Norman Wolmark, MD
For many researchers, being involved in one landmark clinical trial is often enough to make for a storied and illustrious career. But being involved in more than one is something entirely different; over the course of his career, Norman Wolmark, MD, found himself in that rarefied air.
For women prior to 1971, the standard surgery for breast cancer was radical mastectomy, promoted by the Johns Hopkins University surgeon, William Stewart Halsted, during the last decade of the 19th century. He believed that metastasis did not occur through the bloodstream. At the time, adequate local removal of the cancer (ie, radical mastectomy) was thought to cure the patient—any new instance of cancer that appeared was treated as a new process.
Radical mastectomy involves the complete removal of the breast, chest wall muscle, and underarm lymph nodes. This method left many women disfigured. The result is severe scarring and pain, making patients hesitant to undergo the procedure. Other, less invasive, surgeries were also explored, but no randomized clinical trials had been initiated to find a definitive answer.
That changed when the National Surgical Adjuvant Breast and Bowel Project (NSABP) initiated trial B-04, which sought to resolve the controversy over the surgical management of breast cancer. The NSABP is a clinical trials cooperative group that has been supported since its inception by the National Cancer Institute (NCI); it is now part of the NRG Oncology Clinical Trials Group as a result of the NCI’s 2014 reorganization of the research network.
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