be made up of all men, warned women not to be “misled” into “lesser, unproven surgeries.” 

VINCENT DEVITA: Everybody knew. I mean, everybody knew that you couldn’t cure cancer with drugs. So it wasn’t a matter of, let’s find out whether you can, as we know it can’t.

STACY WENTWORTH: This is Dr. Vincent DeVita again. He was one of the early oncologists at the NCI and would later become NCI director. He was also a pioneer of using drugs to treat cancer, even developing the first cure for Hodgkin’s disease in the 1970s. He recalls that the reaction from others in the field to this kind of work was intense and negative.

VINCENT DEVITA: And that, you know, the lid blew off. His own colleagues were trying to kill him. (laughs)

STACY WENTWORTH: Why did they do that? What motivated them?

VINCENT DEVITA: There was something offensive about the idea you can cure cancer. And I don’t really understand why. I think that was so deeply ingrained, that they just were upset when people said they could do it. It was very well fixed that you couldn’t cure it.

[MUSIC]

STACY WENTWORTH: Surgeons didn’t take kindly to one of their own saying that surgery wasn’t the answer. Bernie’s peers spread vicious rumors that he was a bad surgeon who couldn’t operate his way out of a paper bag. Some surgeons, though certainly not all, felt that they had indulged Bernie, and the task force’s call for randomized studies. But now he was undercutting the basic job that surgeons did. And what’s more, because there was so much attention on Bernie’s findings, patients started asking their surgeons about options. Because of Bernie, women with breast cancer started questioning doctors, too.

The surgical standard, driven by assurance and confidence, was immovable. But Bernie Fisher was unstoppable. 

 

STACY WENTWORTH: One of the fiercest critics of Bernie’s work was the head of what was then called Memorial Hospital and the Sloan Kettering Cancer Center in New York—Dr. Jerome Urban. Here he is in a TV interview, discussing whether women should, or could, advocate for their own care.

JEROME URBAN: Sure the patient has a free choice, but it’s like a child having a free choice to eat sugar candy or drink some milk…the child doesn’t know any better and neither does a patient know anything about what is the proper treatment for her.

STACY WENTWORTH: A few weeks after Betty Ford’s diagnosis, the Vice President’s wife, Margaretta Rockefeller, nicknamed “Happy,” went to Memorial after she found a lump in her breast. Urban was her doctor. He did a procedure he called a “mirror image biopsy,” taking samples from both breasts. Rockefeller had a modified radical mastectomy of her left breast, leaving some of her chest muscle behind. Here’s her husband, Vice President Nelson Rockefeller, announcing the surgery to the public at a press conference, and getting a term wrong about the kind of surgery she had.

NELSON ROCKEFELLER: Ladies and gentlemen, you’re not going to believe what I’m going to tell you. Happy has just had a radical mastectomy of the left breast, and all I can say is that we just thank God that she went in and that this country has such wonderful doctors who have such tremendous skill and ability to cope with this kind of situation.

STACY WENTWORTH: While Rockefeller was recovering, Urban found an area of precancerous cells about the size of two pinheads in the biopsy of her right breast. He and the Vice President kept this information secret from Happy for three weeks while Urban was out of town. Urban then returned and performed a second mastectomy on Mrs. Rockefeller. 

Dr. DeVita consulted on Rockefeller’s case, and recommended chemotherapy. Urban said no. Later, Urban said chemotherapy “should not be used as a crutch for inadequate primary surgery.”

Urban was the voice of the status quo. He had a lot of doctors and surgeons on his side. But Bernie wasn’t going to stop his research, or give up on trying to make sure it went into practice.

VINCENT DEVITA: You know, he was a basically combative guy.

 DeVita remembers seeing him speak at Rockefeller University in 1974, in front of Urban and his supporters.

