Quality statement 4: Tumour genetic testing for stage 3 or 4 non-mucinous high-grade epithelial ovarian cancer
Quality statement
Adults newly diagnosed with stage 3 or 4 non-mucinous high-grade epithelial ovarian cancer are offered tumour genetic testing. [new 2025]
Rationale
Tumour genetic testing identifies gene variants that are present only in the tumour. This can help determine which treatments are the most effective. Offering tumour testing at the time of diagnosis means that results are available when they are clinically relevant to treatment options during first-line treatment. Performing both tumour and panel germline testing is important because variants detected uniquely by each form of genetic testing can be identified.
Quality measures
The following measure can be used to assess the quality of care or service provision specified in the statement. It is an example of how the statement can be measured, and can be adapted and used flexibly. Some localities may want to focus on equality of care depending on local needs, such as by comparing data on uptake stratified by ethnicity.
Process
a) Proportion of adults newly diagnosed with stage 3 or 4 non-mucinous high-grade epithelial ovarian cancer who were offered tumour genetic testing.
Numerator – the number in the denominator who were offered tumour genetic testing.
Denominator – the number of adults newly diagnosed with stage 3 or 4 non-mucinous high-grade epithelial ovarian cancer.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
b) Proportion of adults newly diagnosed with stage 3 or 4 non-mucinous high-grade epithelial ovarian cancer who had tumour genetic testing.
Numerator – the number in the denominator who had tumour genetic testing.
Denominator – the number of adults newly diagnosed with stage 3 or 4 non-mucinous high-grade epithelial ovarian cancer.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. Data on tumour testing by cancer site and by gene is collected by NHS England's National Disease Registration service.
What the quality statement means for different audiences
Service providers (secondary and tertiary gynaecology services) ensure that tumour genetic testing in adults newly diagnosed with stage 3 or 4 non-mucinous high-grade epithelial ovarian cancer is offered in accordance with local pathways and protocols.
Healthcare professionals (members of gynaecology oncology multidisciplinary teams, clinical geneticists supporting mainstream services or genetic counsellors) have access to tumour genetic testing and are aware of local pathways and protocols.
Commissioners ensure that they commission services that can provide tumour genetic testing for adults newly diagnosed with stage 3 or 4 non-mucinous high-grade epithelial ovarian cancer, in line the NHS England's national genomic test directory. They monitor providers to ensure that testing is offered, and when it is taken up, it is carried out at the time of diagnosis.
Adults newly diagnosed with stage 3 or 4 non-mucinous high-grade epithelial ovarian cancer are offered genetic testing of their tumour. The testing of tumour tissue enables gene variants to be detected. Having the results soon after diagnosis means that the person has the best options available to them when considering first-line treatment.
Source guidance
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Consensus for genetic testing in epithelial ovarian cancer in the United Kingdom. British Gynaecological Cancer Society and British Association of Gynaecological Pathology (2024), sections 4.1 and 9.1
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Several NICE technology appraisals refer to treatments that involve further testing to guide treatment options. See NICE's guideline on ovarian cancer: recognition and initial management, sections 1.5 and 1.6
Definitions of terms used in this quality statement
Tumour genetic testing
DNA extracted from tumour tissue before systemic therapy (as part of surgical or radiological staging) which is tested for pathogenic variants and homologous recombination deficiency (HRD). A proportion (around two-thirds) of variants detected in tumours are inherited (germline); around one-third are present in the tumour only. Details of tumour tests are available through NHS England's national genomic test directory. [British Gynaecological Cancer Society and British Association of Gynaecological Pathology's consensus for genetic testing in epithelial ovarian cancer in the United Kingdom, section 1.1; British Gynaecological Cancer Society and British Association of Gynaecological Pathology's consensus for germline and tumour testing for BRCA1/2 variants in ovarian cancer in the United Kingdom, introduction; and expert opinion]
Equality and diversity considerations
Differences in uptake of genetic testing by ethnic group was identified as an equalities issue during development of the quality standard. It is important that information is provided to reduce barriers limiting understanding around genetic testing. This can be addressed by providing educational resources, in multiple languages, such as:
These resources have been developed by Ovarian Cancer Action's IMPROVE-UK programme Demonstration of Improvement for Molecular Ovarian Cancer Testing (DEMO) in collaboration with Sandwell and West Birmingham NHS Trust, in conjunction with the Cancer Research UK Cambridge Centre. They have not been produced by NICE and are not maintained by NICE. We have not made any judgement about the quality and usability of the resources. Other resources may also be available.