About project DELTA
Project DELTA: integrateD diagnostic solution for EarLy deTection of oesophageal cAncer
Incidence of the cancer type oesophageal adenocarcinoma (OAC) has increased 6-fold since the 1990s and carries a dismal prognosis. The UK has some of the worst outcomes from this disease in Europe. Clinical guidelines have focussed on minimising endoscopy referrals unless patients have "alarm symptoms" suggestive of cancer. Nevertheless, General Practice referral rates vary widely, and low endoscopy referral rates have been linked with poor outcomes from oesophageal cancer.
A major risk factor for this cancer is chronic heartburn caused by reflux. Three to six percent of individuals with reflux predominant symptoms may have the precursor lesion called Barrett's oesophagus, but only around 20% of patients with Barrett's are diagnosed. It is estimated that the burden of OAC could be reduced by up to 50% as a result of increasing the proportion of individuals with reflux symptoms who are investigated. This is a formidable task since heartburn symptoms affect between 5%-20% of the population and account for up to 10% of GP consultations. GPs therefore focus on controlling reflux symptoms with acid-suppressant medication, particularly proton pump inhibitor therapy (PPI). PPIs are highly effective but patients often continue taking them life-long and there are increasing concerns about long-term side effects including osteoporosis, pneumonia and recently allergy.
In 2008, the Chief Medical Officer, Sir Liam Donaldson, raised oesophageal cancer as a public health concern and identified an urgent need to develop a need for a safe, minimally invasive, affordable test applicable to the office setting to diagnose Barrett's oesophagus. We have developed a new minimally invasive test for patients with reflux that can be performed in the GP surgery. This test is called Cytosponge-TFF3 which has been tested in over 4,000 individuals across 3 continents with very promising results.
Project DELTA aim
Our vision is to redesign the clinical pathway for reflux. A new algorithm applied to NHS prescribing databases will flag symptomatic individuals at risk for oesophageal cancer to their GP. Individuals at risk will be offered a Cytosponge test in a nurse led clinic. The TFF3 stained cells collected by the Cytosponge will be assessed using Artificial Intelligence to increase the throughput and reduce the cost. Individuals at high risk for cancer will be referred for endoscopy and PPI use will be rationalised. These changes will result in an economic benefit to the NHS, a social benefit for early detection of a lethal cancer and a reduction in over-use of PPI medication.
Project DELTA began on 1 February 2020 and will run until 31 January 2023. The project will be split into four work packages:
Economic & implementation research
Investigate factors affecting implementation of the novel pathway
The relationship between the work packages is illustrated in the below flow chart: