The BEST4 Screening trial will find out if a new ‘pill-on-a-thread’ test could be used to screen people with heartburn for Barrett’s oesophagus – a condition that can lead to oesophageal cancer.
The trial is backed by £6.4 million of funding from Cancer Research UK and the National Institute for Health and Care Research (NIHR).
A capsule sponge test takes ten minutes to do and can be done by a nurse – making it much faster and less expensive than an endoscopy. The trial will find out if the capsule sponge test can detect oesophageal cancers earlier, reducing the need for intensive treatments and preventing deaths.
The capsule sponge starts off as a small, coated pill attached to a piece of thread. When a patient swallows the pill and it reaches the stomach, the coating dissolves and the sponge inside it expands to the size of a cherry tomato. The sponge collects cells from the oesophagus as it is gently pulled out from the stomach by a nurse or GP. The cells are then sent for testing for two proteins which tell doctors if someone has Barrett’s oesophagus or oesophageal cancer.
Following the initial rollout of the trial in Cambridgeshire in November 2024, mobile screening vans have arrived in Halifax. People in West Yorkshire received text messages from NHSresearch inviting them to join Heartburn Health, a revolutionary platform supporting clinical trials into cancers linked to heartburn. They will be randomly selected to participate in the BEST4 Screening trial.
Over the next three years, the trial aims to recruit 120,000 people who regularly take medication for heartburn. Heartburn is the most common symptom for Barrett’s oesophagus which is a precursor condition to oesophageal cancer, where cells in the food pipe start to grow abnormally.
The trial is being led from Cambridge University Hospitals NHS Foundation Trust (CUH) and the University of Cambridge, with the Cancer Research UK Cancer Prevention Trials Unit at Queen Mary University of London designing the trial and analysing results from it.
According to analysis from Cancer Research UK* there are around 9,300 new cases of oesophageal cancer in the UK every year. It is the seventh most common cause of cancer death in the UK, with around 22 deaths a day from the disease**.
Philip Dunn, from Halifax has been taking lansoprazole tablets for chronic heartburn for 30 years.
The retired dad-of-two, who has five grandchildren and is married to Margaret, was given the choice to undergo intrusive surgery in an attempt to stop the problem or continue taking the medication.
The 66-year-old said: “Carrying on taking the tablets has always seemed the sensible option rather than undergoing major surgery at my age.
“Am more than happy to be a guinea pig and help out in a clinical trial if it will help others in the future.”
Richard Coyle, from Halifax, has suffered from indigestion throughout his whole life. The 61-year-old, who recently retired, has always relied on over the counter remedies to keep the problem at bay.
But the dad-of one has recently tried out a novel remedy.
He said: “Heartburn has been a lifelong problem for me, but it has soothed recently as I’ve been drinking cabbage juice!
“The pill on the thread sounds fascinating and it’s exciting to be involved in something which could help create a future screening programme.”
Lead Upper GI Clinical Nurse Specialist at Airedale NHS Foundation Trust and principal investigator of the BEST4 Screening trial in Halifax, Aidan Henry, said: “Early detection of cancer can save lives and we need more reliable tools to find cancers earlier and improve survival outcomes. The BEST4 Screening trial will provide important data which could take us a step closer to a formal screening programme for oesophageal cancer.
“The mobile van allows us to offer the capsule sponge test to cities, towns and villages across West Yorkshire. It gives people taking part in the trial the convenience of having the test on their doorstep and it shows how readily the test could be rolled out to communities if the trial is ultimately successful.
“By taking part in this trial, people in Halifax and across West Yorkshire are helping us in our mission to catch cancer earlier. I’m grateful to every person who has accepted their offer to join the trial and help us change how we identify people at risk of oesophageal cancer.”
The trial follows decades of research by Professor Rebecca Fitzgerald and a team of scientists, clinicians and nurses at the Early Cancer Institute, University of Cambridge and Cancer Research UK Cambridge Centre, who invented and refined the capsule sponge test.
Cancer Research UK has funded several successful clinical trials to demonstrate that the test is safe and accurate, which have been designed and run by the Cancer Research UK Cancer Prevention Trials Unit at Queen Mary University of London. A previous clinical trial, BEST3, showed that the capsule sponge test picks up 10 times more cases of Barrett’s oesophagus in people with chronic heartburn, compared to routine GP care.
Piloted in health services in England, Scotland and Northern Ireland for patients who are currently on waiting lists for endoscopies due to long-term heartburn or a Barrett’s oesophagus diagnosis, over 24,000 capsule sponge tests have been performed to reduce diagnostic backlogs in endoscopy and NHS pathology.
Director of the Early Cancer Institute at the University of Cambridge, inventor of the capsule sponge test and co-principal investigator of the BEST4 studies, Professor Rebecca Fitzgerald, said: “The capsule sponge is changing how we detect Barrett’s oesophagus and oesophageal cancer. Catching it earlier can save lives by reducing the need for chemotherapy and surgery to remove the oesophagus.
“The BEST4 Screening trial is the pinnacle of many years of painstaking research. and thousands of people have already benefited in trials and pilot programmes. Now we’re taking the test to the next level.
“This trial could fundamentally transform the lives of people affected by oesophageal cancer by providing the crucial evidence needed to make it a viable screening programme, rolled out to every part of the UK.”
Chief Executive of Cancer Research UK, Michelle Mitchell, said: “Around 59% of all oesophageal cancer cases are preventable. Yet endoscopy, the gold standard for diagnosing and treating this cancer, is labour-intensive and not practical for a population screening programme.
“Backed by funding from Cancer Research UK, the capsule sponge has become one of the most exciting early detection tools to emerge in recent years. It’s a remarkable invention by Professor Fitzgerald and her team, and previous trials have shown how powerful it can be in identifying cancer earlier.
“We are proud to be supporting this landmark clinical trial, bringing the capsule sponge test into Halifax and offering it to a much wider group of patients. After many decades of research, we’re on the cusp of transforming oesophageal cancer diagnosis forever.”
Research Director at the Yorkshire and Humber Regional Research Delivery Network within the NIHR, Gail Mills, said: “Funding innovation and research that leads to better outcomes for patients is essential to all that we do, and we are proud to be part of this important cancer trial. Early diagnosis is key to ensure people in Yorkshire and Humber get the help they need at the soonest opportunity. “To continue such pioneering trials in Yorkshire and Humber and beyond, we ask everyone to get behind our ‘Be Part of Research’ 2025 campaign at www.bepartofresearch.nihr.ac.uk.
“Please sign up, share and be a champion for life-changing research and trials, such as this one."
The trial is open to men aged 55 to 79 and women aged 65 to 79 who currently receive medication for chronic heartburn/acid reflux. More information about how to join the trial can be found at https://www.earlycancer.cam.ac.uk/our-research/our-clinical-studies/best-4-trial or by contacting [email protected].





