NHS Trust rolls out ovarian cancer surveillance for women with BRCA mutations

A new algorithm-based surveillance test for ovarian cancer is being offered on the NHS to women carrying BRCA1 or BRCA2 mutations.

Women carrying mutations in the BRCA1 or BRCA2 genes have a higher chance of developing breast and ovarian cancers. Mutations in these genes can be detected through DNA testing, which is mostly offered to people with a family history of these cancers. Women carrying a cancer-causing variant in the BRCA1 or BRCA2 gene have a 44 percent and 17 percent lifetime risk respectively of ovarian cancer, up to 80 years old. NHS guidelines recommend preventative surgery to remove the ovaries and fallopian tubes, which can cause early menopause, infertility and other health issues. University College London Hospital (UCLH) has now become the first to offer the new risk of ovarian cancer algorithm (ROCA) surveillance test on the NHS, which could allow women to defer surgery.

'Having pioneered the clinical trials in this area, we have reached a significant milestone in being able to offer ROCA surveillance for high-risk women in our NHS Familial Cancer Clinic,' said Professor Adam Rosenthal, consultant gynaecologist at UCLH. 'The service will give women with BRCA1 or BRCA2 gene alterations a surveillance option if they want to complete their families or defer preventive surgery for other reasons.'

The algorithm takes into account many factors such as a woman's age, BRCA1/2 status and levels of CA125 – a blood marker that can be elevated during ovarian cancer or other non-cancerous reproductive conditions. A ROCA blood test is offered every four months to build up a profile of CA125 levels over time and identify changes at an early stage.

Professor Rosenthal said that the test 'builds up a picture of what a woman's normal fluctuations are, what is normal for the individual woman... you look for the rate of change of CA125 after two or three tests and the computer algorithm has a pretty good idea as to what's normal for her.'

Taken together, three studies conducted in the UK and USA have shown that the ROCA test could reduce the number of women being diagnosed with advanced ovarian cancer (stage III or IV), that would require more rigorous treatments such as extensive chemotherapy, by 44 percent. Based on these data, the National Institute for Health and Care Excellence recommends the ROCA test for surveillance, and research also indicates that the test could lead to cost savings for the NHS (see BioNews 1167).

One patient, Natasha Wray, told Channel 4 News how the ROCA test, which she paid for privately, offered an alternative to surgery in her 30s and enabled her to have a child at 41. Doctors recommended removing her ovaries when she was found to carry a BRCA mutation aged 36 after a breast cancer diagnosis. However, Wray said, 'I didn't want to go through a surgical menopause in my mid-30s. I also very much wanted to be a mum.'

The team at UCLH hopes that soon the test can be rolled out across more hospitals in England.