In 2010, the UK government announced a £60 million investment to introduce flexible sigmoidoscopy (also known as a ‘bowel scope’) as part of the English NHS Bowel Cancer Screening Programme.
This decision was based on evidence provided by the UK Flexible Sigmoidoscopy Screening Trial (UKFSST). Running since 1994, the UKFSST has screened over 40,000 people aged 55-64 across the UK. It has conclusively shown that flexible sigmoidoscopy is very effective at preventing bowel cancer, and that the effect is long-lasting: a follow-up study published in 2017 demonstrated that a single flexible sigmoidoscopy can protect for at least 17 years. This transformative clinical trial, which is still on-going, is coordinated and run by Imperial’s Cancer Screening and Prevention Research Group (CPSRG), headed by Amanda Cross and until recently, the late Wendy Atkin.
Such a trial perfectly sums up the vital importance of cancer epidemiology, but also exemplifies the long-term nature of an epidemiologist’s work: the prospect of having to wait decades for data would be perturbing to most scientific fields, to put it mildly. However, Amanda Cross says that projects don’t take quite so long to pay off as it might seem: “You have your main hypothesis at the forefront, but many other things come up in the meantime—there are always really interesting spinoffs.” And the ultimate job satisfaction is pretty good: “Colorectal cancer is a massive public health problem. While there are means of reducing the risk of developing this disease in the first place, for those who are diagnosed, we can also reduce their risk of dying if we detect it early” Amanda says. “The work we do in this group provides evidence for national policies on colorectal cancer screening and surveillance”.
As well as epidemiologists, the CPSRG involves PhD students, data clerks, clinical trial managers, data analysts, a statistician, a research support officer and a project manager, who all ensure that the many ethical and legal requirements involved in collecting and storing named patient data are met. As their main aim is to provide evidence for primary and secondary care, so that early detection and diagnosis of cancer can be improved, the group also collaborates extensively with gastroenterologists, surgeons, and geneticists; their latest CRUK grant, ‘Screening, Prevention and Diagnosis of Colorectal Cancer’ lists multiple collaborators spread across fourteen different sites in the UK.
Whilst the CPSRG are on the radar of the medical community within and outside Imperial, Amanda thinks there is great potential for collaboration. The huge amounts of data that is being collected and analysed should be an intellectual lure to computer and information scientists, or mathematicians and statisticians, which could be potentially used to develop better ways of modelling cancer risk. She’s very pleased that the CRUK Imperial Centre is encouraging such cross-disciplinary collaborations: “Although it’s tricky to share the health information we collect because of its sensitive nature,” she says, “I’m sure there are people out there who have very little idea of what we do, but would definitely be interested in working with us. I’m very much looking forward to meeting them!”