Congratulations to Prof Rebecca Fitzgerald (MRC Cancer Unit) and her Upper GI team, who recently (5 May) received a Gastroenterology Team Award at the BMJ Awards 2016 (Cytosponge – find cancer early). The BMJ Awards are the UKs premier medical awards programme, recognising and celebrating the inspirational work done by doctors and their teams.

Competition for this year’s BMJ Awards, now in their eighth year, was very strong, with 320 entries.  A rigorous selection process included presentations by shortlisted teams to a panel of judges that featured patient representatives for the first time. In collaboration with colleagues at Cambridge University Hospitals NHS Trust, the team at the MRC Cancer Unit developed a simple diagnostic test for oesophageal cancer, called the Cytosponge^TM, which the patient swallows, thereby avoiding the need for endoscopy.

Upper GI Team (left to right): Mrs Irene Debiram-Beecham (Research Nurse), Professor Rebecca Fitzgerald (Principal Investigator), Dr Pierre Lao-Sirieix, (Senior Scientist) and Dr Maria O'Donovan (Consultant Pathologist and Research Associate).

The biggest risk factor for cancer of the oesophagus is heartburn - acid reflux - but the vast majority of patients who go to their GPs with this complaint are not sent for endoscopy. The Cytosponge^TM is a simple pill-on-a-string, which is swallowed by the patient, remains in place for a few minutes for the gelatin-like coating to dissolve, and is then retrieved with only minor discomfort. The cells it has collected are tested for the presence of a protein, Trefoil factor 3 (TFF3), which is a marker for Barrett’s oesophagus, a common precursor of cancer. Once patients have been diagnosed with Barretts’, they can then undergo routine surveillance and preventative treatment. In a series of four studies, the Cytosponge^TM has proven itself suitable for use in primary care, accurate in diagnosing Barrett’s and acceptable to patients.

 

It has taken 10 years for this concept (Cytosponge^TM device and subsequent test) to be developed to clinical application, but it is now entering its final stages. The team are currently launching a final study in primary care (BEST3 trial) to ensure that the health economics add up. BEST3 will be a trial of over 9,000 patients, recruited across 176 GP surgeries spread throughout the UK. The surgeries will be randomised into two groups. One group will treat their patients with heartburn in the same way that they would usually. The other group will offer all their patients a Cytosponge^TM test to see whether they have Barrett's (a condition that can in some cases develop into cancer) as part of their clinical care. The trial will take three years to complete and should tell us whether this test is suitable for routine clinical use. Commenting on the trial, Prof Fitzgerald said: “Then we’ll take it to the National Institute for Health and Care Excellence and say, ‘Here it is.’” There is a risk that use of the test might generate such a need for follow-up that endoscopy departments would be flooded. “We’re aware of that, so now we’re working on going one step further”, Prof Fitzgerald says.

BEST3 will start recruitment in late summer. Members of the trial team will be available to talk about the trial for International Clinical Trials Day on Friday 20 May. There will be a stall promoting clinical trials, including the opportunity to take part in a mock 'chocolate trial' on the main concourse at Addenbrooke’s Hospital from 11.30-14.00.

- Photos used in the report are © Copyright Philippa Gedge Photography www.philippagedge.com.

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