VINCENT DEVITA: He gave a talk and he made the mention of the fact that they did what they did because they made more money. And that got them really, really angry. And then he showed a slide. And he, I swear to God, he did, he put the slide up and he showed the curve going up and the curve going down. And there was no labels on it. One was like, one said, CR, the lower one. And the top one said PR. And he said, “And the other factor is,” and he points to the slide, he said, “This is what happens, this is cerebral rigidity, and this is penile rigidity, implying that as they get older, they were both impotent and losing their- I mean, they went completely bananas, they walked and got up, walked out of the auditorium and so on. He was just you can see where they kind of hated him because he wouldn’t give in. And when they mocked him, he just mocked them back.

[MUSIC]

STACY WENTWORTH: Rollicking debate was common at medical meetings of this time. A back and forth between small gatherings of all male doctors. In this instance, though, Bernie had had it with Urban’s obfuscation and delay. He took the gloves off and challenged Urban on his own turf. 

Soon, the fight spilled over into the pages of medical journals. One side was advocating for research and choices, the other was doubling down on tradition. For example, Dr. Malcom Watts, a highly respected physician at UC San Francisco took issue with clinical trials and with patients gaining more of a say in medical decision making. He wrote an editorial bemoaning the “lessening [of] a physicians’ professional authority.” 

And an anonymous—i.e., cowardly—doctor wrote this in the Western Journal of Medicine: 

ANONYMOUS DOCTOR: Physicians also know that patients who are ill, in pain or fearful, are often simply not capable of understanding, or of making sound decisions on their own behalf. It is for reasons such as these that physician dominance in health care came into being and should not be lightly cast aside. It is perilous to ignore the special role of a physician or to substitute the patient in his role.

[MUSIC]

STACY WENTWORTH: This debate got intense. There were shouting matches at medical conferences. DeVita remembers Bernie almost turning down an invitation to speak at Memorial.

VINCENT DEVITA: That’s when he said to me, “Vince, I don’t think I can come because I’m think- I might actually meet- get some physical harm done to me if I come.”

STACY WENTWORTH: At one point, another doctor—a resident of Dr. Haagensen—did indeed grab Bernie by the lapels and scream in his face.

BERYL MCCORMICK: No, I think they really couldn’t change the way they thought. They just couldn’t do it. (laughs)

STACY WENTWORTH: Dr. Beryl McCormick is a radiation oncologist at Memorial today. She heard Bernie speak at meetings.

BERYL MCCORMICK: You know, I would not not call Fisher shy at all. He was as boisterous and outspoken as any of the other surgeons in the room. 

STACY WENTWORTH: Bernie could be gruff at times, and he certainly wouldn’t finesse his detractors into following his findings. But he was press-shy, and he didn’t try to fight in public. That’s why there aren’t a lot of recordings of him speaking. He didn’t trust the press to get things right. Here he is talking to an oral historian in the 1980s:

INTERVIEWER: I’ve read some of the articles in Newsweek and in the Chronicle and so on. 

BERNIE FISHER: They’re not very well written, I’m sorry to say.

INTERVIEWER: No, they’re not.

STACY WENTWORTH: Later in this interview, Bernie goes on to say he’s been misquoted and misrepresented. That’s why he targeted his message to the scientific community, in speeches he made to professional audiences and the hundreds of articles he wrote in medical journals. 

BERNIE FISHER: It doesn’t bother me in the least because I’m convinced that what most people read or know about today, they forget about tomorrow. 

STACY WENTWORTH: And he relied on his data. Data, he believed, would speak for itself, though maybe a few clever insults at a conference could help. This strategy wouldn’t be enough to change the surgical establishment—to move the immovable object. Fortunately, Bernie Fisher wasn’t the only unstoppable force out there. 

BERYL MCCORMICK: You know, certainly, I think with some of some very important political wives getting breast cancer at that time, and just people talking more about it, plus the whole women’s movement in general, not specifically for breast cancer. I think that’s how everything just did open up. 

STACY WENTWORTH: Beryl McCormick again.

BERYL MCCORMICK: Certainly from my experience at that time in the clinic, I don’t…I don’t recall too many patients who really came in and said, my six year old granddaughter says, It’s my body, I’ll do what I want with it. 

