Read the full article here. Read co-lead author Professor Kathreena Kurian’s Op-Ed in the Telegraph here.

Published in Neuro-Oncology Practice today, this UK-wide research presents for the first time a study into the landscape of molecular neuropathology in brain tumours, identifying rapid, but inequitable, uptake across the NHS for patients with a brain tumour.

Drawing on data from 21 UK neuro-oncology centres (covering 84% of the UK population), it identifies major progress in genomic testing but reveals persistent inequities in access and rising turnaround times (TATs). Immediate policy action is needed to ensure sustainable, equitable, and accountable service delivery in line with NHS ambitions for precision medicine.

Why do we need molecular testing in brain tumours?

Molecular diagnostics is now essential to accurate brain tumour classification, prognosis, and treatment. The 2021 World Health Organization (WHO) guidelines require molecular profiling to define glioma subtypes and identify actionable mutations. Lack of access to testing has numerous effects on patients:

Timely and equitable access to molecular testing is hence critical to delivering high-quality, personalised care and ensuring that patients in all UK regions benefit from advances in brain cancer research.

Key findings and recommendations

Finding #1: Ensuring Sustainable Service Delivery – testing is expanding faster than the NHS can deliver timely results.

Genomic testing has more than doubled across UK neuro-oncology centres since 2021, with WGS uptake rising by 291%, Figure 1. However, the system isstruggling to keep pace:

• Final diagnostic turnaround times (TATs) increased from 15 to 21 days – Figure 2
• Only 30% of centres met the 14-day standard in 2024 (down from 48%)
• WGS turnaround averages 58 days, with delays up to 150 days

Capacity gaps in pathology staff, outdated testing workflows, and limited access to rapid sequencing technologies are key bottlenecks.

Recommendation #1: Invest to ensure sustainable service delivery:

• Training in molecular pathology and genomics for NHS workforce
  

  

• Adoption of rapid diagnostic technologies like long-read sequencing
• Research into AI and automation to improve throughput and accuracy

Finding #2: Addressing Equity of Access – a patient’s postcode may determine whether they receive high-quality diagnostics and trial access.

Testing availability varies widely across the UK:

• Only 71% of centres offered WGS in 2024

• 

  Access in devolved nations remains limited

• Snap-freezing practices range from 0 to 650 samples per year (Figure 3), and freezing delays reach up to 180 minutes

Key barriers include lack of freezer space, out-of-hours cover, and logistics.

Recommendation #2: Address inequitable access to tissue freezing and molecular testing

• Standardise sample collection and freezing protocols
• Fund basic infrastructure for testing and freezing tissue, especially in under-resourced regions
• Align commissioning policies for genomic testing across all four UK nations, removing inequitable access outside England

Finding #3: Embedding Monitoring and Accountability: centres that audit and hold GTABs perform better and make more use of genomic data.

Audit and governance have improved since the Centre of Excellence process launched in 2021:

• Centres conducting regular TAT audits rose from 29% to 86%
• 57% now discuss genomic results in dedicated Genetic Tumour Advisory Boards (GTABs)

These practices support better turnaround, accuracy, and use of genomic test results.

Recommendation #3: The NHS should continue to work to embed monitoring and accountability:

• Make auditing standard practice
• Incentivise GTABs to ensure genomic data is clinically actioned
• Expand participation in the Tessa Jowell Centre of Excellence programme – ensuring every centre takes part to drive up standards nationally

Conclusion & Policy Asks

This dataset provides clear, evidence-based recommendations to align the UK’s molecular neuropathology services with precision medicine goals. While there has been significant progress, regional inequities, diagnostic bottlenecks, and under-resourced infrastructure threaten sustainable, equitable delivery.

Policymakers should:

• Fund training and technology to future-proof diagnostics.
• Ensure equitable access and sampling protocols across all UK nations.
• Embed quality assurance through national audit and designation schemes like the Tessa Jowell Centre of Excellence programme.