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Modelling the effect of multi-threshold FIT regimens in bowel cancer screening

  • Full or part time
  • Application Deadline
    Thursday, January 02, 2020
  • Competition Funded PhD Project (European/UK Students Only)
    Competition Funded PhD Project (European/UK Students Only)

Project Description

Applications are invited from graduates with a BSc (First or Upper Second) or MSc (Distinction), or equivalent, to work within the Wolfson Institute of Preventive Medicine. This 3 year studentship will commence in Spring 2020 and will be based at the Charterhouse Square Campus. This is an exciting opportunity for a graduate from disciplines related to epidemiology, statistics, and behavioural sciences.

Project description

Background

The NHS Bowel Cancer Screening Programme has recently moved from faecal occult blood testing using guaiac to faecal immunochemical testing (FIT). In addition to potential improvements in uptake due to greater acceptability of the test, this confers potential improvements in test accuracy and a substantial increase in information from the test due to the quantitative nature of the test, which unlike the guaiac test, provides a measure of haemoglobin in stool per gram of faeces. However, contemporaneous with the introduction of FIT, there is an aim to steadily expand the age range for screening, at a time when there is already considerable strain on endoscopy resources. There is therefore a need to develop flexible screening protocols which fully exploit the information in FIT testing while maintaining a manageable call on colonoscopy capacity.

Aims

(1) To use existing data resources to estimate the likely detection rates of cancer and premalignancy and the burden on colonoscopy services, for a number of different proposed screening regimens, all based primarily on the result of a FIT test.
(2) To identify a regimen which is estimated to improve on current detection rates of significant pathology while maintaining annual colonoscopy rates as close as possible to current rates.

Methodology

A major data resource is the UK FIT pilot study, in which 27,000 subjects completed a FIT test. Moss et al (Gut 2017; 66: 1631) used this dataset to estimate the expected harvest of cancers and advanced adenomas for different FIT thresholds. Cooper et al (Br J Cancer, 2018; 118: 285) proposed a risk score incorporating continuous FIT level, age and sex. Both assumed a system whereby only two outcomes could occur: a positive test (FIT or risk score above a certain fixed level) triggering a colonoscopy; or a negative test (FIT or risk score below that level), with a return to routine screening, next screen in two years’ time. It could be argued that this underexploits the continuous FIT information. We propose, using data from the FIT pilot and published results from other studies, to model the likely outcomes in terms of detection of cancer or significant pathology, and calls on colonoscopy resources, of a regimen with multiple diagnostic workup actions for different levels of FIT.

Outputs
The project will aim to determine the optimal categories for the multiple actions and results will be used as part of a programme of research on stratified screening to inform a trial of such a regimen within the national programme.

Informal enquiries can be made to via email: Stephen W. Duffy

How to apply

Your application should consist of a CV and contact details of two academic referees. You must also include a personal statement (1,000 words maximum) describing your suitability for the selected project including how your research experience and interests relate to the project.

Please submit your application to: Patrick Mullan ().

Funding Notes

This 3 year PhD studentship is funded by the Wolfson Institute of Preventive Medicine and comes with a tax-free stipend of £21,000. It is open to UK Nationals, EEA/Swiss migrant workers and non-UK nationals with indefinite leave to remain in the UK who will have three years ordinary residence in the EU prior to the start of the studentship. University tuition fees (at UK/EU levels) will be met by the Institute.

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