Question to the Department of Health and Social Care:

To ask His Majesty's Government whether they have considered the development of a national testing "cancer manual" to support the consistent delivery, governance and expansion of genomic and non-genomic biomarker testing within routine cancer pathways.

The National Cancer Plan for England sets out the Government’s commitment to expand and integrate biomarker testing, including blood-based biomarkers known as liquid biopsies and genomic testing, across cancer services to improve treatment selection and outcomes. In particular, the plan commits that every cancer patient who needs a genomic test to guide their treatment will receive one, with the results returned in time to inform clinical decisions. To achieve this, the National Health Service is integrating testing across pathology networks and the Genomic Medicine Service, ensuring that multidisciplinary teams (MDTs) have timely access to test results when determining the best treatment options. Ongoing investments in diagnostic infrastructure, for example, in digital pathology and comprehensive molecular profiling of cancers, will support this integration and enable earlier use of precision medicines in routine pathways. This joined-up approach means that genomic and other biomarker test results will directly inform MDT decision-making and help clinicians match patients to the most effective therapies.

The NHS Genomic Laboratory Hubs deliver testing as directed by the National Genomic Test Directory (the Test Directory), which includes tests for over 7,000 rare diseases and over 200 cancer clinical indications, including both whole genome sequencing (WGS) and non-WGS testing. The Test Directory outlines the nationally commissioned genomic testing offer, including the eligibility for testing, the test method, and target genes. NHS England, supported by a Genomics Clinical Reference Group and expert Test Evaluation Working Groups, reviews the Test Directory to keep pace with scientific and technological advances, while delivering value for money for the NHS. A robust and evidence based process and policy is in place to routinely review the Test Directory and ensure that genomic testing continues to be available for all patients for whom it would be of clinical benefit.

The National Cancer Plan also confirms that over the next five years, the NHS Genomic Medicine Service will extend ctDNA and other biomarker testing to other cancers beyond lung, colorectal, and breast cancer, subject to efficacy and value for money, further embedding precision diagnostics into routine care.

As part of a new approach to quality in cancer care, the National Cancer Plan introduces the development of new cancer manuals. These manuals will set out national standards for cancer care by tumour type. NHS England is working with clinical experts and stakeholders on the scope of these cancer manuals. Further details on their implementation, including specific guidance on diagnostics and testing, will be set out in due course.