We research disease prevention and early detection with particular, although not exclusive, focus on breast and colorectal cancer
Lifestyle factors account for a very high proportion of both bowel and breast cancer, and work using NHS screening episodes to deliver behavioural theory based, weight management (diet, physical activity and alcohol) interventions has been carried out recently. This has taken the form of primary research with a view to implementation within the national screening programmes. Additional target groups for lifestyle interventions include children, postpartum women and other vulnerable groups.
There is also interest in how quantitative faecal immunochemical testing (FIT) for haemoglobin can be harnessed to rationalise the investigation of patients with lower gastrointestinal symptoms. This is particularly germane at the present time since colonoscopy capacity has been severely constrained by the COVID pandemic, but demand outstripping capacity has been a problem in this area for a number of years. This work has shown that low levels of faecal haemoglobin (fHb) are associated with very low risk of serious bowel disease, so that FIT can be safely used to triage symptomatic patients, and implementation of this policy in primary care Tayside has resulted in a substantial reduction in the demand for colonoscopy without adverse diagnostic consequences. This has recently been adopted as national policy in response to the pandemic.
Colorectal cancer screening research has also been a major interest for many years. Work from this grouping led directly to the Bowel Screening Programmes across the UK, and to recent modifications to these programmes, particularly the transition from the old guaiac faecal occult blood test to FIT. Current research interest is focused on how FIT can be used to best effect both in screening and symptomatic populations, and how its quantitative power can be combined with multiple other parameters to enhance its performance. There is addition interest in the wider implications of fHb following his observation that elevated fHb is associated with premature death from a wide range of chronic conditions apart from colorectal cancer. Future plans include exploring the potential of genetic variance in refining colorectal cancer screening.
For a number of years, these activities have been co-ordinated by the Centre for Research into Prevention and Screening (CRIPS) which has received programmatic funding from MRC, CSO, CRUK, BCUK and Scottish Government. The grouping has strong links with NHS Tayside Public Health and with Public Health Scotland through the Bowel Screening Programme Board and the National Screening Oversight Board.
There are a number of additional public health initiatives ongoing with NHS Tayside. These include work on smoking cessation (in users of food banks, and patients with lung and head and neck cancers); improving sexual health (such as the Bridge-It study on provision of progesterone only pill for women presenting to community pharmacies for emergency contraception); and work on substance use and drug deaths.