Future gazing
Professor Rebecca Fitzgerald OBE of the Early Cancer Institute at the University of Cambridge shares exciting breakthroughs, which give hope for the future that this terrible disease will one day be prevented
Istarted working as a junior doctor looking after cancer patients in the 1990s; since then, the landscape has totally transformed. Back then, it was all about treating late-stage disease; today, the focus is on predicting and detecting cancer early. The change has come about because we’ve developed powerful tools to detect minute changes, so they can spot potential cancers very early in a way we couldn’t do before.
In an ideal world, we’ll be able to pinpoint individuals who are at greater risk before they even have any idea there are malignant cells in their bodies – and then we’ll intervene to diminish the risk.
Thirty years ago, many of my patients had advanced disease with few treatment options. I was very struck that we needed to do better, and that meant diagnosing cancer at an earlier stage. I wanted a research opportunity that would help me understand the earliest stages of cancer development and I found a mentor at Stanford University in the US – a doctor who was working on understanding what makes a pre-cancer in the gullet or oesophagus turn into cancer.
Oesophageal cancer is particularly horrid; fewer than 20% of people who are diagnosed with it at an advanced stage (3 or 4) are still alive five years later, in comparison with more than 80% when diagnosed at stage 1. Looking back, it was the patients in the early days of my career who spurred me on to do the work I’ve done. I thought, if only we could have got there earlier, we could have stopped this cancer before it even started – because the vast majority of cancers take many years to develop. We already knew that cancer in the oesophagus often starts with something called Barrett’s oesophagus – a condition in which some cells in that upper part of your digestive system begin to develop abnormally. Not everyone who has Barrett’s will get cancer, but most of those who get cancer will have had Barrett’s, so identifying those patients was key.
It’s taken many years to do that, but I’ve led the team that’s made big progress in this direction. We’ve designed a test to detect very early changes in the oesophagus: it’s a small pill on a string device, coupled with new lab tests. After you swallow the pill, it dissolves inside your stomach, releasing a tiny sponge. When the nurse pulls it back up, via the string, that sponge collects cells lining the oesophagus. These are then tested for the precancerous condition using antibody tests. If it’s present, the abnormal cells can be removed via endoscopy to prevent cancer from developing, which is effective in most cases. Research has found the
