“One sting” can replace half of cancer screening

Cambridge researchers show that capsule sponge tests safely identify the risk of esophageal cancer, potentially retaining 500,000 patients from invasive endoscopy each year.

According to a major study published today by the University of Cambridge in the Lancet, more than half of patients monitoring the risk of esophageal cancer can replace uncomfortable endoscopy.

The “capsule sponge” test correctly identified more than 54% of Barrett esophageal patients at low risk, with only 0.4% of advanced precancerous changes requiring treatment. This rate is much lower than the 3% clinical threshold used to justify invasive surgery, suggesting that these patients can safely skip routine endoscopy.

A milder alternative to the throat

Esophageal cancer remains one of the most difficult challenges in medicine. Less than one-fifth of patients who survived five years after diagnosis, a statistics that did not improve within thirty years. Meanwhile, cases have tripled since the 1970s.

Patients with Barrett’s esophageal tubes have stomach acid that changes the lining of food tubes, facing one in 10 chances of cancer. Those with more severe changes in cells called advanced dysplasia increase their risk to one in five.

Currently, these patients undergo endoscopy frequently – usually 10 or more in a lifetime. The process involves driving the camera into the stomach, requiring sedation, and the patient needs someone to take them home.

“The chances of Barrett developing into cancer are low,” explained Professor Rebecca Fitzgerald, director of the Cambridge Institute for Early Cancer. “What we need is an alternative surveillance method that is less invasive, easier to manage and more reliable.”

How does fine lines pill work

Capsule sponge involves swallowing pills attached to thin threads. Once inside the stomach, the pill dissolves to release a small sponge. When pulled back through the esophagus, it gently collects cell samples.

Laboratory technicians then examine these cells under a microscope, looking for two key warning signs: p53 protein abnormalities that usually prevent tumors from abnormalities, and cells that appear irregular or malformed.

Cambridge tested this method among 910 patients in 13 UK hospitals. The results show that the accuracy of risk assessment is very high:

• 15% of people classified as high risk have a 38% chance of precancerous change
• 31% considered moderate risk require continued endoscopy
• 54% of the chances of risky cell changes identified as low risk are only 0.4%
• Patients with two warning signs are 85% likely to face precancerous changes

Real-world impact

Duncan Cook, a 57-year-old water pipe engineer who participated in the study, welcomed the results after nearly 20 years of routine endoscopy.

“I’m very busy at work, and it’s easy to be able to have a sponge instead of an endoscopy and save a lot of time,” Cook noted. “The sponge test is faster, you don’t need a sedative, and you don’t have to find someone who drives home with you. I’m able to finish the test and then go back to work.”

The test can be managed by nurses in GP practice rather than requiring a professional hospital facility. This may significantly reduce NHS resource strain while maintaining patient safety.

Professor Peter Sasieni of Queens University in London emphasized the significance of safety: “Given that these people have developmental abnormalities and then undergo esophageal cancer, it is safe to replace their usual endoscopy with capsule sponges.”

Looking to the future

The research team also tested an artificial intelligence system that could reduce the workload of pathologists by two-thirds without missing any positive cases. This digital approach correctly identifies all patients with dangerous cellular changes while eliminating the need to review 68% of the samples.

Michelle Mitchell, CEO of the UK Cancer Institute, called the technology “one of the most promising breakthroughs in early discoveries we have seen so far” and its potential “to save a large number of people from discomfort and invasive endoscopes”.

The study found that relying solely on subdivision lengths (a proposed alternative) would miss three types of esophageal carcinomas, highlighting the excellent accuracy of biomarker-based capsule testing.

There are over 500,000 people living in Barrett’s esophagus in the UK, and surveillance that can alter cancer is widely adopted while releasing endoscopic resources for high-risk patients who need immediate attention.

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