Blog by Dr Valerie Sills, Programme Manager for the CRUK-funded CanTest Programme.
The CanTest programme supports research, capacity building and collaboration in the field of early detection and diagnosis of cancer in primary care. CanTest was announced by Cancer Research UK as the winner of the first ever Catalyst Award in January 2017, so the programme is still only two years into the five year funding term. The growing research portfolio includes 40 active projects, covering a range of different cancers. There is a focus on the ‘hard to detect’ cancers – pancreatic, colorectal, lung and ovarian. These typically present in primary care with non-specific symptoms and tend to be diagnosed once the cancer has advanced. They may not then be amenable to treatment with curative intent.
CanTest is led by Dr Fiona Walter from the University of Cambridge and Professor Willie Hamilton from the University of Exeter. There are nine universities in the Collaborative – four in the UK and five from Europe, the US and Australia.
Projects are investigating topics such as: the diagnostic accuracy of biomarkers such as Faecal Immunochemical Tests (FIT) for symptomatic patients and CA125 and other ovarian cancer markers; the role of imaging approaches such as mpMRI in avoiding prostate biopsy in men with symptoms and a raised PSA count; the impact of patient and practitioner experience on primary care diagnostic testing; the use of cancer risk assessment and prediction models in primary care consultations; and the health economics of novel diagnostic testing strategies.
In the FIT studies, we are working with the East of England and South West Cancer Alliances to investigate the recent roll-out of FIT in these regions. These studies aim to answer key questions, which are unknown in primary care populations, such as:
- Do symptoms add to the predictive power of FIT?
- What level of haemoglobin in faeces should be regarded as a positive test?
- Does this level vary, for instance, by gender, age or ethnicity?
In terms of capacity building, CanTest aims to create a global community of clinicians and scientists to support the development and delivery of cancer diagnostic research for primary care. To date, this has been addressed by establishing an annual International School for Cancer Detection Research in Primary Care and launching a Travelling Fellowship scheme, encouraging researchers to travel and collaborate effectively across the nine CanTest institutions.
The Second International School was held at Jesus College in Cambridge in April 2019 and welcomed 40 Junior Faculty from around the world. This year’s School built on the successes of the previous event in 2018, using feedback and evaluation to fine-tune the content and delivery. The School included a packed timetable of presentations, workshops and networking sessions, delivered by members of the CanTest Senior and Junior Faculty and invited external speakers.
The next steps for CanTest’s capacity building are to encourage fellowship applications from researchers in other UK and international institutions, including those from low- and middle-income countries, to enable them to attend future Schools and connect with colleagues in the wider Early Detection and Diagnosis community.