Cambridge oesophageal cancer trial finds “pill on a string” test effective

A ‘pill on a string’ test has been proven to identify ten times more people with possible early signs of oesophageal cancer than the standard method of diagnosis, NIHR-supported research found.

The BEST3 study, published in The Lancet, has found that the new test can successfully identify Barrett’s oesophagus, a condition that can lead to oesophageal cancer in a small number of people.

The Cytosponge test involves the patient swallowing a small pill with a long thread attached to it. The pill expands into a small sponge when it reaches the stomach. After a few minutes, the sponge is pulled back up by a nurse using the thread, bringing with it cells from the oesophagus which can then be analysed.

Barrett’s oesophagus is usually diagnosed in hospital by endoscopy – passing a camera down into the stomach – following a GP referral for long-standing heartburn symptoms. It is hoped the test will help doctors determine which patients have early signs, and therefore require an endoscopy.

Over 9,000 people are diagnosed with oesophageal cancer in the UK each year and about 7,900 die. The Cancer Research UK-funded study involved 13,222 participants randomly allocated the sponge test or standard care, including 6,576 in GP practices across the eastern region.

Over a year, the odds of detecting Barrett’s were ten times higher in those offered the Cytosponge with 140 cases diagnosed compared to 13 in usual care.

The Cytosponge also diagnosed five cases of early cancer (stage 1 and 2), whereas only one case of early cancer was detected in the GP group.

Alongside better detection, the test means cancer patients can benefit from less severe treatment if it is caught at an earlier stage.

The University of Cambridge’s Professor Rebecca Fitzgerald, who led the research, said: “It’s taken almost a decade of research and testing thousands of patients to show that we’ve developed a better route to diagnosing Barrett’s oesophagus.

“And the sponge could also be a game-changer in how we diagnose and ensure more people survive oesophageal cancer. Compared with endoscopies performed in hospital, the Cytosponge causes minimal discomfort and is a quick, simple test that can be done by a GP.

“Our test is already being piloted around the country, so we hope more people across the UK could benefit from it.”

The researchers are putting the test through an economic evaluation and hope it will be rolled out to GP practices within three to five years.

For more information on all research happening near you and how you can get involved, visit the NIHR’s website at www.bepartofresearch.uk.