[STACY LAUGHS]

I think they really did listen, because they knew people at Memorial knew what they were talking about. But to me, it was just more prominent figures getting breast cancer, more money going for research, partly the women’s movement. And then I think, as some of these trials came out, for the first time, you really have the news media picking up these stories and saying, wow, you know, look at this. So it was a slow transition. 

[MUSIC]

STACY WENTWORTH: Let’s talk about that transition, why it was so slow, and who pushed it to happen.

The women pushing for a voice in their care had a lot to push against. To even debate the surgical establishment, they had to start a conversation about breast cancer. And that was still a taboo, even in the 1970s.

JUDY PEARSON: Patients for their part, didn’t want their families to know because they didn’t want them to worry. Furthermore, the contagion thing was real. I mean, you became absolutely ostracized if you had cancer or someone in your family had cancer, because you then were going to carry this, this germ that was going to mow down the rest of the neighborhood, or the rest of the town.

STACY WENTWORTH: Judy Pearson is an author and breast cancer survivor. Her latest book highlights the women who advocated for less radical breast cancer treatments. 

JUDY PEARSON: Hearing about that now, we do think it’s ridiculous, but it was that way.

STACY WENTWORTH: New research into treatments meant cancer wasn’t always a death sentence. And as more people survived their diagnosis, the taboo faded. 

JUDY PEARSON: So it was hardly spoken about, then it became gradually more spoken about, and gradually the contagion thing sort of melted away. 

STACY WENTWORTH: But breast cancer was still a tough topic. 

JUDY PEARSON: The problem with breast cancer is not the cancer part, it’s the breast part. You know, breasts have- have inhabited this strange position in society where they are, they are the nurturer of the species. They are, as Playboy magazine says, “entertainment for men,” and that’s their tagline. 

STACY WENTWORTH: The prominent cases among famous women like Betty Ford and Shirley Temple Black made it clear that cancer was a serious issue, and one that women could—and should—talk about. Breast cancer was the most common cancer among women. Put another way, it was the cancer that was most likely to affect half of the population. And in the early 1970s, that half was fed up with inequality in medicine, and in basically every other aspect of life.

JUDY PEARSON: Because women were so horrifically being kept down in all ways, and let me tell you, so the women’s movement then spawned the women’s health movement. And then, of course, an arm of the women’s health movement just had to be the breast cancer movement. 

STACY WENTWORTH: Women like Rose Kushner made it clear that there was a connection between women’s liberation and women’s health. And finally, medical research was beginning to show that there were options for women. Options that could be just as effective as what a surgeon traditionally recommended, but not as debilitating or disfiguring. 

JUDY PEARSON: Rose Kushner, she was a journalist, and as she said herself, had a stubborn streak and a loud voice, and she was the one who really rallied the sisters to have women realize that they should have options in their treatment, that it should be a two step process, where it’s biopsy, talk it over, breast cancer, surgery, whatever that looked like, and then many other things that insurance should cover, mammography and reconstruction. 

STACY WENTWORTH: Remember that in the early ‘70s, women couldn’t even get a credit card without their husband’s permission. And yet, 18 states would eventually pass legislation forcing doctors to talk to women about their treatment options.

[MUSIC]

STACY WENTWORTH: The two-step procedure, which separated the biopsy and the potential tumor removal, had other benefits, too. If women had time to think about their treatment after a biopsy, then they had time to enroll in clinical studies.

A quick word on how Bernie’s studies work. He led them from his office in Pittsburgh, but they involved doctors and patients far beyond Pennsylvania. He recruited doctors who would then recruit patients. The doctors followed the strict guidelines of the study and reported their data back to Bernie. To test the efficacy of potential treatments, doctors needed patients. And patients needed time to consider choices about their treatment, including the choice to enter one of Bernie’s trials.

In 1976, Bernie began a study called B-06. It looked at an even smaller surgery, called a lumpectomy, which just removed the tumor and a little surrounding tissue. Barney Crile and Rose Kushner were early advocates for this option. And B-06 asked whether a lumpectomy, coupled with radiation, could be as effective as the radical or modified radical mastectomies. 

