Adele Margaret Francis Fitzgibbon (b 19 March 1959; q University of Birmingham 1990, PhD, FRCS), died on 8 January 2017
“For a surgeon to say we’re doing too much surgery might sound unusual but very caring,” remarked a colleague. At the vanguard of breast cancer treatment, Adele Francis believed that “the priorities for breast surgical oncologists are to work in a multidisciplinary way to cure breast cancers while simultaneously reducing or ceasing operative treatment that is not required.”
In future, thousands of women with both invasive breast cancer and ductal carcinoma in situ (DCIS) may be spared surgery or have it greatly reduced, thanks to her research.
In 2013 a review chaired by Michael Marmot, the director of the Institute of Health Equity at University College London, found the national breast screening programme to be a mixed blessing. It was preventing 1300 deaths a year but resulting in the overdiagnosis of about 4000 women. The review recommended further research, and Francis and her colleagues stepped forward.
In July 2014 the LORIS (LOw RISk ductal carcinoma in situ) trial opened, with Francis as its chief investigator. It aims were to determine whether active monitoring of low and intermediate grade DCIS was equal to standard surgical treatment.
Francis had a talent for getting trials up and running: her organisational skills and gentle authority were the glue that held the complicated enterprise together. She also had a quirky, endearing style—giving soft toy lorises to people joining the trial, for example. Although she was the leader, the trial belonged to the whole team: an ethos that will ensure its success after her death.
LORIS needed to recruit over 900 women. Aware of clinicians’ reluctance to burden newly diagnosed women with talk of a trial, Francis worked to give them the confidence to enrol patients. Patient and public involvement were pivotal to the trial’s development. Members of Independent Cancer Patients’ Voice and psycho-oncologist Lesley Fallowfield sat on the steering committee and reassured clinicians that patients would welcome joining a trial. The shelf of thank you cards in Francis’s home from patients enrolled on the trial show that they were right.Now successfully through its pilot phase, the LORIS trial has triggered similar projects in other countries including the Netherlands, Australia, and the US.
Adele Francis was born on 19 March 1959 in Solihull, where her parents ran a printing business. Growing up with her sister Lorna, she loved showjumping and had her own horse. Much later she returned to riding, prompted by her son who had taken up polo.
Her affinity for scientific research initially drew her to a career in the laboratory. After a BSc in biology, she became a research assistant to hepatologist Sheila Sherlock at London’s Royal Free Hospital. After her PhD, she returned to Birmingham and became a postdoctoral research fellow at the Queen Elizabeth Hospital’s renal unit.
But in 1986 her career took a new path. She entered a fast track medical course at the University of Birmingham, graduating in 1990. It was during this time that she met gynaecologist Noel Fitzgibbon, whom she married in 1998. The couple had two children: Marianne in 1999 and Michael in 2001.
Francis rose through the ranks at the Queen Elizabeth Hospital Birmingham, becoming a consultant in 2001 and the linchpin of the unit, according to colleague Michael Hallissey. As well as the LORIS trial, Francis organised several other research projects. In 2007 she became the chief investigator of the Neo-Excel trial, which aimed to find the best combination of aromatase and COX-2 inhibitors to shrink postmenopausal breast cancer, in order to minimise subsequent surgery.
NOSTRA was another project to minimise surgery. Opening this year, the preliminary trial aims to show whether surgery is still needed when there is no discernible tumour after chemotherapy.
Francis became an honorary professor in cancer sciences at the University of Birmingham and in 2013 was appointed the subspecialty lead for breast cancer research at the Royal College of Surgeons. She used her appointments to campaign to make research an integral part of all UK breast units’ work and to mentor young breast surgeons and nurse specialists. She attended meetings of the Mammary Fold (the national breast trainees’ group) and other groups, commending the benefits of patient involvement in trials.
Francis savoured life and its pleasures—she delighted in her family and loved to travel. When she was taken ill her bag was found packed, ready to go skiing on Boxing Day. Colleagues remember her laugh, her kindnesses, and readiness to talk into the evening over a glass of wine. She was at the top of her game when she was taken ill in December with pancreatic cancer, dying on 8 January at the age of 57.
Her colleague and friend Lesley Fallowfield spoke of a poem by Ralph Waldo Emerson defining success as: “To know even one life breathed easier because you have lived.” Many thousands of women with breast cancer may breathe easier thanks to Adele Francis.
She leaves her husband, Noel, and two children.