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New breath test tackles growing rates of oesophageal cancer

George Hanna

 

Professor George Hanna Imperial College, London

Oesophageal cancer affects the pipe that connects the mouth to the top of the stomach. It’s the ninth most common type of cancer in the UK and 8,500 new cases are diagnosed every year. Professor George Hanna is an upper gastrointestinal consultant surgeon at St Mary’s Hospital. He and his team devised a breath test which can diagnose oesophageal cancer quickly and effectively, without the need for an endoscopy. In this, Oesophageal Cancer Awareness Month, Professor Hanna explains why the condition is on the rise and how a simple breath test could help save lives.

The UK has the highest rates of oesophageal cancer in Western Europe, with 7,000 people dying each year from the disease. Like many types of cancers, certain lifestyle factors can increase your risk, such as smoking, drinking, and being overweight or obese. Another risk factor is long-term, persistent heartburn, which can lead to chronic inflammation in the cells lining the oesophagus, and chemical changes to the DNA inside them. This is known as Barrett’s Oesophagus and can lead to cancer.

Oesophageal cancer is very difficult to detect because early symptoms like heartburn are non-specific and common. By the time a patient experiences more specific symptoms – difficulty breathing and pain with swallowing – the disease is at a later stage. As a result, the long term survival rate for patients is only 13 per cent.

Currently we carry out an endoscopy to diagnose oesophageal cancer. This is a procedure where the inside of the body is examined using a probe with a light source and video at the end via the mouth and down the gullet. It’s an invasive and expensive test, costing the NHS around £400-£600 per procedure, and can lead to infections and complications, such as tearing of an organ. Only two per cent of patients who are referred for an endoscopy by their GP are diagnosed with oesophageal cancer.

Taking the breath test

To make sure patients with the disease get to see a specialist at an earlier stage, it’s important we improve the way oesophageal cancer is diagnosed. To this end, as part of a team of clinicians, scientists and researchers from Imperial College London and other institutions, I devised a non-invasive breath test. The test is 90 per cent accurate at diagnosing oesophageal cancer and provides results in minutes as opposed to the four to six hours it would take with conventional methods.

To take the test, patients breathe into a device similar to a breathalyser, which is connected to a bag. The test looks for chemical compounds in the exhaled breath that are unique to patients with oesophageal cancer. Between 2011 and 2013, we carried out our first clinical trial with the test and found it could detect the difference between malignant and benign oesophageal cancer in over 200 patients.

In the long-term, the breath test has the potential to help diagnose patients with early, non-specific symptoms. By diagnosing oesophageal cancer earlier, we can increase patients’ chances of survival and present them with more treatment options than if they were diagnosed later. The test could be used to target groups of patients most susceptible to oesophageal cancer, such as men over the age of 60. And it could help to reduce the number of invasive endoscopies carried out on patients.

Next steps

Following our original clinical trial at Imperial College Healthcare, we are now running a larger study involving three other hospital trusts in London to see whether the breath test can produce similar results with a bigger group of patients. We’ve recruited these patients from cancer centres throughout the UK. We hope to apply the results from the trial to create a sensor device GPs can use to refer patients for further investigations, and ultimately save more lives.

For more information on oesophageal cancer contactCancer Research’s Cancer Information Nurses.

This month is Oesophageal Cancer Awareness Month: an initiative led by the charityAction Against Heartburn. The aim of the awareness month is to encourage more people suffering from symptoms, such as persistent heartburn, to visit their GP to check for underlying causes


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