Radical Roots

“Radical” can mean a lot of things. In math, it’s a symbol for a root. In culture, it describes rule breakers—people who challenge the norm, stir things up, and sometimes make others squirm. The word can sound reckless. But in medicine, being radical—twice over—helped save millions of lives.

To Cut Is to Cure
In the late 1800s, surgery was the only weapon doctors had against breast cancer. At Johns Hopkins, Dr. William Halsted developed what he called the radical mastectomy—removing not just the breast, but the chest muscles and nearby lymph nodes. By the standards of the day, it was bold, groundbreaking—and yes, truly radical.

Halsted believed breast cancer spread slowly, so cutting wide and deep could stop it in its tracks. The results were dramatic—local recurrences dropped. But the price was steep: women were left with large, disfiguring chest wounds. Without their lymph nodes, many developed painfully swollen arms, a condition known as lymphedema. And over time, one truth became clear—this extreme surgery didn’t actually help women live longer. Still, for nearly a century, the radical mastectomy was the gold standard.

Dr. Halsted’s influence went far beyond one operation. He revolutionized surgical hygiene—trading street clothes for sterile gowns and introducing rubber gloves after his nurse (and future wife), Caroline Hampton, developed skin irritation from disinfectants.

But an experiment nearly destroyed him. While testing cocaine as a new anesthetic, Halsted became addicted. Doctors tried to cure him with morphine, which only led to a second lifelong dependency.

Yet even as his personal life unraveled, Halsted left an indelible mark on medicine. He didn’t just pioneer the radical mastectomy and transform surgical hygiene—he also created the residency training system that continues to shape generations of surgeons today.

A Radical Rethink
Almost a century later, Dr. Bernard Fisher a surgeon and researcher at the University of Pittsburgh, dared to ask: What if cutting more didn’t mean curing more?

Fisher, who helped found the National Surgical Adjuvant Breast and Bowel Project (NSABP) in 1958, proposed that breast cancer was a systemic disease—that cancer cells could spread through the bloodstream early on. If that were true, removing more tissue wouldn’t save lives. Many surgeons called his view heresy.

But Fisher had data. Through National Institutes of Health (NIH) funded clinical trials, he compared Halsted’s radical mastectomy to less invasive surgeries like lumpectomy plus radiation and chemotherapy. The results were revolutionary: women did just as well without losing their breasts. By 1985, studies in the New England Journal of Medicine confirmed it—and the radical mastectomy was largely laid to rest.

As Fisher put it, “For the first time, the treatment of breast cancer was based on science rather than anatomy.”

Rooted in Research
Thanks to the NIH and its cancer arm, the National Cancer Institute (NCI) – the world’s largest funder of cancer research—new breakthroughs kept coming. Herceptin, approved in 1998, transformed outcomes for women with HER2-positive breast cancer, proving that radical ideas backed by rigorous science save lives.

But progress isn’t guaranteed. The current Administration’s deep cuts to NIH and NCI funding threaten the very pipeline of discovery that brought us Herceptin—and countless other lifesaving advances.

As October marks Breast Cancer Awareness Month, it’s a moment to reflect on the radicals who changed the game. Drs. Halsted and Fisher challenged the status quo in their time—and to keep saving lives today, we must be radical too: standing up for science, not cutting it down.

Happy reading,
Suzanne Daniels,Ph.D.

Suzanne Daniels, Ph.D.
AEPC President
P.O. Box 1416
Birmingham, MI 48012
Office: (248) 792-2187
Email: [email protected]

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