When National Health Service (NHS) England called for professional bodies to input into its National Cancer Plan in Spring 2025, The Royal College of Pathologists (RCPath) welcomed the opportunity. In collaboration with The Royal College of Radiologists, it submitted a consultation response advising on how to fill the most pressing gaps in cancer diagnostics.
We connected with Adrian Bateman, Chair of the RCPath Cellular Pathology Specialty Advisory Committee, to hear about some of the specifics of that response.
What is the remit of the RCPath Cellular Pathology Specialty Advisory Committee?
This committee is the source of expert advice and opinion for questions and topics related to cellular pathology, for the Royal College of Pathologists. Essentially, it is the most senior committee devoted entirely to cellular pathology within the College. Many of the committee members are experienced consultants in cellular pathology, across a range of subspecialties within this overall specialty area. The committee works closely with the group of Cellular Pathology Subspecialty Advisors in the College, who can each provide advice and specialist opinion. An example is supporting the development of the College policy on screening for prostate cancer.
The Cellular Pathology Specialty Advisory Committee receives requests for advice and opinion from other areas within the College and from College members and fellows. Examples of the activity of the committee are responding to requests for opinions on developments within and beyond the College, responding to external consultations, and developing clinical guidelines and best practice recommendations.
Why does England need a Cancer Plan, and what will it aim to achieve?
In my view, the new NHS Cancer Plan in England is essential to focus the national health agenda. It will provide high-level guidance on the future direction of the NHS in terms of cancer care, as overseen by the Department of Health. Presumably, developments within the NHS that are well aligned to the NHS cancer plan are likely to gain the most support, in financial terms.
RCPath welcomed the plan, as it will cover the entirety of the cancer pathway, from referral and diagnosis to treatment and aftercare for patients. Our consultation response brought in a range of specialties across the College, not just from cellular pathology.
What did RCPath advise on achieving earlier diagnosis of cancers?
The College has advised that pathology in general, and cellular pathology in particular, are central to the diagnosis and management of patients with cancer. For example, a biopsy diagnosis of cancer made by a cellular pathologist is usually seen as the “gold standard” for cancer diagnosis.
There has been historical underfunding of pathology services for many years within the NHS. This has led to the current situation in which cellular pathology laboratories across the NHS are often significantly understaffed in medical and scientific terms. Part of the reason that this situation has developed is that increased clinical activity in other areas of NHS hospitals has not been mirrored by appropriate increases in funding for cellular pathology. There is also a significant increase in the complexity and volume of cases that pathologists face.
Despite a high fill rate for new training posts in cellular pathology, the number of training posts in this specialty has been recently reduced. And a significant proportion of established consultants are close to retirement age. It is, therefore, very difficult for many laboratories to meet service standard such as turnaround times for reports. Unless this situation is recognized and addressed, the service is very likely to face increasingly severe pressures in the future.
How would the committee like to see genomic testing used to guide cancer treatment pathways?
The use of genomics in cancer treatment pathways has increased enormously over the last few years. The committee would like to see improved funding for cellular pathology laboratories that are required to identify and check tissue samples from cancer patients, choosing the most appropriate material to undergo genomic testing. This pre-analytical phase is often carried out by laboratories that do not undertake the genomic analysis themselves.
Initially unfunded, the pre-analytical phase has placed extra pressure on cellular pathology laboratories. This is now being addressed, a least to a degree, with the creation of regional centers within existing cellular pathology laboratories. Some funding is being provided to create the capacity to undertake much of this pre-analytical work for surrounding hospitals, who will send the relevant tissue blocks to the regional centers.
There is also current debate relating to the optimum arrangement of genomic laboratories for the timely provision of a clinical service. For example, should commonly requested genomic tests for common cancers be performed in local genomic laboratories, where there is a close working relationship with the local cellular pathology laboratory? And should more unusual tests, for uncommon cancer types, be performed in the regional genomic hubs?
The College is convening an event in November, Rapid Genomic Testing for Cancer Patients, to consider and seek consensus on many of these issues.
What research priorities would the RCPath like to see in oncology?
This is a difficult question to answer as oncology is a clinical specialty. However, the number of academic cellular pathologists has significantly reduced in recent decades, mirroring the situation across clinical medicine as a whole. The College would like to see an increase in academic cellular pathology posts to support research lead by oncologists, for example, as well as to encourage pathologist-led cancer research.
What measures should be prioritized to address inequities in access to screening and treatment?
Since cellular pathology is mainly not a patient-facing specialty, it can be difficult to influence the clinical components of screening and treatment pathway. And yet, we know people diagnosed with cancer at an earlier stage have higher survival rates than those diagnosed at a later stage – so it is vital pathology uses its voice for patients. This is where the College has a key role – through raising the issue with parliamentarians, working with All Party Parliamentary Groups, collaborating with charities or making the case in consultation responses, such as the 10-Year Health Plan or the Men’s Health Strategy, for example.
The key way that pathology as a group of specialities could help in this regard is to be properly funded and organized such that there is optimum access to pathology services on a national basis. At present, there are marked differences in the level of medical and scientific staffing across the country, with some (especially smaller) cellular pathology departments carrying multiple vacancies at consultant level, for example. This may result in variations in the timeliness and efficiency of pathology services within different areas of the country in a way that is separate from, and in addition to, any other forms of inequality in access to screening and treatment.
Overall, how would you sum up the priorities for the national cancer plan from a pathology perspective?
In my view, pathology can best support the priorities for the national cancer plan if there is improved investment – in workforce, IT, digital capability, and the laboratories we work in. A re-evaluation of the working patterns of cellular pathologists would also be beneficial. This should include a review of the way in which cellular pathologists contribute to multidisciplinary team (MDT) meetings for cancer patients.
MDT meetings require a significant level of resource in terms of staffing across many specialities; there are likely to be ways in which cellular pathologists can provide input to these meetings in a more focused and time efficient way, thereby releasing time for other activities, such as the preparation of reports for cancer specimens.
There also need to be closer links between cellular pathology, genomics, and other closely related specialities to ensure they are aligned in the best way possible for optimal patient care.
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