Changing the story of cancer: early detection to halve deaths from oesophageal cancer

Executive summary

Cases of oesophageal cancer have increased sixfold since the 1990s. On average only 12% of patients live more than five years after diagnosis. The early detection of Barrett’s oesophagus, an indicator of potential oesophageal cancer, could halve the number of deaths each year.

Barrett’s oesophagus is the changing of some cells in the lining of the oesophagus, or food pipe, which over time can develop into cancer. Barrett’s oesophagus is caused by repeated acid reflux, or heartburn. Not everyone with regular heartburn or even Barrett’s oesophagus will go on to develop cancer but it can be a key indicator of potential cancer of the oesophagus. Traditionally Barrett’s oesophagus is identified via an endoscopy and a biopsy, a camera down the throat into the stomach, which allows the doctor to take a small sample. This is generally carried out in hospital following a GP referral. This test is time-consuming, unpleasant, and quite invasive for patients as well as being expensive for the healthcare system. Professor Rebecca Fitzgerald of Cambridge University is also a consultant clinician at Cambridge University Hospitals. With her understanding of patients’ needs and the research environment, Professor Fitzgerald has been leading research to devise, test, and implement the capsule sponge - a quick, simple, and inexpensive test to detect Barrett’s oesophagus and precancerous cells. The test takes just 10 minutes, and can be done in a GP surgery usually by a nurse. In clinical trials, when the capsule sponge was offered to people taking medicine for heartburn it detected 10 times more cases of Barrett’s oesophagus compared with standard practice thereby limiting unnecessary referrals for endoscopy.

Oesophageal cancer key facts

• More than 9,200 people are diagnosed with oesophageal cancer in the UK each year
• Most people with oesophageal cancer don’t realise there’s a problem until a late stage of the disease when they have trouble swallowing
• Less than half of those with oesophageal cancer in the UK will survive for a year after diagnosis; only about 12% will survive for five years or more; and about 10% for ten years or more
• Those most at risk of getting oesophageal cancer are aged between 65 and 70
• Men are three to four times more likely to develop oesophageal cancer
• Longterm heartburn symptoms, being overweight and smoking all increase the risk of oesophageal cancer.

The capsule sponge

The capsule sponge is a small, easy to swallow, capsule on a thread which contains a sponge. The patient swallows the capsule which dissolves in the stomach and the sponge expands to the size of a 50p coin. After a few minutes, the sponge is pulled back up using the thread. As it travels up the oesophagus the sponge collects cells which are then tested in a laboratory using antibody tests developed by Professor Fitzgerald’s team.

If abnormal cells are found a patient may be monitored to see if further cell changes occur, or be referred for an endoscopy. If abnormal cells aren’t found, the patient doesn’t need an endoscopy, saving time, money, and worry for the patient. Feedback from trials shows patients are comfortable with the process and many prefer it to being referred for an endoscopy.

Most heartburn patients are just treated for acid reflux rather than having an endoscopy to explore further. The capsule sponge opens up the opportunity for more people to be tested, increasing the potential for early diagnosis and therefore, saving more lives.

Professor Fitzgerald started working on the idea in the early 2000s. Since then, her team has developed the device and the laboratory tests, and the capsule sponge has been successfully clinically trialled in thousands of UK patients to see how well the test performs. During Covid-19 introduction into the NHS was accelerated due to the Covid-related risks of endoscopy at that time. Successful feasibility and economic modelling studies followed.

Since July 2021 the capsule sponge has been used across mainland Scottish health boards to study people with Barrett’s oesophagus. The same year NHS England also introduced a capsule sponge pilot. Recently, a £6.4 million 14-year trial was announced by Cancer Research UK and NIHR to see if cytosponge could be established as a routine screening programme.

Since Covid-19 there have been large scale implementation pilots in the NHS. If rolled out into the mainstream NHS as part of business as usual, the capsule sponge could change the story of cancer for patients by improving earlier diagnosis. Work continues to make this a reality - a perfect example of the vision of the Cambridge Cancer Research Hospital which will bring together clinical and research expertise in a new world-class hospital.

Summary

Oesophageal cancer has increased dramatically in recent years. Demographics and lifestyle have a big impact on those most at risk. Repeated heartburn in those most at risk can be an indicator of Barrett’s oesophagus, a potential early indicator of oesophageal cancer. Traditional methods of detection are expensive, time-consuming, and invasive. The capsule sponge is shown to detect 10 times more Barrett’s oesophagus cases compared to current GP practice. It is cheaper, quicker, simpler than traditional diagnostics and can be done in a GP’s surgery in a few minutes. It has been successfully trialled and has financial backing.

Path choices and outcomes

Tony, 65, is a lorry driver. The nature of his job means he rarely moves from behind the wheel during his working day. He is always on the go, and his meals are often quick convenience food. He suffers from heartburn, which is getting more regular. There are two paths Tony could take - which one he choses could be a matter of life or death.