For people with bowel cancer, the stage at diagnosis can shape their chances of survival: around 9 in 10 people diagnosed at stage 1 survive at least 5 years, compared with around one in 10 at stage 4.
The University of Birmingham is leading STRIDE-RCT, a government-funded trial designed to assess whether a range of blood tests can improve cancer outcomes in primary care. The Office for Life Sciences is funding it through the National Institute for Health and Care Research (NIHR), with up to £8.49 million.
More than 20,000 NHS patients aged 45 and over will be offered the multi-cancer tests at about 200 GP surgeries in England. Patients who come to their GP with symptoms including pain or persistent bloating will give one or two tubes of blood alongside their routine tests.
The study is aimed at cancers that can be difficult to identify from symptoms alone. The tests will look for proteins or fragments of DNA in blood, using artificial intelligence, that may signal cancer. They are intended to detect bowel, small bowel, stomach, oesophageal, pancreatic, liver, bile duct, gallbladder, ovarian, endometrial, kidney, bladder and prostate cancer.
Professor Aneel Bhangu is a consultant colorectal surgeon and co-chief investigator on the trial. Dr Anisha Patel, an NHS GP and bowel cancer survivor, was diagnosed with stage 3 bowel cancer at a young age.
Professor Peter Johnson, NHS England's national clinical director for cancer, said detecting abdominal cancer early was 'notoriously difficult' because symptoms can easily be mistaken for other less serious conditions.
That difficulty has consequences across the health service. Around 71,000 people in England receive a diagnosis of pancreatic, stomach, liver, ovarian or bowel cancer each year, while nearly 35,000 die each year from those cancers. Currently, just 2% to 6% of urgent referrals for cancer result in a diagnosis.
The trial will use tests supplied by four companies: Proteotype's Enlighten, Pinpoint AI's PinPoint, Natera's Signatera and Mercy BioAnalytics' Halo. Signatera is already used to detect cancer recurrence and works by identifying circulating tumour DNA fragments shed into the blood by tumours.
A positive result does not automatically mean cancer is present, while a negative result is not a guaranteed all-clear.
The study follows a separate NHS trial of the Galleri blood test, which failed to meet its main goal of reducing diagnoses of late-stage cancers. Health Minister James Frith called STRIDE-RCT 'an exciting and world-first major trial for earlier diagnoses for abdominal cancers, which are notoriously hard to spot.'
Frith said it could take 18 to 24 months to establish whether any of the tests are suitable for a national rollout. The findings will help determine whether blood testing in GP practices is suitable for wider NHS use.
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