Doctors were still skeptical about studies like this, but since more women were pushing for time after their biopsies, there were more women who could enroll. And, more forward-thinking doctors jumped at the chance to be involved. In Montreal, for example, Bernie signed up Dr. Roger Poisson, the head breast surgeon at St. Luc’s Hospital. Poisson was a fervent supporter of techniques that could allow women to keep their breasts, and he was happy to join the NSABP. Like a growing number of doctors, he knew and respected Bernie. He admired him. He later called him “a father figure.” Poisson recruited almost a fifth of the patients for the B-06 trial, more than double the next surgeon.

In 1979, at the same place where Bernie presented the B-04 findings five years earlier, the NIH convened a panel of experts on breast cancer. The plan was to agree on the first official recommendations for doctors treating early-stage breast cancer. The NIH does this from time to time when new research on a disease comes out.

Prominent surgeons from across the U.S. and Europe were there. Rose Kushner was a voting member, too. Her book and her advocacy got her foot in the door of the breast cancer conversation, and now she had a seat at the table. 

[MUSIC]

STACY WENTWORTH: She was the only panelist who wasn’t a doctor—and the only woman. Bernie was there too. And after hours of debate, Rose and Bernie emerged triumphant. The radical mastectomy was out and so was the one step procedure. The official guidance from the NIH meant that women would have time to discuss their care and to enroll in studies. The Halsted radical mastectomy, after a century, was declared dead.

If only it were that easy. 

Jerome Urban was another member of the panel. He wrote his own opinion separate from the rest of the group. It read in part:

JEROME URBAN (TRACKED): It has become popular to downgrade the need for radical surgery in the treatment of breast cancer. A great deal of publicity has appeared in the public media implying that all types of local therapy are equally effective Unfortunately, the more well-informed public who read such articles are most likely to be influenced to seek inadequate alternatives that do not provide optimal control of their disease. The use of a two-stage approach in patients with breast cancer is unnecessary in the great majority of cases.

STACY WENTWORTH: Keep in mind that he’s not defending the Halsted mastectomy here so much as he’s defending the one-step procedure—defending an action in which a woman feels a lump and is rushed into surgery, unaware if she would wake up without a breast or pieces of her chest muscle. Or able to ever raise her arm again. Unaware of her options for treatment. Unable to enroll in a clinical study that could help refine treatments for more women. Unable to have a choice or a voice about something going on in her own body. 

Here’s Urban debating breast cancer treatments on television in 1973—and note, he’s still clinging to the old Halstedian idea of how cancer spreads. The most important thing to Urban is to cut it all out.

JEROME URBAN: When you take a lump out of the breast like this, the great majority of patients still have these other seeds of cancer in the breast which will ultimately come out as a cancer. And when you decide to do a lumpectomy on the patient, you’re really playing Russian roulette with that patient. [unintelligible] You’re being [unintelligible] with that patient’s life.

WOMAN: I didn’t feel that way.

JEROME URBAN: I know you don’t, but just—this is two years, my dear.

WOMAN: And I had a mammography.

JEROME URBAN: Okay. Fine. I mean, if the patient wants to say save my breast and I’ll gamble on a 40% ten year salary against the 75%—let her take that risk. I think it’s stupid. And I think anybody who encourages women to do this is doing a disservice to our women.

STACY WENTWORTH: Bernie published the results of B-06 in 1985—these studies take time to process, review, and publish.

DAN RATHER: The headline over an editorial in the current New England Journal of Medicine reads “less may be as good as more.” That comment on new studies about surgery for breast cancer, a disease that will strike an estimated 119,000 American women this year. 

STACY WENTWORTH: The findings were a further blow to the old ways of treatment. A lumpectomy followed by radiation was as effective as a mastectomy in treating cancer. A more radical treatment did not offer a better chance of cure. A little over a decade after Betty Ford’s radical mastectomy, women now had the choice to not remove their breasts at all. Here’s Bernie from 1985.

