Less Radical

Mammograms were introduced fifty years ago. Recommendations for women to have annual screening mammograms began thirty years ago. The hope was that by finding breast cancer early, we could drastically reduce the number of women dying from breast cancer. And in some ways, we have been successful. The problem with annual screening mammograms is that it is based on the assumption that every breast cancer follows the pattern - progressing from a pre-cancerous lesion to a more aggressive tumor in a logical, linear way. Today, we know this isn’t true. Yes, some cancers are slow growing. So slow growing that they may not need treatment at all. But others, especially those in young women, grow fast. So fast, in fact, that they develop into masses in between annual mammograms. Or develop in women that are “too young” to be screened. And why aren’t we doing more to prevent breast cancer from forming in the first place? Why aren’t we finding women at high risk and doing more than just pushing them into radical surgeries?TLDR: Our current breast cancer screening paradigm is not working. We are doing too much for some women and not enough for others. Today, I’m talking with two women who think women deserve better than this outdated, one-size-fits-none approach. Martha Kaley is a breast cancer survivor and founder of Earlier.org: Friends for an Earlier Breast Cancer Detection Test. Martha’s breast cancer was not mammographically detected. She is also tired of the same old debates about what age we should start screening women for breast cancer. Martha has dedicated her life to supporting innovation in earlier detection methods - finding a better test than a mammogram. Dr. Laura Esserman is a surgeon and professor at University of California - San Francisco. She’s spent her career trying to find less radical ways to treat breast cancer. Now she’s leading a study trying to find the best way to screen women for breast cancer. (Hint: it’s probably not going to be annual mammograms for everyone.)Screening will never be perfect. It’s not now. But why are we settling? What if we demanded a screening approach that was better than a mammogram? Do something… This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit cancerculture.substack.com

When a colleague’s misconduct is discovered, Fisher is forced to resign from the NSABP and becomes the subject of a Congressional investigation. As the walls close in, Fisher fights back. He spends the rest of his life trying to restore his reputation. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit cancerculture.substack.com

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. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit cancerculture.substack.com

In 1958, Bernie Fisher participated in the first randomized clinical trial in patients with breast cancer. The trial was a disaster, leading most surgeons to abandon the idea of using chemotherapy to cure more patients. Bernie, however, noticed something different. This put him on a path that would change the course of cancer treatment forever. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit cancerculture.substack.com

For most of history, the voices of women with breast cancer have been silent, including the daughter of an American president. Fifty years ago, they began to speak. While Bernie Fisher worked to change doctor’s minds, women demanded input into their care. Those whose lives are impacted by cancer continue to influence how doctors, including me, approach our patients and your treatment. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit cancerculture.substack.com

At the end of the 19th century, a New York surgeon determined that the only way to cure breast cancer was with radical surgery. For the next hundred years, millions of breast cancer survivors bore the mark of his disfiguring approach. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit cancerculture.substack.com

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. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit cancerculture.substack.com

Introducing Less Radical, the true story of Dr. Bernie Fisher, the surgeon-scientist who revolutionized the way we treat breast cancer. After generations of surgeons subjecting women to brutal, disfiguring surgeries, Bernie found a better way. And the thanks he got? 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.The first episode of Less Radical debuts September 25. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit cancerculture.substack.com