UK pathology services ‘patchy’ say experts

A new report being launched at the British Thoracic Oncology Group (BTOG) Annual Conference today (Dublin, 25th January 2019) says UK pathology services are ‘patchy’ and the NHS has been ‘slow to respond’ to the rapid advances in molecular diagnostics.¹

New treatments for lung cancer based on molecular tests are emerging rapidly and leading to improvements in survival for many patients. However, limitations in rapid access to high quality tests are denying some lung cancer patients access to the most accurate diagnosis and the best possible treatments.  Currently, the UK has among the worst five-year survival rates for lung cancer across Europe.²

Despite the recent launch of seven NHS genomic testing labs across England³ – and the Government’s ambition to increase the proportion of early cancers diagnosed by 2028⁴ – currently only three percent of pathology departments have enough staff; there is a wide variation in the quality of tissue samples being received by pathology labs; and there are significant delays in turning around test results.¹

Among its detailed recommendations, the UK Lung Cancer Coalition (UKLCC) is calling for a national, molecular diagnostics quality assurance programme and increases in funding to address the critical workforce issues in cellular pathology.¹

“Molecular diagnostics is central to lung cancer diagnosis and treatment. If we are to deliver a world-class lung cancer service more needs to be done to ensure timely and rapid access diagnostic testing for lung cancer patients, wherever they live in the UK,” says Professor Mick Peake, Clinical Lead, UKLCC; Clinical Director, Centre for Cancer Outcomes, Cancer Collaborative, UCLH; Emeritus Consultant and Honorary Professor of Respiratory Medicine, University of Leicester.

The report ‘Molecules matter: Turning the science of molecular diagnostics in lung cancer into a practical service for all patients’ is the culmination of a meeting comprising a select group of highly qualified molecular diagnostic and lung cancer experts.¹ It is a companion report to ‘Millimetres Matter: Implementing the National Optimal Lung Cancer Pathway’ which was launched in November 2018.⁵

“The UKLCC is committed to doubling five-year lung cancer survival to 25 percent by 2025⁶ – and universal and rapid access to high quality molecular diagnostics is a vital element in our ability to reach that target”, adds Professor Peake.

To access the report, visit: uklcc.org.uk/our-reports/

About lung cancer

Lung cancer remains the UK’s biggest cancer killer, with over 35,000 deaths each year.⁷ The disease accounts for over a fifth of all UK cancer deaths (21 per cent) and one in seven (13 per cent) of all new UK cancer cases. It is reported that four people die from lung cancer in the UK every hour (nearly someone every 15 minutes).⁷ Although the majority of cases of lung cancer are caused by smoking, it is estimated that ‘Lung Cancer in Never Smokers’ is the 8th most common cancer in the UK.⁸

About genomics and molecular diagnostics

Once a patient has a tumour, the medical team can use a range of different tests and scans to diagnose the cancer.

Immuno-histochemistry (IHC) tests are commonly used to deliver an initial diagnostic report.  These consist of staining a tissue sample, which is then examined under a microscope.  IHC testing has a role in diagnosis, prognosis and in identifying markers that inform treatment options.

Molecular diagnostics is a specific part of laboratory medicine or clinical pathology which uses the techniques of molecular biology to, diagnose disease, predict disease course, select treatments and monitor the effectiveness of treatments. Molecular testing can be done as single gene abnormality testing which focuses on testing for unique, identified gene alterations that have been correlated with an effective targeted therapy (one-gene, one-test) or with panel testing which look at several different gene alterations.

Since the first sequencing of the human genome, it has become possible to understand a wealth of information about cancers that can help to guide treatment with personalised medicines.

About the UKLCC

The UKLCC was set up in 2005 with the founding ambition to tackle poor lung cancer survival outcomes and, specifically to double five-year survival by 2015, which has now effectively been achieved (9 per cent in 2005 to 16 per cent in England).⁹ The UKLCC is now committed to re-double five-year lung cancer survival to 25 percent by 2025.⁶

The UKLCC is the UK’s largest multi-interest group in lung cancer and was established to help bring lung cancer out of the political, clinical and media shadow.  Its membership includes leading lung cancer experts, senior NHS professionals, charities and healthcare companies.  Its charity members include the British Lung Foundation, Tenovus Cancer Care, Macmillan Cancer Support, Marie Curie Cancer Care, Roy Castle Lung Cancer Foundation, and Cancer Black Care. Please visit www.uklcc.org.uk for more information and details of all of the UKLCC partners.

References

1. Molecules matter: Turning the science of molecular diagnostics in lung cancer into a practical service for all patients. UK Lung Cancer Coalition. January 2019. Accessible at: uklcc.org.uk/our-reports/
2. London School of Hygiene and Tropical Medicines: Cancer Survival Group, CONCORD Programme, via: http://csg.lshtm.ac.uk/research/themes/concord-programme/ Accessed November 2018
3. NHS England, Genomic Laboratory Hubs. October 2018. Available via: https://www.england.nhs.uk/genomics/genomic-laboratory-hubs/
4. The NHS Long Term Plan. NHSE January 2019. Available via: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan.pdf
5. Millimetres Matter: Implementing the National Optimal Lung Cancer Pathway. UK Lung Cancer Coalition. November 2018. Accessible at: uklcc.org.uk/our-reports/
6. 25 by 25: A Ten-Year Strategy to Improve Lung Cancer Survival Rate. UK Lung Cancer Coalition October 2016. Accessible at:  uklcc.org.uk/our-reports/
7. Walters S, Benitez-Majano S, Muller P, et al., ‘Is England closing the international gap in cancer survival?’ Br J Cancer, 4 S 2016, doi: 10.1038/bjc.2015.265. Accessed September 2016 via: http://www.nature.com/ bjc/journal/vaop/ncurrent/pdf/ bjc2015265a.pdf