BERNIE FISHER: If one just took the breast off, didn’t take out the muscles, didn’t take out the lymph nodes and so on. And well, when we had that kind of information, we then felt more secure about going on to doing the lumpectomy trial. And as a result of that lumpectomy trial, we demonstrated that even just removing the primary tumor and controlling the local disease without taking the breast off has given us the same kind of results in terms of distant disease and regional disease as one got when one did the bigger operations. But obviously the reward has been that women can maintain, keep their breasts, they don’t have the horrendous kinds of trauma that resulted from these radical operations and so on. 

STACY WENTWORTH: Despite these positive results, and the official recommendations from the NIH, the debate continued among doctors and women. 

Nancy Reagan found a lump in 1987, two years after Bernie published the B-06 study. And she still chose the one-step procedure of a biopsy and a mastectomy all at one time.

NANCY REAGAN: And I had evidently said in the operating room, I kept saying, did you take my breast? And before they could answer me, I’d fall back to sleep again. And finally, after about the fourth time, I stayed awake long enough for them to say yes. And then I didn’t. I didn’t ask anything more.

STACY WENTWORTH: The old ways were not going quietly.

NEWS ANCHOR: Also, there is medical debate tonight over the best way to treat breast cancer. That debate [is] heating up because of a controversial new study, which now concludes that a total mastectomy is often unnecessary. 

TIM JOHNSON: Two major criticisms, one, the follow up of these women, these comparison groups, is only an average of 39 months, little over three years. The critics say we need at least 10, 15, 20 years before we can truly say the methods are comparable. Second major criticism, the radiation involved may also cause hazards over the long period, scarring, maybe even leading to some cancers itself.

JEROME URBAN: I think in the long run, the present enthusiasm for a local excision and X-ray therapy is going to taper off, just the way other shortcuts have done in the past.

TIM JOHNSON: This study will not satisfy medical critics of lumpectomy, but it clearly will go a long way toward influencing the future choice of hundreds of thousands of women who develop breast cancer.

ANGELOS PAPATESTAS: My concern is that we may swing to the opposite side, and instead of having patients having mastectomies when they could have lumpectomies, we will have more patients going to lumpectomies, even the high risk groups.

LEM TUCKER: The author of the study cautioned that some doctors won’t perform lumpectomies because of their own attitude toward cancer treatment. So he said it’s important for a woman to be informed, ask questions and get a second opinion if she doesn’t like the first answer.

STACY WENTWORTH: Bernie’s data was solid. And he was quickly becoming the face of a new type of thinking in cancer treatment. The guy from Pittsburgh—the kid who read Microbe Hunters while sick in bed; whose dad pushed him to not be a fruit wholesaler; the Jewish student who made it into schools despite strict quotas; the sports fan who almost became a radio announcer; the surgeon who said surgeons didn’t have all the answers; the doctor who didn’t like to talk to the press and took no guff—had become one of the most groundbreaking scientists in medicine. 

NANCY DAVIDSON: I can remember at some European meeting, I can’t remember what, early in my career somehow being at the same dinner table with Bernie was very, very intimidating, you know, because here’s Bernie who’s changing everything. And you know, Bernie is kind of a gruff, no nonsense kind of guy.

STACY WENTWORTH: Dr. Nancy Davidson is a breast cancer researcher who was the University of Pittsburgh Cancer Center Director in the early 2000s. She says despite his tough reputation, Bernie could also be thoughtful and sensitive. She remembers getting a letter from Bernie after she had interviewed for a job with him. 

NANCY DAVIDSON: At my home, in his Bernie Fisher handwriting, a couple of weeks later came this handwritten note with this poem, from this modern Greek poet called Cavafy about this poet, this poem, “Ithaca,” you know, with a note for him saying, “You know, I know you’re facing some decisions, I’ve faced some decisions in my life too, and just thought you might be interested to read this.” So that was a side of Bernie that I would never ever, ever, ever, ever have imagined. 

STACY WENTWORTH: But that side of him was important to getting his work done. 

NANCY DAVIDSON: I think you have to have a certain charisma to be able to do what he did, which is to band together a whole bunch of surgeons that all want to, you know, march to their own drummers, and bring them together and bring them into a clinical trials group that’s basically designed to do trials that are going to put them out of business. That’s what Bernie did. 

