The CCE pilot was introduced at pace during the Covid pandemic. This was done to provide additional capacity for the investigation of symptomatic patients at risk of colorectal cancer.

These futuristic miniature cameras are a time- and labour-saving alternative to a colonoscopy. They can help rule out colon cancer and be used as a filter or triage test. This means therapeutic colonoscopy can be saved for people who need a biopsy or polypectomy.

If used in the right cohort of patients, CCE can help release endoscopy capacity and aid early cancer detection, by prioritising people in need of further tests and treatment.

The Cytosponge is a capsule with a small sponge inside. The patient swallows the capsule, which has a thread or string attached.

The sponge is then released from the capsule, and a trained nurse/clinician pulls the thread back up, collecting small samples of cells. This is then sent to pathology for analysis.

The aim of the pilot study was to determine if offering the test to patients on medication for gastro-oesophageal reflux would increase detection of Barrett’s oesophagus. This condition is currently diagnosed via endoscopy following a GP referral to a gastroenterologist, or other specialist in secondary care.

Gastro-oesophageal reflux is a relatively common condition. Approximately 20% of the population experience symptoms, and some may already have or may develop BO, a precursor to oesophagus cancer (El-Serag et al., 2014).

A variety of demographic and lifestyle factors may increase the risk of gastro-oesophageal reflux, including:

• Old age
• Male sex
• Intake of analgesics
• Consumption of certain types of food and drink
• Smoking
• High body mass index (BMI)
• Limited physical activity

Endoscopy remains one of the most pressurised services in the NHS. Using Cytosponge as a triage tool in secondary care has the potential to release capacity of endoscopy services by discharging patients at low risk (routine and surveillance), and ensures patients at high risk can be prioritised effectively.

Patients who present with non-specific symptoms or combinations of symptoms that potentially indicate various cancers often face problems. These challenges, associated with poorer patient outcomes, include:

• Delays in diagnosis
• Higher rates of late presentation
• Emergency presentation

Patients without established effective referral pathways may have:

• Seen their GP several times before referral
• Been more likely to attend in an emergency setting, such as a hospital accident and emergency department
• Presented with cancer at an advanced stage
• Been referred on to multiple pathways
• Gone back and forth between primary and secondary care

NSS pathways can be based in primary care, run by GPs, or in hospitals as a consultant or nurse-led service. Details of symptoms will be taken, as well as a range of tests, including:

• Blood test
• Chest X-ray
• CT scan
• Endoscopy

Such tests will rapidly progress patients to the most appropriate pathway. Less than 7% of patients referred to NSS pathways receive a cancer diagnosis. Approximately 45% have a non-cancer condition diagnosed, and don’t need to be referred back to their GP.

NSS services are in place across all Humber and North Yorkshire Trusts, and the roll-out of the NSS pathway is a core commitment of the NHS Long Term Plan. We’re working to ensure all patients with NSS will be referred via this pathway.

Each year, 1,100 colorectal cancers are caused by Lynch syndrome. It’s the most common form of hereditary colorectal cancer, and around half of all people with Lynch syndrome develop this cancer.

The National Institute for Health and Care Excellence (NICE DG27 diagnostic pathway) recommends all people with colorectal cancer are tested for Lynch syndrome.

The national programme ensures everyone diagnosed with either bowel or endometrial cancer is offered genomic testing. A Lynch syndrome diagnosis helps with personalised cancer treatment and also means the patient’s relatives can be offered testing.

PinPoint uses AI to examine features in blood and is currently being piloted by the NHS.

This diagnostic test was developed using the data of hundreds of thousands of patients investigated for cancer between 2011 and 2019. Through machine learning, 33 biomarkers of blood sample are measured. This information is combined with other data, such as age and gender, to generate a single number. This number reveals the chance of a patient having cancer.

PinPoint, when used in the earliest stages of clinical investigation, helps doctors determine within 72 hours the chance of a patient having cancer. They can then either prioritise the patient for hospital testing, or rule them out of the cancer pathway entirely.

Read frequently asked questions about the PinPoint test.