Rebecca Fitzgerald - clinician scientist
This profile is taken from the MRC Annual Review 10/11, Perspectives, which tells the stories of MRC scientists who made some of the most compelling research discoveries of 2010/11 by thinking about research problems from a new angle.
Group leader at the MRC Cancer Cell Unit, Cambridge.
Dr Rebecca Fitzgerald has invented a simple test for early oesophageal cancer, which could help doctors to intervene before incurable cancer develops.
Rebecca has a long history with the MRC. After her medical training and a research stint in the USA, she gained an MRC clinical scientist fellowship, and then became a group leader at the MRC Cancer Cell Unit in where she has worked for the past decade. She splits her working hours between seeing patients in the clinic and carrying out research on early detection of oesophageal cancer.
“Oesophageal cancer is a relatively under-studied, very aggressive cancer. The overall five-year survival rate is about 13 per cent. It’s increasing in the UK and also in the US and Australia, so it’s a big public health problem,” explains Rebecca.
One of the main reasons why the disease has such a bleak outlook is that by the time patients are diagnosed, the cancer has got to an advanced stage, by which point it is incurable. Rebecca says: “Of the people we diagnose with oesophageal cancer, only about 30 per cent have any chance of being cured, and the rest will usually die within a year. And the treatments for it are pretty horrific – usually chemotherapy, radiotherapy and surgery to remove the whole oesophagus.”
Hidden in heartburn
The disease begins as a condition called Barrett’s oesophagus which, in 10 per cent of cases, develops into cancer. Barrett’s oesophagus can be picked up with an endoscopy examination, which involves putting a camera on the end of a flexible tube into the stomach, under sedation. An early warning sign of this condition is heartburn. But because heartburn affects millions of people, it’s not practical to give an endoscope examination to all of them – especially since the vast majority will not have Barrett’s.
Therefore the holy grail of Rebecca's team's work has been to develop a quick, simple and cheap screening test for the condition which could flag up those at risk of going on to develop deadly oesophageal cancer.
“The best chance of really having an impact on patient survival is to detect those at risk of getting the disease very early,” says Rebecca. “We know that most cancers take years to develop, so you’ve got a long lag time when potentially you could intervene.”
Life-saving sponge on a string
Last year, Rebecca’s team carried out a trial of an innovative new test they have invented, called the Cytosponge. It consists of a sponge enclosed in a dissolvable capsule, attached to a string. Patients swallow the capsule with a drink of water and the sponge expands in the stomach, collecting thousands of cells from the lining of the oesophagus as it is pulled out. In the lab, the cells are then compacted into a pellet and cut into slices. By looking at the genes expressed in Barrett’s oesophagus cells, the scientists identified a protein, or biomarker, which only Barrett’s cells have. So the last stage of the test mixes the cells sample with an antibody, which sticks only to this Barrett’s-specific protein, giving either a positive or negative test result.
The research team tested the accuracy of the diagnostic device in 500 patients and also investigated how well it could be used by patients as a practical screening method. Virtually all patients (99 per cent) were able to swallow the device without a problem and the test accurately diagnosed the three per cent who had Barrett’s oesophagus. Importantly, each test only costs £25, which is considerably cheaper than endoscopy, and if it were to be mass produced it would be even cheaper.
Research to people
Rebecca and her colleagues are very excited about the results. Now they are busy working on finding new biomarkers to single out those Barrett’s oesophagus patients who are at the highest risk of developing the cancer and they have just started a trial in 1,000 patients to try and find them.
“Another good reason to start screening now is that we've got very good treatments. Up until about five years ago, all we could do was remove the oesophagus, which as you can imagine is pretty awful. But if you find early cancer now, you can just burn off the lining of the oesophagus with something called radio frequency ablation,” she says.
Rebecca is now working with manufacturers, economists and others to work through the practical and regulatory considerations required before the test can be commercialised and rolled out as a screening test on a national scale. More work is needed before this can go ahead, so it may be some years before this happens.
How would she like to be remembered at the end of her career? “Not necessarily as just the sponge lady,” she laughs, “but if something I had done actually made a difference to oesophageal cancer outcomes that would be fantastic – and if we could reduce deaths from the disease by picking up patients early and if that could be applied on a global scale that would be even better.”
Watch a video of Rebecca talking about her work
Published October 2011