Ground-breaking cancer trial for Fareham patients

The BEST4 Screening trial, which is also heading to Portsmouth and Waterlooville, will find out if a new ‘pill-on-a-thread’ test could be used to screen people with heartburn for Barrett’s oesophagus – a condition that can lead to oesophageal cancer.

The trial is backed by £6.4 million of funding from Cancer Research UK and the National Institute for Health and Care Research (NIHR).

A capsule sponge test takes ten minutes to do and can be done by a nurse – making it much faster and less expensive than an endoscopy. The trial will find out if the capsule sponge test can detect oesophageal cancers earlier, reducing the need for intensive treatments and preventing deaths.

The capsule sponge starts off as a small, coated pill attached to a piece of thread. When a patient swallows the pill and it reaches the stomach, the coating dissolves and the sponge inside it expands to the size of a cherry tomato. The sponge collects cells from the oesophagus as it is gently pulled out from the stomach by a nurse or GP. The cells are then sent for testing for two proteins which tell doctors if someone has Barrett’s oesophagus or oesophageal cancer.

Following the initial rollout of the trial in Cambridgeshire in November 2024, mobile screening vans have arrived in Locks Heath and will be heading to New Milton, Portsmouth, Waterlooville and Fareham in the coming weeks.

People in the South East received text messages from NHSresearch inviting them to join Heartburn Health, a new platform supporting clinical trials into cancers linked to heartburn. They will be randomly selected to participate in the BEST4 Screening trial.

Over the next three years, the trial aims to recruit 120,000 people who regularly take medication for heartburn. Heartburn is the most common symptom for Barrett’s oesophagus which is a precursor condition to oesophageal cancer, where cells in the food pipe start to grow abnormally.

The trial is being led from Cambridge University Hospitals NHS Foundation Trust (CUH) and the University of Cambridge, with the Cancer Research UK Cancer Prevention Trials Unit at Queen Mary University of London designing the trial and analysing results from it.

According to analysis from Cancer Research UK there are around 9,300 new cases of oesophageal cancer in the UK every year. It is the seventh most common cause of cancer death in the UK, with around 22 deaths a day from the disease.

Ian Stewart, 63, from Locks Heath is joining the BEST4 trial because he experiences acid reflux and was invited to support the research.

Ian said: “The sooner you can get something diagnosed the better and it’s fantastic that these tools are being developed that could potentially improve screening for something that could quietly go undetected.

“My wife and I appreciate the benefits of screening as I’ve undergone a number of colonoscopies for bowel cancer due to my family history and my wife, who is a transplant recipient, has required a number of endoscopies to ensure she hasn’t developed Barrett’s oesophagus. I know she would prefer a less invasive procedure such as the capsule sponge test so it would be wonderful to know my involvement in research could help make that possible.”

Father and grandfather, John Paffett, 74, from Netley, is a childhood cancer survivor and amputee, who also lost his first wife and mother of his three children to breast cancer.

John said: “Last year my second wife was diagnosed with bowel cancer after she took part in the home screening kit. She’s now cancer-free so it just shows how helpful screening can be.

“I suffer a bit of heartburn and I’m not sure what’s causing it but I take medication to settle it down. Being part of the BEST-4 trial not only allows me to help the researchers and potentially other people, it could give me peace of mind or alternatively, alert me to something in its early stages when it’s more treatable.

“It took over five years for the sarcoma in my leg to get diagnosed when I was a youngster, so early diagnosis is important to me. I first experienced symptoms of pain at the age of 10. When I was 16, I was told I was inoperable and had 4 to 6 months to live unless I had my whole right leg amputated with part of my hip bone and pelvis too. It was life-changing but it was also life-saving and gave me an incredible journey through life. Because of that, I really appreciate how important this trial could be.”

Consultant at University Hospitals Southampton NHS Trust and principal investigator for the BEST4 trial in South East Central, Dr Patricia Duarte, said:

“Oesophageal cancer is becoming more commonly recognised in the UK. Despite impressive advances in treating the disease over recent years, only 1 in 5 people survive this cancer for 5 years or more.

“To turn the tide against this deadly cancer, we need to find those people who are at the greatest risk much earlier than we do now. This group includes people over the age of 55 with chronic heartburn. Current methods to diagnose Barrett’s oesophagus and oesophageal cancer are slow and require a hospital appointment for a camera test that can be uncomfortable for patients.

“The capsule sponge test is much quicker, less expensive and can be delivered in the community. We hope that the BEST4 Screening trial will help us identify more people earlier and crucially reduce deaths from oesophageal cancer.”

The trial follows decades of research by Professor Rebecca Fitzgerald and a team of scientists, clinicians and nurses at the Early Cancer Institute, University of Cambridge and Cancer Research UK Cambridge Centre, who invented and refined the capsule sponge test.

Cancer Research UK has funded several successful clinical trials to demonstrate that the test is safe and accurate, which have been designed and run by the Cancer Research UK Cancer Prevention Trials Unit at Queen Mary University of London. A previous clinical trial, BEST3, showed that the capsule sponge test picks up 10 times more cases of Barrett’s oesophagus in people with chronic heartburn, compared to routine GP care.

Piloted in health services in England, Scotland and Northern Ireland for patients who are currently on waiting lists for endoscopies due to long-term heartburn or a Barrett’s oesophagus diagnosis, over 24,000 capsule sponge tests have been performed to reduce diagnostic backlogs in endoscopy and NHS pathology.

Director of the Early Cancer Institute at the University of Cambridge, inventor of the capsule sponge test and co-principal investigator of the BEST4 studies, Professor Rebecca Fitzgerald, said:

“The capsule sponge is changing how we detect Barrett’s oesophagus and oesophageal cancer. Catching it earlier can save lives by reducing the need for chemotherapy and surgery to remove the oesophagus.

“The BEST4 Screening trial is the pinnacle of many years of painstaking research. and thousands of people have already benefited in trials and pilot programmes. Now we’re taking the test to the next level.

“This trial could fundamentally transform the lives of people affected by oesophageal cancer by providing the crucial evidence needed to make it a viable screening programme, rolled out to every part of the UK.”

Chief Executive of Cancer Research UK, Michelle Mitchell, said:

“Around 59% of all oesophageal cancer cases are preventable. Yet endoscopy, the gold standard for diagnosing and treating this cancer, is labour-intensive and not practical for a population screening programme.

“Backed by funding from Cancer Research UK, the capsule sponge has become one of the most exciting early detection tools to emerge in recent years. It’s a remarkable invention by Professor Fitzgerald and her team, and previous trials have shown how powerful it can be in identifying cancer earlier.

“We are proud to be supporting this landmark clinical trial, bringing the capsule sponge test into Bursledon and offering it to a much wider group of patients. After many decades of research, we’re on the cusp of transforming oesophageal cancer diagnosis forever.”

Speciality lead for Gastroenterology and Hepatology at the NIHR South Central Regional Research Delivery Network, Dr Waleed Fateen, said:

"The BEST4 trial a major step forward in rethinking how we deliver cancer screening, not just in hospitals, but right at the heart of local communities.

“By trialling a quick, nurse-led test that can be offered outside traditional clinical settings, BEST4 is bringing early detection within reach for thousands more people. It’s an excellent example of how research can be translated into real-world impact."

The trial is open to men aged 55 to 79 and women aged 65 to 79 who currently receive medication for chronic heartburn/acid reflux. More information about how to join the trial can be found at https://www.earlycancer.cam.ac.uk/our-research/our-clinical-studies/best-4-trial or by contacting [email protected].