Cambridge GPs host UK’s first heartburn cancer test unit


09-06-2021
Outside the new heartburn test facility (L-R): Dr James Morrow, Liz Chipchase, Mimi McCord and Professor Rebecca Fitzgerald, who has developed the Heartburn Sponge Test

A new ‘game-changing’ test, which might save lives by spotting the early warning signs for cancer, is being brought to the doorstep of people in the Cambridge area.

Patients from Granta Practices, who have surgeries in Sawston, Linton, Royston and Great Shelford, will be some of the first in the UK to have the simple 10-minute Heartburn Sponge Test outside a hospital setting or a medical trial.

They will be invited to the innovative mobile unit, that’s been funded and equipped jointly by Heartburn Cancer UK (HCUK), the charity that promotes awareness and champions early oesophageal cancer diagnosis, and Innovate UK funded Project DELTA, which is rolling out the sponge test technology as a routine procedure in GP practices and other locations.

At the mobile unit – which is the first of its kind – patients on medication for heartburn will be invited to have a quick but potentially lifesaving test, using a ground-breaking new detection technique for early signs of oesophageal cancer, developed by researchers at the University of Cambridge and Addenbrooke’s Hospital.

The first patients are expected at the mobile unit at Shelford GP surgery on Friday 11 June.

New test has the potential to both cut waiting lists and save more lives

Incidence rates of oesophageal adenocarcinoma (oesophageal AC), the most common cancer of the food pipe in the UK, have increased six-fold since the 1990s, but survival remains poor (at just 17% after five years).

Research shows, however, that 59% of cases of cancer of the oesophagus in the UK are preventable.

"Early diagnosis is key to survival for oesophageal cancer. The Heartburn Sponge Test, using the Cytosponge and lab test, is a game-changer when it comes to picking up early cell changes, which could be cancer or the pre-cancerous condition, called Barrett’s oesophagus,” said Dr James Morrow, GP and Managing Partner at Granta Medical Practices.

“At present, we have to send people we’re concerned about to hospital for an endoscopy. But the Heartburn Sponge Test is a quicker, cheaper, easier and a less invasive way to look for and monitor people who could be at risk of this dangerous, but often preventable, cancer.”

He added: “The test at the mobile unit will - at the very least - bring peace of mind to some of our patients and could - for others - catch serious conditions much earlier than they would through other processes.”

Mimi McCord, chairman of Heartburn Cancer UK (HCUK), who set up the charity when her husband died from cancer of the oesophagus after inadvertently ignoring early warning signs of persistent heartburn, said: “Early diagnosis is vital. By funding the mobile test unit and bringing the test to the doorstep of their GP, we can help more people be seen sooner, and do it in a much less intimidating and more convenient way.

“If we pick up more cases of Barrett’s oesophagus or early signs of cancer, we are much closer to preventing people from dying unnecessarily.

“This is so often a preventable disease but we just have to be clever about how we do it. The mobile unit and the Heartburn Sponge Test, using the Cytosponge, is a clever way. We hope to raise more money to widen the reach of this initiative as far as we possibly can, and we thank everyone who has supported us so far.”

Michelle Mitchell, chief executive of Cancer Research UK said: “It’s exciting to see this pilot of the Cytosponge in a primary care setting get off the ground, following over a decade of research by Cancer Research UK-funded scientists. If it means we find people with Barrett’s oesophagus, a pre-cancerous condition, sooner than would otherwise be the case, it’s possible this test could be rolled out across the NHS.

“However, the crucial question will remain of having enough capacity in the NHS to do the test and look at the samples quickly and safely. This will require long term investment from Government and sufficient cancer staff to take and process samples.”

Recent trial picked up 10 times more worrying pre-cancerous conditions

A recent Cancer Research UK funded medical trial picked up 10 times more cases of Barrett’s oesophagus, a pre-cancerous condition, than the GP’s usual first course of action.

