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NHS England has commissioned genetic testing for rollout by April 2027. BRCA-DIRECT assessed 3,500 patients, showing home sampling can widen access and ease genetics-service pressure.
NHS England has commissioned a direct-to-patient genetic testing pathway for breast cancer, following a successful evaluation of the BRCA-DIRECT model across 14 North London breast units.
Developed by The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, BRCA-DIRECT is designed to make inherited cancer-risk testing more accessible and efficient. Rather than relying on routine face-to-face genetics appointments, eligible patients can complete consent and provide a saliva sample from home. Digital and written information supports the process, while dedicated genetic counsellors remain available by telephone where needed.
The evaluation included more than 3,500 breast cancer patients and identified potentially harmful inherited variants in 4.7% of those tested, across seven cancer-susceptibility genes. Identifying these variants can help inform treatment decisions, future surveillance and testing options for family members.
Traditional pathways can depend on detailed family-history assessments and specialist appointments before testing is offered. While this approach remains important for complex cases, it can create bottlenecks within clinical genetics services and may mean some inherited risks are not identified promptly. BRCA-DIRECT offers an alternative pathway for suitable patients, combining remote sample collection with expert support and laboratory-based genomic analysis.
The model also reflects a broader shift towards patient-centred diagnostics. Home sampling can reduce the need for hospital visits, while digital communication can help patients access information at a time that suits them. For clinical teams, a more streamlined pathway could support referrals and reduce the administrative burden associated with routine testing.
NHS England plans to introduce direct-to-patient genetic testing nationally by April 2027. The rollout will provide an important opportunity to assess how the model performs across a wider range of services, patient populations and laboratory networks.
For laboratory professionals, the programme underlines the importance of scalable and well-connected genomic workflows. Remote collection must be matched by robust sample tracking, clear patient information, reliable testing processes and timely reporting back to clinical teams. It also highlights the value of collaboration between laboratories, clinical genetics, oncology and pathology services.
As genomics becomes increasingly embedded in cancer care, pathways such as BRCA-DIRECT could help bring testing closer to patients while maintaining the quality, governance and specialist expertise required for clinically meaningful results.