STACY WENTWORTH: While some surgeons stayed stuck in the past, other doctors flocked to Bernie as he did his studies. One surgeon told me that after working with Bernie Fisher she understood what it was like to be in a cult because that’s how in his thrall she was. He was confident and a great salesman of ideas. Dr. Edward Levine is a breast surgeon and a friend of mine who enrolled women in NSABP trials. He shared with me what it was like to hear Bernie speak at a meeting.

EDWARD LEVINE: He talks like a clergyman. He delivers a talk like a rabbi giving a sermon. He said tell you what he’s going to tell you, he’s going to tell you, and his voice will escalate. And he’s a great orator. Truly, and so he is absolutely terrific. But they were on a, almost a religious mission to improve things.

[MUSIC]

STACY WENTWORTH: I want to emphasize here that Bernie did what no one has ever done before or since. Bernie Fisher took tens of thousands of surgeons who thought they were God, and made them consider that they were not. He changed the mindset of every single surgeon in the world—well, maybe except Urban and Haagenson.

Scientific discoveries are cool, but changing minds? Literally changing how we understand a disease that has plagued humanity since the beginning of recorded human history? That’s a once in a generation paradigm shift.

After B-06, Bernie and the NSABP went beyond questions of surgery. They studied novel chemotherapy regimens, oral anti-estrogen medications like tamoxifen, and combinations of both. Bernie was the first listed author for hundreds of published articles. He conducted more than a dozen randomized trials, and enrolled almost 40,000 women in those trials. There wasn’t a breast cancer patient in the world not affected by Bernie’s work. 

In 1991, federal funding became available for cancer prevention studies. And Bernie leapt at the chance. A surgeon who had once witnessed women’s arms being amputated due to swelling from radical mastectomies, he could now be the one to prevent breast cancer from ever forming. 

The anti-estrogen drug, tamoxifen, had shown results that made Bernie think it could not just treat, but prevent cancer. He developed a trial where women 35 and older who were at increased risk of breast cancer would get either tamoxifen or a placebo for five years. The National Cancer Institute agreed to fund the study.

The next year, Bernie was elected president of the American Society of Clinical Oncology, one of the largest professional cancer organizations in the world. Other ASCO presidents have gone on to lead the NCI and the NIH, and even be considered for the Nobel Prize. Bernie, elected at the age of seventy-three, was the first surgeon to serve as its president. 

[MUSIC]

STACY WENTWORTH: This was the peak. In less than two decades, Bernie had overseen the transformation of breast cancer care from draconian surgery to humane treatment, and now to prevention. He dispelled the myth that surgeons couldn’t be scientists. Through his wide-reaching recruitment of doctors for his studies, he brought community physicians into the process of planning and implementing knowledge gained in clinical trials. 

But just when Bernie reached the point in his career where he should’ve been able to rest on his laurels, his world fell apart. It has been a long, hard fight to get to this point. But it would all come undone much more quickly.

DANIEL KEVLES: And so Dingell saw political opportunity, but he also saw a need for giving a wake up call to the American biomedical community, certainly.

VINCENT DEVITA: He was obsessed as an investigator that he always won didn’t make any difference. Otherwise, you could present him the cure for cancer. And if he was after you, he’d be after you.

EDWARD LEVINE: It was heartbreaking. It was heartbreaking. I mean, these guys were well-know, very well respected surgeons and that respect was well earned over decades of hard work dedicated to cancer care. And it was going up in flames. 

STACY WENTWORTH: 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. And we get marketing support from Tink Media. Music is from Epidemic Sound.

Special thanks to Dr. Vincent DeVita, Judy Pearson, Dr. Nancy Davidson, Dr. Ed Levine, Dr. Beryl McCormick, John Moore, Chad Hock, and Earlier.org.

Next week is the last chapter of our story. If there’s someone you know whose had cancer, or been affected by it, please help get the word out and share the podcast with them. And if you leave us a five-star review in your podcast app, that also helps others find the show. 

If you want to share your reactions to today’s episode and continue the conversation, join me in the discussion thread for this episode at cancerculture.substack.com. 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.

Thank you for listening.