Alliance with Boots for Capsule Sponge testing: Benefits for BEST4 trial and future implementation 

The recent announcement that Boots pharmacies will support an NHS England (NHSE)-Boots pilot of capsule-sponge testing in pharmacies, as well as help identify patients for the BEST4 trial, is welcome news.

• The NHSE-Boots pilot will assess whether carrying out the capsule sponge test in pharmacies is feasible and whether people will take up the offer when advised by a pharmacist. This relatively small-scale pilot will involve around 1,500 individuals across two regions (East Midlands and London), starting in January 2026.
• In parallel, the BEST4 trial – a large randomised controlled trial – will provide the evidence required to determine whether screening with the capsule sponge test can reduce deaths from oesophageal cancer and whether a national screening programme should be introduced. Participants randomised to the test arm will receive their capsule sponge test in mobile diagnostic units, not in pharmacies. Boots will also help to recruit participants to the BEST4 trial across the UK.
• The pilot and the BEST4 trial teams will work closely together to minimise overlap.

The media interest in the Boots partnership with Cyted for the NHSE-Boots pilot may help raise public awareness of the capsule sponge test. This might encourage more people to take part in the BEST4 Trial and to respond to the text message invitation. If a national screening programme is introduced in future, we will need to find the best way to run it – involving pharmacies could be one option.

While it is unusual for an intervention to be piloted by the NHS while simultaneously being evaluated in a large clinical trial, this situation is not unique. In this case, launching the NHSE-Boots pilot ahead of the BEST4 trial results can be justified on the following grounds:

• The capsule sponge test is already known to be safe and well tolerated.
• The NHSE-Boots pilot explores a novel delivery route – using pharmacies to enhance case-finding within the NHS.
• Crucially, the BEST4 trial remains essential. With 120,000 participants to be randomised, it is the only study large enough to provide definitive evidence on the clinical benefits of targeted screening.

Without clear evidence that screening reduces mortality and identifies pre-cancerous changes early enough to intervene, the capsule sponge test will not achieve its full potential to improve population health.

Professor Rebecca Fitzgerald OBE FMedSci FRS Hon FREng

Director, Early Cancer Institute, University of Cambridge

Professor Peter Sasieni CBE FMedSci

Director, CRUK Cancer Prevention Trials Unit at QMUL, Queen Mary University of London