From promise to practice: What must happen next for genetic biomarker testing in UK cancer care

Cancer treatment is undergoing a quiet revolution. Increasingly, what matters most is not where a tumour begins, but what is driving the cancer itself.

Through precision medicine, like genetic and biomarker testing (GBT), clinicians can identify these drivers and match patients to the therapies most likely to work for them. But, while the science has advanced rapidly, the systems needed to deliver this testing consistently across the NHS are still evolving to keep pace with these scientific advances.

The UK has already taken important steps in the right direction through the NHS Genomic Medicine Service and the creation of Genomic Laboratory Hubs, both of which have expanded access to genomic testing across the country.

The 10-Year Health Plan for England: Fit For The Future, released last year, had already highlighted this as a critical area for our health service. February’s National Cancer Plan for England then brought it to life for cancer services in a number of ambitious ways.

The challenge now: Delivery

Over the next few years, the focus must shift from the exciting science, which it certainly is, to practical implementation. Ensuring testing services function smoothly within frontline care, equipping the workforce to deliver them, and preparing the system for the rapidly expanding role of precision oncology are just some of the hurdles ahead.

The National Cancer Plan for England reinforces the NHS’s ambition to meet the challenge and turn it into opportunities for patients. It does this through recognising the growing importance of GBT services in enabling personalised treatment and calling for genomic analysis to become a routine part of cancer care, with results returned in time to inform treatment decisions.

Both Plans commit to ensuring that all cancer patients can access comprehensive genomic analysis and molecular profiling – this is a bold and welcome ambition.

Where the system is struggling

Despite the promise of precision oncology, many cancer teams still face practical barriers to using biomarker testing in routine care, and this is where the disconnect between the scientific endeavour and the day-to-day delivery of treatment can occur.

Timing is one of the biggest challenges. It is one thing sending off samples for research purposes where the timelines may be months or years, it is quite another for testing results to guide treatment decisions. It must happen early in the diagnostic pathway and results must be returned quickly. In practice, however, turnaround times can vary, often driven by workforce shortages and stretched laboratory services. When results arrive after treatment has already begun, the opportunity to offer the most effective first-line therapy may be lost.

Even when results are available, interpreting them is not always straightforward. As testing becomes more complex, clinicians need clear reports that translate technical findings into practical treatment decisions.

Access also varies across the country. While biomarker testing is well established in some tumour pathways, it is still developing in others, meaning patients’ access can depend on where they are treated or which cancer pathway they are on.

At the heart of these challenges is the NHS workforce. Biomarker testing relies on highly specialised expertise across pathology, genomics, and laboratory science – services that are working hard to keep up with rising demand as precision medicine continues to expand.

However, capacity pressures extend beyond people alone. The availability of diagnostic and testing infrastructure – from laboratory equipment used for genomic analysis to imaging technologies such as CT and MRI scanners – also plays a critical role in determining how quickly patients can be diagnosed and begin treatment. In particular, England’s longstanding shortage of CT and MRI scanners continues to act as a major bottleneck across the cancer pathway, delaying diagnosis and limiting the speed at which patients can access appropriate therapies. Addressing these infrastructure gaps will be essential to ensure that advances in precision medicine can be translated into timely care for patients.

Turning ambition into action

To realise the full potential of precision oncology, England now has an opportunity to build on the ambition set out in the National Cancer Plan by focusing on practical delivery.

Workforce investment will be essential, making the Government’s upcoming workforce plan a key opportunity to strengthen capacity and training across pathology, genomics, and laboratory services. Expanding training places for biomedical scientists, supporting specialist molecular pathology roles, and strengthening bioinformatics capability will help ensure the NHS has the capacity to meet growing demand.

Alongside this, improving diagnostic coordination and laboratory capacity will help ensure results are delivered in time to guide treatment decisions. Greater transparency will also be essential, with national data on testing activity, uptake, and turnaround times helping the NHS identify variation and target support where services are under the greatest pressure.

Putting these foundations in place will be critical if precision medicine is to become a routine part of cancer care across the NHS.

A collective effort to deliver change

Delivering this ambition will require collaboration across the cancer ecosystem. Keep Up With Cancer (KUWC), as the industry-led coalition focused on improving cancer outcomes, welcomes the UK’s ambition to expand genomic and biomarker testing and is committed to supporting its effective rollout.

KUWC brings together life sciences companies with a common interest in oncology and works closely with clinicians, patient groups, and charities. One of the aims of KUWC is to help identify practical solutions that can support the NHS to improve access to genetic and biomarker testing and ensure services are delivered consistently for patients.

Precision oncology has the potential to transform cancer care, but that promise will only be realised if we focus now on delivery.

Delivering genetic and biomarker testing consistently across the country will require continued investment in the NHS workforce, infrastructure, and supporting systems. Personalised care will of course not be personalised if it is not built around patients, and that will require building these pathways in partnership with them. If we get these foundations right, we can ensure that by 2035 personalised care is a routine part of every cancer pathway – helping patients access the treatments most likely to benefit them, faster.

Bibliography

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About the author

James Hargrave is the head of government affairs for Daiichi Sankyo UK, a Japanese pharmaceutical company which specialises in cancer and cardiovascular disease. Before joining Daiichi Sankyo in July 2022, he was a member of MSD’s corporate affairs team covering policy and communications for their oncology portfolio, with a particular focus on lung cancer. He is the Chairman of Keep Up With Cancer, a coalition of pharmaceutical companies with a particular focus on cancer treatments. Beginning his policy and press office career in prisons and policing, he went on to head up the public affairs function of Westminster based agency JBP.