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New study to detect oesophageal cancer earlier

by Phil Prime | In depth

28 April 2022

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Credit: Medtronic

We are jointly funding a follow-up study which will find the final evidence on the impact on oesophageal cancer mortality of screening using the Cytosponge.

Together with the National Institute for Health and Care Research, we’re jointly investing £6.4m over the next 14 years in BEST4, the latest trial for the Cytosponge as a screening device for detecting Barrett’s oesophagus.

The trial could pave the way for a test to be established as a routine screening programme to detect the condition, which can lead to oesophageal cancer.

Previous studies showed the Cytosponge, pioneered by Professor Rebecca Fitzgerald and her team at the University of Cambridge, detected 10 times more cases of Barrett’s oesophagus compared with routine GP care. Professor Fitzgerald said: “The BEST4 trial is an exciting opportunity to take our work on the Cytosponge-TFF3 to the next level and see whether this test not only detects more cases, but also saves lives from cancer of the oesophagus. It will be a big piece of work, but it’s timely given the push from the NHS leadership, the Life Sciences Industrial Strategy and Cancer Research UK to detect cancers earlier in order to improve outcomes for patients.”

Rebecca Fitzgerald is Professor of Cancer Prevention at the University of Cambridge and Director of the CRUK Cambridge Centre Early Detection Institute.

Researchers will also investigate if the Cytosponge, coupled with additional lab biomarker tests, can be used to monitor people already diagnosed with Barrett’s oesophagus instead of an endoscopy – an invasive hospital procedure experiencing a major backlog caused by the COVID-19 pandemic.

It is anticipated the trial team will begin setting up sites in autumn, with 120,000 patients to take part over 14 years. Those involved will be randomised to different groups and a third of those will receive the Cytosponge, a quick and simple test that can be carried out by a GP. Fitzgerald is leading the trial with Professor Peter Sasieni from King’s College London.

Dr Iain Foulkes, executive director of research and innovation for Cancer Research UK, said: “Cancer Research UK is celebrating 120 years of life-saving discoveries this year and we’re really pleased to be funding what will hopefully be the final trial before this pioneering development is established as a screening device to detect Barrett’s oesophagus.

“There are 9,200 people diagnosed with oesophageal cancer in the UK every year and the Cytosponge will mean they can benefit from kinder treatment options if their cancer is caught at a much earlier stage, hopefully helping to boost survival rates at the same time.”

During the height of the pandemic patients were not being seen for routine gastroscopy. It was decided to rapidly implement use of the Cytosponge test because it has a low aerosol generation and needs only one person to carry out the procedure.

Irene Debiram-Beecham led on the implementation and at the Royal College of Nursing’s annual Nursing Awards she was highly commended in the Excellence in Cancer Research Nursing Award category. The award is sponsored by Cancer Research UK and the only one in the UK to recognise research nurses working on cancer trials and studies.

Irene, principal research nurse for the Cambridge ACED Clinic, said: “As part of this initiative, I provided a new robust training programme for nurses, clinicians and health care professionals across the UK. Having developed a system to sign them off as competent to carry out the procedure, I also provided a 24-hour support service for my colleagues if they had any questions.

“As a research nurse, it makes me proud to see something I’ve been working on for many years has finally made it into clinical practice.”