The age of patient power – Jeri Francoeur on advocating for better axillary treatment

One such patient is Jeri Francoeur, a two-time breast cancer survivor and patient advocate, who sits on the boards of the Florida Breast Cancer Foundation and Susan G Komen for the Cure, among many others.

In 2019, Jeri was diagnosed with high-risk Ductal Carcinoma in-Situ (DCIS) for a second time and was told that surgery would be needed to remove it. In addition, a sentinel lymph node biopsy (SLNB) would be required to analyze further spread and stage the cancer.

However, Jeri had done her own research and heard about an emergent ‘delayed’ SLNB technique that was beginning to be used across the US, which was sparing axilla surgery for up to 80% of high-risk patients undergoing a mastectomy.

In this advanced procedure, the Magtrace® lymphatic tracer is injected at the time of surgery to remove the DCIS. As Magtrace® can be retained in the lymph nodes for many weeks, the biopsy can then be delayed until pathology confirm if the DCIS is either invasive or not.

If the DCIS is found to be non-invasive, then no surgery is required. In the worst-case scenario that an invasive result is returned, the nodes are already marked, ready for the surgeon to go back for a separate surgical procedure to remove them.

→ Find out more about ‘delayed’ sentinel lymph node biopsy and our ‘SaveOurNodes’ campaign

During Jeri’s first diagnosis in 2003, she had received a sentinel lymph node biopsy, performed alongside the removal of the suspicious DCIS during a mastectomy.

In that procedure, her previous surgeon had injected her with a radioactive tracer called technetium-99 to find the sentinel nodes. While the procedure proved to be a success, Jeri explained how the tracer had left a “horrible burning” pain. She decided she did not wish to experience that again on her second time round.

“I started doing some investigating I found that a compound had been developed that was non-toxic and non-radioactive called Magtrace” explained Jeri. “I wrote a letter to the powers that be at UF [University of Florida] Health and said I’d like Dr Lisa Spiguel as she’s one of the best surgeons around, and I wanted Magtrace”.

Dr Lisa Spiguel of the University of Florida Shands Hospital has long held an interest in providing better lymphatic care to her patients, having seen the negative long-term effects caused by lymphedema.

“If we can avoid these sentinel lymph node biopsy procedures in patients that don’t need them, then we can improve the quality of life for our breast cancer patients”, said Dr Spiguel.

Already aware of Magtrace® and interested in using it, the arrival of Jeri’s case could not have been better timed. It was a perfect union to get started on performing the technique.

“I had wanted to start using Magtrace for some time before we finally got the approval. I’m very grateful that Jeri chose to be our first patient to pioneer this approach at the University of Florida.”

“I was thrilled. I had done my research and knew that this was going to be a much better option than technetium – and I had the best surgeon, so I knew everything was going to be fine” Jeri said.

Ahead of surgery, Dr Spiguel reiterated to Jeri that there was a 20% chance that further surgery could be required and took her through every step of the procedure, before putting her under anesthesia.

“We injected it [Magtrace] in the pre-operative area. We then massaged the breast for about 5-10 minutes and then took her to the operating room for the procedure. It was extremely simple” explained Dr Spiguel.

When the pathology results returned post-surgery, it was good news. Jeri’s DCIS was found to be non-invasive and no further surgery was required.

Speaking about the whole experience, Jeri told us how Magtrace® had been worlds apart from her previous axillary treatment, helping to calm her on the day of her DCIS surgery.

As for UF Health Shands, the opportunity to work with Jeri on this first case has opened the floodgates to offering this pioneering surgery-sparing technique to patients across the region.

“Since Jeri’s procedure, this has become our standard practice, so we’re very thankful to her for helping us take the leap” said Dr Spiguel.

→ Find out more about ‘delayed’ SLNB here

’Delayed’ sentinel lymph node biopsy with Magtrace® is currently only indicated for US patients undergoing a mastectomy. Speak with your healthcare team to find out if you could be eligible.