The BEST3 trial involved more than 13,000 people and included research through GP practices which was facilitated by the Cambridgeshire and Peterborough Clinical Commissioning Group.

It used the ‘heartburn sponge’ (or Cytosponge and special lab test) developed by Professor Rebecca Fitzgerald, a Heartburn Cancer UK trustee, and her University of Cambridge and Addenbrooke’s Hospital teams.

The trial also identified early cancer in some patients.

One person particularly thankful for the sponge test is 71-year-old Liz Chipchase from Cambridge

Liz Chipchase joined the BEST3 medical trial to help out. She’d been treated for acid reflux/heartburn for 40 years but didn’t expect any issues to show up. The results of the sponge test revealed she, in fact, had oesophageal cancer.

Fortunately - she feels ‘completely well thanks’ to the sponge test trial - it was found at an early stage and was treatable.

Liz was one of the lucky ones. Because oesophageal cancer is often found late, is more usually fatal. Only 17% of people diagnosed with it live for a further five years or more after diagnosis.

Following its stay in Cambridge, the mobile Heartburn Sponge Test unit will move on to Essex and then Suffolk as the pilot aims at proving a wider benefit to the NHS.

It is hoped this could one day become a test used by GP surgeries throughout the country to identify potential issues for people who are on long-term heartburn medication, or when someone has had heartburn or indigestion for three weeks or more.

Image: Left to right- Dr James Morrow, GP and Managing Partner at Granta Medical Practices, the GP surgery group hosting the first mobile diagnostic unit; Liz Chipchase, from Cambridge, who had her early-stage cancer discovered by the Heartburn Sponge Test during the trial stages; Mimi McCord, chairman of Heartburn Cancer UK (HCUK), which has helped fund the mobile unit, and bring it to Cambridge. Mimi set up the charity when her husband died from cancer of the oesophagus after inadvertently ignoring early warning signs of persistent heartburn; and Professor Rebecca Fitzgerald, who has developed the Heartburn Sponge Test, the Cytosponge and associated laboratory test, with her team from The University of Cambridge and Addenbrooke’s Hospital.

 

 

How the Heartburn Sponge Test works

 

  • Patients are invited to have the test at the mobile unit when it’s brought to, or near, a GP surgery

  • The nurse-led unit is being funded through a partnership between Heartburn Cancer UK (the charity that promotes awareness and champions early diagnosis), the University of Cambridge (which created the Cytosponge), Project DELTA (which is funded by Innovate UK to roll out the new technology as a routine procedure in GP practices and hospitals, in partnership with Medtronic who makes the device, and Cyted whose laboratories perform the diagnostic test) and other vital supporters

  • People invited for the test by GPs will be over 50 and will have used medication to reduce stomach acid (PPIs - proton pump inhibitors) for some time

  • A limited number of people can also self-refer for the test at the HCUK website. These are likely to be regular users of over-the-counter or off-the-shelf reflux, heartburn or indigestion medications (such as Gaviscon, Rennie and Nexium) 

  • With some water, they will swallow a small ‘pill’, which is about the size of a large vitamin tablet. The capsule is attached to a string which will be used to retrieve the device

  • The pill-on-the-string will sit in the stomach for five to seven minutes allowing the capsule to dissolve, releasing a small sponge

  • The sponge is then retrieved using the string, catching cells on the way back up

  • The retrieval will only take one or two seconds

  • The whole process takes less than 10 minutes and is much easier, cheaper and less invasive than an endoscopy performed in a hospital, which is the normal way the NHS checks for these issues

  • The collected cells will be sent to the Cyted lab to be checked using an advanced artificial intelligence-based diagnostic test developed by the University of Cambridge

  • Only patients with something unusual detected by the sponge test will then be referred for an endoscopy by their GP

  • The test will make sure people who need it can receive regular checks or endoscopy treatment to prevent cancer so that anything worrying is detected at an earlier stage

 

The Heartburn Sponge Test, using the Cytosponge, in pictures*

Step 1: swallow a small pill on a string

With some water, the patient swallows a capsule attached to a thread containing the Cytosponge.


