Sat in her London lab in the late 90s, Professor Rebecca Fitzgerald had a curious idea. Over the following decades, this idea would grow into the creation of a diagnostic test that’s now transforming how we diagnose a condition called Barrett’s oesophagus – a common forerunner to oesophageal cancer.
Back in July, we celebrated the incredible findings from the project and this novel diagnostic test – called Cytosponge-TFF3 – took its first tentative steps into widespread clinical implementation. Developed by Professor Fitzgerald and her team at our Cambridge Institute, the Cytosponge is a dissolvable pill on a thread, which expands into a small sponge when it reaches the stomach. When it’s gently pulled back up, the sponge collects some of the cells lining the oesophagus on its way, which are analysed using a new laboratory marker called TFF3. The test is quick and easy to perform in GP surgeries and allows doctors to quickly refer people with abnormal cells for further tests.
We caught up with Professor Fitzgerald recently to learn how sustained major funding from members of our Catalyst Club has enabled her extraordinary work and why she’s convinced early detection research provides our best chance of defeating cancer.
The Cytosponge is a remarkable feat of innovation. Where did the idea come from?
I was very aware that endoscopy is a barrier for people getting a diagnosis for Barrett’s oesophagus and wanted to come up with something simpler. One day I was chatting with my then boss, the physician and researcher Professor Mike Farthing. He said to me: “What you need is a bottle brush for the oesophagus!” and that got me thinking in very practical terms. A little while after that, in the early 2000s, I moved to Cambridge and set about making a prototype. But I knew the device wasn’t enough on its own. While it allows you to grab a number of cells from the oesophageal passage, it doesn’t tell you which ones are pre-cancerous. So in tandem, we developed a laboratory test to perform on the cells.
My team and I put an awful lot of effort into deciding on the best biomarker test and how to make that practical for clinical labs. We made a conscious decision to use a standard antibody test rather than rely on expensive sequencing technologies.
How did it feel when the extraordinary results started to emerge and you realised the test’s potential?
I was completely blind to the results during the clinical trial and a few weeks before I found out, a colleague asked me what I was hoping for. I said that the best I’d anticipated was three times more effective detection of Barrett’s oesophagus than ordinary GP methods. So the magnitude of the difference we achieved and what this could mean for people with the condition was very exciting. As well as the test being 10 times more effective, we also found a number of people who had early cancer and dysplasia – abnormal cells that can indicate cancer – even though the trial wasn’t designed with that as a main outcome.
The personal stories from those people were very touching and they emphasised the importance of what we’d achieved. They really did spur me on as it takes a lot of time, effort and perseverance to progress new innovations through the regulatory bodies for clinical use. It’s not enough to say: “We’ve done the trial, now we can put our feet up.” The follow-through is so important.
How has philanthropy enabled your research?
This work couldn’t have happened without major funding. The clinical trial work was all funded by Cancer Research UK and much of that was thanks to philanthropic donations.
As individuals, we have choices to make about what we give our money to, but cancer research will always be important. I remain convinced that, within the cancer field, the biggest impact we can have for society in the next 50 years is improving and speeding up the way we diagnose the disease. Throughout my career as a clinician, I’ve found that it’s ultimately very difficult to make a big impact for patients with cancers diagnosed late – both in terms of survival and quality of life, as people suffer enormously with the side effects of late-stage treatment. Getting a handle on things early is how we’ll make the biggest improvement in cancer outcomes, but this kind of research costs a lot of money and it’s complex. You need to do it right and avoid the many false positives and their ramifications.
With the many recent technological developments in medicine, I feel we’re on the cusp of being able to more precisely make cancer diagnoses in a timely way that allows people to have simpler, more cost-effective and less invasive treatments. And for me, that is just as important as focusing on ever-more complex precision medicines for advanced cancers. You can argue all these things are important, but I personally see the greatest impact happening in the early detection space. And sustained major funding will allow us to get there.
Beyond the bench
In my downtime…
I conduct a small community music group. I also enjoy cycling in the countryside.
If I weren’t a scientist…
I would love to have pursued a career in music. Interestingly, two of my children are going down that route. It must be in the genes somewhere!
all about happy chaos with our four boys and their friends enjoying food and relaxing in our garden.
Interview by Joanna Lewin
We’ve been funding the Cytosponge studies since 2010, with generous support from members of our Catalyst Club.