Interview with Professor Rebecca Fitzgerald, University of Cambridge
Professor Rebecca Fitzgerald, University of Cambridge
PMWC 2027 Track 3, Day 1 Luminary Honoree
Topic: Early cancer detection, Capsule Sponge implementation, and moving from screening to interception
1
From Evidence to Implementation: Crossing the clinical chasm
Capsule Sponge has moved further than most early detection technologies, but strong evidence alone does not change practice. Professor Fitzgerald explains why large trials, community delivery, and clinician adoption have proved harder than invention itself.
To generate compelling evidence for an early detection tool, you need large-scale studies. These trials are expensive, challenging to coordinate, and take time to report the results. We have completed three large trials to date, and the last one involved randomising 13,000 patients and interacting with lots of primary care practitioners to deliver the test conveniently in the community. Even though the evidence is sufficient for case-finding, we are now doing a 150,000-patient morbidity and mortality endpoint trial in mobile units to inform the UK National Screening Committee whether systematic, centralised screening could be warranted.
The test is now in clinical guidelines, but even though patients and the public are very keen on an easier, accessible tool, clinicians tend to be very cautious and need a lot of persuasion to move away from endoscopy as the first-line test. This is the case even when the data is compelling and even when this means that lots of individuals at risk for esophageal cancer are never tested for Barrett's esophagus. The implementation gap is well known, but I would call it a chasm rather than a gap.
2
Detection Is Not Enough: Screening must lead to action
Finding more abnormalities is not the same as saving lives. The real test of screening is whether it reaches the right population and connects patients to an intervention that changes outcomes.
In addition, we are not advocating testing everyone. We and others did a lot of work to understand who is at risk. For a cancer like esophageal cancer that is not common, it is vital to enrich the population for those at risk. This approach maximises the benefits and minimises the risks.
3
From Screening to Interception: The three links that must connect
Precision diagnostics will matter only when risk selection, test design, and treatment pathways work as one system. Otherwise, the field risks building expensive tests for people least likely to benefit.
Making expensive tests for the worried well with a low pre-test probability and uncertain treatment pathways will kill this important field.