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Step 2: wait for 5 to 7 minutes

The capsule dissolves in the stomach and the Cytosponge expands. This takes between five and seven minutes.


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Step 3: pull it back in seconds

A nurse pulls on the string attached to the Cytosponge and brings it back, along with some cells. This process takes one to two seconds.

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*Images courtesy of UCL Health Creatives.

 

Main features and findings of the Cytosponge medical trial (BEST3 trial)

  • The ‘sponge on a string’ pill test identified ten times more people with Barrett’s oesophagus than the usual GP route (where most people were given medication and not referred for an endoscopy)

  • The test can also pick up abnormal cells and potentially early-stage cancer

  • The research was carried out by Professor Rebecca Fitzgerald, who is a Heartburn Cancer UK trustee, and her team from the University of Cambridge, and was funded by a grant from the Medical Research Council (MRC) and Cancer Research UK

  • The trial involved 13,000 people (around 1,600 of whom received Cytosponge testing) and was a multicentre, pragmatic, randomised controlled trial run across 109 GP clinics in England

  • Patients involved were 50 or older, had been taking acid-suppressants for symptoms of gastro-oesophageal reflux for more than six months, and had not undergone an endoscopy procedure within the past five years

  • Half of the group were offered the sponge test. Half were in the standard care group

  • The team compared how many people in each group were diagnosed with Barrett’s oesophagus. They also looked at whether cancers diagnosed from the Cytosponge test were at an earlier stage than those diagnosed in standard care

  • The key finding was that around 10x more patients with Barrett’s oesophagus were diagnosed with Cytosponge compared with the standard GP practice

  • Of the 131 people diagnosed with Barrett’s oesophagus and/or early cancer, nine people with early cancer benefitted from treatment as an outpatient via endoscopy.

Useful facts and figures about oesophageal cancer and Barrett’s oesophagus

  • Each year, up to 40% of the adult population in the UK is thought to experience dyspepsia, which is pain or discomfort in the upper gut that covers indigestion, heartburn, acid reflux, regurgitation and sickness/nausea

  • One-off issues are unlikely to signal a problem but having regular bouts of heartburn, or other similar conditions, can be a sign of cancer or a pre-cancerous condition called Barrett’s oesophagus, which considered the most important risk factor for oesophageal adenocarcinoma (oesophageal AC), the most common cancer of the food pipe (oesophagus) in the UK

  • People who have regular heartburn are often unaware that they may have Barrett’s oesophagus. Those who do know will be offered regular checks

  • Barrett's oesophagus can increase your risk of developing the most common cancer of the oesophagus (oesophageal adenocarcinoma), although the risk is still small. Many people with Barrett’s oesophagus do not develop cancer

  • Between 3 and 13 people out of 100 (between 3 and 13%) with Barrett’s oesophagus in the UK will develop oesophageal AC, the most common cancer of the oesophagus, in their lifetime

  • Each year, less than 1 in 100 people with Barrett’s (less than 1%) develop oesophageal adenocarcinoma. The risk of developing oesophageal cancer is higher if you have more severe cell changes (high-grade dysplasia)

  • 8,000 people will die from oesophageal cancer each year in the UK

  • About 22 people die each day of oesophageal cancer in the UK

  • Overall, oesophageal cancer is the seventh most common cause of cancer death in the UK. In males in the UK, oesophageal cancer is the 4th most common cause of cancer deaths

  • The UK has the worst survival figures in Europe for oesophageal cancer

  • Oesophageal cancer rates in men have risen by 56% since the early 1970s. In women, they have increased by 14%

Partnership working behind the mobile Heartburn Sponge Test unit

The mobile unit has only been made possible through the support and funding of generous partners, donors and supporters.

They include:

More funds and sponsors will be needed to extend the project to new areas.

 

Revolutionising diagnostics to change lives.

Working to build a world where disease is prevented rather than treated.

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