Fresh from her Don Listwin Award presentation at The Early Detection of Cancer conference, we spoke to Professor Rebecca Fitzgerald about the power of collaboration, taking risks and the rise of early detection as a hot topic for researchers…

Whilst early detection research has yielded some incredible advances, there is still a long way to go to rule out late diagnosis of cancer… what areas of research give you the most encouragement that we will get there?

The most encouraging thing is that early detection is now a hot topic. Lots of researchers are tackling what has been a neglected area for many years. With lots of talented researchers supported by investment from funding agencies and industry we are likely to make progress.

I don’t think there is one single thing that will sort out late diagnosis of cancer – it will be a combination of advances. The fact that there are tools which are now so much more sensitive means that we have much more power to detect early cancerous changes. In addition, we are moving towards a more personalised approach so that it isn’t a one size fits all for screening. The public are also becoming more willing to come forward and get checked before they have symptoms to stay healthy.

The field of early detection encompasses a huge variety of approaches and research expertise – how important is it to get the right collaborations in place for any given project?

Collaboration is key. Not only for success in this field, but it is also incredibly rewarding and makes the research fun. I have forged and relied on collaborations with public health and primary care, engineering (materials science and chemical engineering), pathologists, clinical triallists and statisticians, patient groups, clinicians, policy makers, industry partners and investors.

Obviously advanced technologies will continue to have an important role to play in early detection – but interestingly, despite its incredible effectiveness, the cytosponge on which you have worked on extensively is actually quite a low-fi solution. What do you think are the key factors for successful early detection technologies?

Early detection needs to be deployed at a population level. The tests need to be accessible and acceptable for patients and affordable for the health care system. Once you have identified the early cancer then you can wheel out the high-tech solutions to determine exactly how advanced it is and to treat it etc.

Why is it important for the field to have a ‘roadmap’ for early detection?

It is useful to have a guide to help streamline the process and to share lessons learned. There is no point in repeating mistakes and learning the hard way. However, any roadmap will only be a guide and it is important to have bespoke advice as well. I have been helping to develop a one-stop-shop for researchers developing new devices and advanced therapies in Cambridge so that we can help guide them in the steps required to bridge the gap between preclinical research and the clinical trials. As part of this it is also important to say goodbye to ideas that are unlikely to make it.

GRAIL has entered the trial phase, which is very exciting, but is it too ambitious to hope for a one-test approach to screen for all major cancers?

I think one aspect of this is the tricky question of who to test for which cancers? Should we tailor what we test for according to a person’s risk? And could this concept be incorporated into a blood test so that even if it can test for 50 cancers you only test for a relevant panel?

A tailored approach might help to reduce false positives or identify those lesions which might never cause a problem in a person’s lifetime. Another aspect is that some cancers will be harder to detect than others, and furthermore some will be hard to treat without major morbidity (and even mortality). Therefore, this begs the question as to whether one would wish to know that you have a pre-cancer in a hard to treat organ if the harms of intervening might be worse than the benefits.

Getting an idea from discovery research to actually have an impact is vital – how can the mindset of researchers change to make translational work more of a priority?

I completely agree that clinical implementation is vital to have an impact. Not every idea will work and that is OK – we should be trying some high-risk things that seem crazy otherwise we won’t cause the step-change we need. But when something is promising we need to go all out and follow it through, this takes perseverance and stamina. It may take a lifetime and even if your particular technology doesn’t make it then it will have stimulated other advances along the way. This is how the field will progress.

The Don Listwin Award recognises a sustained contribution to, or singular achievement in, the cancer early detection field. The award, established in 2019, is named in honour of Don Listwin, founder and chairman of The Canary Foundation.

Rebecca, is internationally recognised for her exceptional research into the prevention and detection of oesophageal cancers. The Don Listwin Award honours the work she has done to develop, establish and grow the research needed to detect cancer early.

Rebecca is known for the development of the Cytosponge technology, a sponge on a string that patients can swallow instead of undergoing an endoscopy. The Cytosponge collects cells from the oesophagus for use in a test which can flag the presence of TFF3-positive cells indicative of Barrett’s oesophagus, a precursor to oesophageal cancer.

Find out more about why Rebecca has received this year’s award.

Rebecca is Professor of Cancer Prevention and Interim Director at the MRC Cancer Unit, University of Cambridge. She leads the Early Detection Programme of the CRUK Cambridge Centre which is part of the International Alliance in Early Detection (ACED) and practices medicine as Hon. Consultant in Gastroenterology and Oncology at Addenbrooke’s Hospital.

The focus of her research group is to investigate the steps in malignant transformation in the oesophagus and stomach and to use this information to improve clinical early detection strategies.

In 2013, she was elected as a Fellow of the Academy of Medical Sciences and in 2021 elected a Member of EMBO. Rebecca is committed to teaching and is a Fellow of Medical Sciences at Trinity College Cambridge.

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