Thread by @HemeOncBuddy

Lets bring #MedTwitter back!

Introducing #HemeOncHeroes ➡️ a series about the pioneers, rebels, and visionaries who changed hematology and oncology forever!

Lets dive in 👇 #HemeOncHeroes series. Story #1

In 1994, his own institutions fired him in a single week.

He was 76 years old.

The University of Pittsburgh fired him. The NCI fired him.

He had spent forty years proving that almost every breast cancer surgery for a century had been pointless.

He was right.
🧵 1/15

His name was Bernard Fisher.

He was born in Squirrel Hill, Pittsburgh in 1918. His father Reuben sold apples. Bernard would live within blocks of the house he grew up in for the rest of his life.

2/15

In college, Fisher auditioned to be the radio voice of the Pittsburgh Pirates. He lost to a man named Rosey Rowswell.

Pittsburgh kept him anyway. Pitt for college, Pitt for medical school. First in his family to attend either.

3/15

In 1958, an army general walked into a room at the NIH and recruited him.

Two stars on each shoulder. Twenty-three surgeons sat at the table.

Fisher would later say: "You don't turn down a two-star general at a federal facility."

4/15

That meeting founded the NSABP, the trial network that would, over the next 60 years, rewrite how breast cancer was treated.

The general was I.S. Ravdin.

The surgeon Ravdin recruited that day, would later become a chair of NSABP.

5/15

In 1953, Fisher had opened the first Laboratory of Surgical Research at Pitt.

He spent the next decade studying how breast cancer cells moved through the body.

His mouse work suggested something heretical.

6/15

By the time breast cancer was diagnosed, it had often already disseminated. The disease was systemic from the start.

Removing more local tissue would not change survival.

7/15

The Halsted radical mastectomy had been the standard for 75 years. It removed the breast, the pectoralis muscles, and every node from the chest wall to the apex of the axilla.

Women woke up with concave chests.

8/15
pic: Dr. Halsted

Fisher said all of that surgery had been unnecessary in most patients.

Surgeons did not take it well.
9/15

Following Halsted radical mastectomy many were left with chronic arm swelling, pain, and limited mobility due to lymphedema.

10/15
pic: AI generated images for education purposes.

He took the @NSABP chair in 1967 and moved its headquarters to Pittsburgh in 1970.

11/15

pic: Two Allegheny Center, Suite 1200, Pittsburgh, PA 15212. This location serves as the administrative, scientific, and financial headquarters for @NSABPFoundation

B-04 randomized women to radical mastectomy versus simpler operations.

B-06 compared lumpectomy plus radiation against mastectomy.

Survival was identical.

For many women, the extra mutilation of radical mastectomy did not improve survival.

Then the floor fell out.

In 1994, an investigation revealed that one of his Montreal sites had falsified data on a small number of patients. After correcting the data, final results did not affect the trial's conclusions.

12/15
NSABP B04 trial: pubmed.ncbi.nlm.nih.gov/12192016/

Fisher lost his position as a chair of NSABP chair. He had to leave Pitt and the NCI.

He had spent his career being right.

He lost his job for someone else's fraud.

13/15

The Office of Research Integrity later cleared him of personal misconduct.

Pitt restored his title and his lab. NSABP rebuilt around him.

He kept publishing into his nineties.

14/15

Fisher died in 2019, at age 101.

NSABP, now part of NRG Oncology, @NSABPFoundation runs out of Pittsburgh. The building is one of administrative buildings of Allegheny Health Network, where residents of @AHNIMres and fellows of @AHNhemeonc take their in training exams (ITE)!

The boy from Squirrel Hill who lost an audition to a baseball announcer spent the rest of his life rewriting breast cancer surgery.

15/15

@PittHemeOnc @UPMCnews #ThePitt @AHNhemeonc

#OncTwitter #BCSM

Sources and further reading:

Primary: nejm.org/doi/full/10.10…

Background: en.wikipedia.org/wiki/Bernard_F…