Posted on 5th March 2019 by Bethan Warman

NHS Innovation Accelerator

Dr Ranjit Manchanda from Barts Cancer Institute, Queen Mary University of London, and Consultant Gynaecological Oncologist at Barts Health NHS Trust, was announced today as one of 13 Fellows to join the NHS Innovation Accelerator (NIA), which supports dedicated individuals to scale their high impact, evidence-based innovations across the NHS and wider healthcare system. Dr Manchanda’s innovation is a model of care for testing populations to identify individuals carrying harmful mutations in the BRCA1/2 genes, placing them at an increased risk of developing breast and ovarian cancers.

Early intervention and diagnosis

In the general population, approximately 12 and 1.3% of women will develop breast and ovarian cancer, respectively, during their lives. However, in women carrying BRCA1/2 gene mutations, 69-72% of them will develop breast cancer and 17-44% of them will develop ovarian cancer by the age of 80.

Genetic testing for BRCA gene mutations is currently only offered to women who have a family history of cancer, which fails to identify over 50% of those at risk of carrying harmful BRCA gene mutations, according to recent research. Dr Manchanda’s work suggests that these limitations could be overcome by offering BRCA testing to everyone, irrespective of family history. By identifying mutation carriers, this approach can ensure that individuals can undertake regular screening and take preventative action to reduce their risk.

In a study funded by The Eve Appeal, that applied population-based BRCA-mutation testing to a population of 1,034 Ashkenazi Jewish men and women, an additional 50% of BRCA mutation carriers were identified when compared with the current family history screening approach. As well as reducing breast and ovarian cancer incidence through early detection and intervention, the population-testing approach has been predicted to reduce treatment costs, leading to estimated savings of £3.7M for the NHS.

Dr Manchanda’s approach will initially focus on the Ashkenazi Jewish population, where the frequency of carrying a BRCA1/2 gene mutations is five times greater than that of the general population. In the Ashkenazi Jewish population, 30% ovarian cancers and 10% breast cancers are caused by BRCA genes.

Dr Manchanda, Barts Cancer Institute, Queen Mary University of London and Consultant Gynaecological Oncologist at Barts Health NHS Trust said:

Broadening genetic testing for breast and ovarian cancer genes across an entire population, beyond just the current criteria-based approach can prevent thousands more breast and ovarian cancers than any current strategy, saving many lives. With the costs of testing falling this approach can ensure that more women can take preventative action to reduce their risk or undertake regular screening.

The NIA, an NHS England initiative delivered in partnership with England’s 15 Academic Health Science Networks (AHSNs), has supported the uptake and spread of 37 high impact, evidence-based innovations across more than 1,700 NHS sites since it launched in July 2015. Dr Manchanda’s innovation will join other initiatives that offer solutions supporting priority areas for England’s NHS: Mental Health, Primary Care and early diagnosis and prevention of cancer.

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