Fisher, who went to medical school and trained at the University of Pittsburgh, and then later did research at the University of Pennsylvania and in London, had made observations that called Halsted’s theories into question . He noted that cancer cells entered the blood early in their course, probably before doctors discovered them. If true, doing such a large operation at the site of the cancer made no sense. What would determine whether or not a woman lived was the ability to kill these wayward cells, which is now accomplished by chemotherapy.
Fisher had also become enamored of the randomized clinical trial, a relatively new development in medicine in which innovative procedures were formally compared to older ones. Patients would agree to enter a trial without knowing which treatment they would receive. To Fisher, such trials were a “highly sophisticated methodology” that represented a “major step toward transforming medicine from an art to a science,” as he wrote in his paper The Biological and Clinical Justification for Relegating Radical Breast Operations to the Archives of Surgical History.
Most of Fisher’s fellow breast surgeons wanted no part of this, retaining faith in the radical operation they had learned from their mentors. Some of them even accused Fisher and another renegade surgeon interested in less aggressive operations, George Crile, Jr. of the Cleveland Clinic, of potentially “murdering” the women who would get smaller operations, such as removing only the breast or a portion of the breast—now called a lumpectomy.
Yet Fisher and his National Surgical Adjuvant Breast and Bowel Project (NSABP) finally prevailed, beginning to enroll patients in 1971. By the late 1970s it appeared that, as he had suspected, women with early-stage breast cancers did just as well with these more limited operations, often accompanied by radiation and chemotherapy, as women who had radical mastectomies. In 1985, the New England Journal of Medicine published two of Fisher’s studies that definitively proved these earlier findings.
Fisher became a medical hero, and rightfully so. In 1985, he was awarded the prestigious Lasker Award for medical research. Many colleagues thought he deserved the Nobel Prize. But the same self-assured and pugnacious attitude that had helped him triumph over surgical conservatism soon landed him in hot water. In 1994, the media reported that one of the surgeons who had participated in Fisher’s research had falsified data on 99 cases. Yet neither Fisher nor the National Cancer Institute (NCI), which was in charge of the research, had chosen to go public with this information.
Women, especially those who had undergone less aggressive surgery based on Fisher’s research, were furious, calling the fraud and subsequent secrecy a “shocking breach of trust,” as Sharon Batt put it in her book, Patient No More: The Politics of Breast Cancer. The NCI and the University of Pittsburgh, where Fisher was a professor, removed him as head of the NSABP due to concerns of scientific misconduct.