An NHS trust has become the first in England to offer a new ovarian cancer surveillance test for women with an inherited risk of the disease.
Women with BRCA1 or BRCA2 gene mutations are known to be at significantly higher risk of developing ovarian cancer as well as breast cancer.
University College London Hospitals NHS Foundation Trust (UCLH) will now offer an ovarian screening service to these women, and other hospitals are expected to follow.
Current NHS guidelines say women with BRCA gene mutations should have surgery to remove their ovaries and fallopian tubes, but this means women go through early menopause if they are pre-menopausal, and also cannot have children in the future.
Some women choose to delay surgery because they wish to complete their families or do not want to go through early menopause.
The new test is called risk of ovarian cancer algorithm (Roca), which calculates a womanâs individual risk of developing ovarian cancer based on several factors.
These include blood levels of the protein cancer antigen 125 (CA 125) over time, age, menopausal status and the presence of BRCA1 or BRCA2 gene alterations.
Having the Roca blood test every four months has been shown to dramatically cut the chance of being diagnosed with late-stage ovarian cancer, which often has no or few symptoms.
Professor Adam Rosenthal, consultant gynaecologist at UCLH, told the PA news agency: âAt the moment women face a very stark choice â preventive surgery with the fact that if youâre pre-menopausal, that means you can then no longer have children; and surgical menopause, which has detrimental effects and HRT is not guaranteed to make you feel the same way as you feel now.
âNot surprisingly, (women can) find it a really difficult decision as to what age to go through the surgery, because if they leave it too late, there is a risk they will develop ovarian cancer before theyâve had the surgery.
âThere hasnât so far been any kind of organised surveillance programme for them, there hasnât been anything systematic that actually works until now.â
Prof Rosenthal said the test looks at the rate of CA 125 over time and âbuilds up a picture of what a womanâs normal fluctuations are, what is normal for the individual womanâ.
He added: âWhat you do is you look for the rate of change of CA 125 after two or three tests and the computer algorithm has a pretty good idea as to whatâs normal for her.
âThat means that, for example, if you had a woman whose level was running around, say, between five and 10 consistently for a year or two, and then it ticked up to 15, and then it ticked up from 15 to 20, then that would be alarming, even though the level is well below 35, which is sort of what the lab would typically tell you is a normal result.
âSo in other words, itâs picking up a rising level even within the normal range, which is saying âthis is not normal for this womanâ.
âWhat we do at that point is we arrange a scan and bring the patient in for a full examination and ask them lots of questions about their symptoms and so on.
âThen if the level continues to rise despite everything being normal, we will tell her âwe think you may now have an ovarian cancer, and we would like to do exploratory surgery for youâ.
âIt means that we pick up cancers when they are smaller, when they arenât yet causing symptoms, and that means we can remove those cancers with much less extensive surgery than would otherwise be necessary.â
Studies have shown that the Roca test halves the rate of women being diagnosed with ovarian cancer in the most advanced stages.
Prof Rosenthal said that doctors do want women to have preventative surgery âbut obviously for young women, thatâs a really tough choice and, at the moment, we have nothing we can offer them that has been shown to reduce the stage of diagnosis of ovarian cancer, until now.â
The NHS trust is working with the NHS North Central London Cancer Alliance (NCLCA) and GENinCode PLC to supply the test.
Prof Rosenthal said he hoped other NHS trusts around the country would begin offering the test to prevent women facing a postcode lottery of care.
One option is for women to have their blood samples sent to a central laboratory, which reduces the risk of variation in the results.
He said: âI would like to see the NHS commission a national programme where BRCA carriers get their blood tests taken locally, but it gets posted to a central laboratory.
âI want to see all women around the country offered this, I donât want it just to be in our part of London.â
There are about 7,500 new ovarian cancer cases every year in the UK.
Women who carry a cancer-causing variant in the BRCA1 or BRCA2 gene have 44% and 17% respectively lifetime risk of ovarian cancer.
Hollywood actress Angelina Jolie raised awareness of BRCA mutations in 2013 when she had a double mastectomy to cut her chance of developing breast cancer.
Matthew Walls, chief executive of GENinCode Plc said the company was grateful for the âdetermination and focusâ of teams working on the rollout, adding: âWe look forward to extending the Roca test implementation to other NHS trusts in due course.â
Patient Carly Cayser, 45, from Essex, was diagnosed with breast cancer aged 40 and tested positive for BRCA 2 alterations.
She told PA: âThe reason Iâm delaying the surgery is because Iâm concerned about going into premature menopause.
âBy having the test every four months, so long as the results are normal, that will hopefully help my decision to delay surgery a little bit longer until Iâm in the menopause.
âItâs hugely beneficial in that respect.â
