In the United Kingdom, the National Health Service is launching a new initiative to provide routine genomic sequencing for cancer patients and eventually those with neurological conditions
When it comes to precision medicine, health networks and hospitals in the United States are rolling out routine genetic sequencing in a piecemeal fashion. Most prominently, Geisinger Health system in Pennsylvania announced it would begin routinely performing the service on all of its patients starting this month.
But how would such a program of precision medicine look on a nationwide scale? The United Kingdom may be the first to find out, as its National Health Service begins rolling out what it calls a Genomic Medicine Service to its citizens on Oct. 1.
NHS' Precision Medicine Program to Initially Focus on Cancer Cases
In the first phase of this genetic medicine initiative, the service will focus on patients who recently have been diagnosed with cancer. Gene sequencing will provide insights as to what medications and treatments will be most effective for each patient, and whether they should be steered toward experimental therapies. NHS patients in England, which comprises about 90 percent of the UK's population, will be the first to undergo routine sequencing.
"It won't matter if you live in the northeast (of England) or the southwest, you should have the same access to clinical genome testing," William Newman MA FRCP PhD, professor of translational genomic medicine at Manchester University and vice-chair of the British Society for Genetic Medicine, told the Guardian newspaper.
What is the state of cancer in Britain? According to the charity Cancer UK:
- About 360,000 new cancer cases are diagnosed every year
- About half of all cases are diagnosed in an advanced stage of disease
- Breast, prostate, lung and bowel cancers comprise slightly more than half of all cases
- The rate of new cases has climbed 13 percent over the past 25 years
There is no timetable for the rollout of this new precision medicine service in the UK beyond England. According to the Guardian, the NHS has offered some genomics testing already, but its availability "has been patchy" and is often reliant on having staff with expertise in conducting and analyzing such genetic tests.
Some Skepticism about Scaling Up the NHS Precision Medicine Program
And the British Parliament has also questioned the UK's ability to scale up genomic testing on a nationwide scale. A report issued last April by the House of Commons Select Committee noted there have been delays in building up the NHS' digital infrastructure, as well as recent cuts in budget to train personnel. The report also observed that "82 percent of the British public has either never heard of genomics or has little understanding of it."
Jeremy Hunt, (above) Britain's immediate past Secretary of State for Health and Social Care, said the use of genomics in routine care provided by the National Health Service will make it the first nation to "mainstream" genomic sequencing. This is one of the first national programs in the world based upon precision medicine. (Image Copyright: UK Parliament/Creative Commons).
Should the bugs be worked out in the initiative, the NHS will eventually also conduct routine sequencing on patients to gauge their risk for early onset neurological disorders. The focus would be on Alzheimer's disease and other forms of dementia, multiple sclerosis and Parkinson's disease. And further down the line there would be testing to predict a patient's risk for developing breast cancer, hypertension and diabetes, among other health issues.
The UK began planning for genomic sequencing on a large scale back in 2013, with the launch of its 100,000 Genes Project, which began testing patients in 2016. Sequencing of patients with rare diseases and common forms of cancer has taken place at 13 hospitals throughout England and Wales. More than 71,000 patients have undergone the testing to date, with the 100,000 mark expected to be reached by the end of 2018.
Along with a potential diagnosis for their treatment, the data is also stored and managed in a large database to help guide future healthcare delivery. The NHS said in a statement that that program would act "as a testbed for new applications, encouraging discoveries and their translation into novel medicines and treatments, as well as working to support a thriving genomic medicine industry in the UK."
CEOs and senior administrators of health networks and hospitals here in the United States will want to follow the progress of this specific effort to introduce a precision medicine service into clinical care across the entire country of England. Because the UK's National Health Service has a respected track record for collecting outcomes data on healthcare initiatives like this gene testing program, it can be expected that researchers and clinicians involved in the deployment of genetic testing for cancer patients in England will publish the results of this effort in peer-reviewed healthcare journals.