EGA Institute for Women's Health


Gynaecological Cancer Research Centre (2004 - 2018)

On 1 August 2018, the GCRC team moved  to the MRC Clinical Trials Unit, Institute of Clinical Trials & Methodologies, UCL. We are now based at ICTM, 2nd Floor, 90 High Holborn, London.““

The core research interests of the group are early detection, risk factors and stratification, biomarker discovery and management of women at increased risk of gynaecological cancers especially ovarian.  

GCRC Staff Photo

The trials and studies undertaken during 2004-2018 when the group were based at Institute for Women’s Health include:


UKCTOCS - UK Collaborative Trial of Ovarian Cancer Screening (ukctocs.mrcctu.ucl.ac.uk)

The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) was designed to test whether screening can help save lives by detecting the disease earlier. Between April 2001-Sept 2005, 202,638 postmenopausal women, aged 50-74 years were recruited through 13 trial centres in England, Wales and Northern Ireland. Women were randomly allocated to one of three groups (i) control (C ) - no screening (ii) multimodal screening - annual blood test for serum CA125 measurement. The results were interpreted using the ‘Risk of Ovarian Cancer Algorithm’, with transvaginal ultrasound as a second line test in case of abnormality (iii) ultrasound screening – annual and second line tests were transvaginal scans. 
The trial showed for the first time that multimodal screening results in the detection of significantly more early stage ovarian/tubal/peritoneal cancers than no screening. The reduction in mortality was not definitive at the first analysis. Longer term follow up is underway to confirm if screening can lives. Please visit the link above for more information.

Selected publications:

UKLWC - UKCTOCS Longitudinal Women's Cohort (uklwc.mrcctu.ucl.ac.uk)

UKLWC is the biobank of samples and data donated by the participants of UKCTOCS (202,280 postmenopausal women from the general population in England, Wales and Northern Ireland). A large number of secondary research has been undertaken by many researchers both from UCL and more widely. These are detailed in the website above. As are how you could contact the team if you are a participant or a researcher.

UKOPS - UK Ovarian Cancer Population Study (ukops.mrcctu.ucl.ac.uk)

UKOPS was set up to answer 3 questions: identify a better/complimentary marker to CA125, identify genetic predisposition to ovarian cancer and identify symptoms for the disease. As part of the international Ovarian Cancer Association Consortium (OCAC), an amalgamation of over 75 groups from around the world, close to 40 low risk loci have been identified and further work to elucidate gene-environment interactions has been undertaken. In addition, the Ovarian Tumour Tissue Analysis (OTTA) has furthered the knowledge in molecular typing of different ovarian cancer histotypes. Over 100 publications have resulted from this effort.

Selected publications:


UK FOCSS - UK Familial Ovarian Cancer Screening Study

Between June 2007 and May 2012, 4,348 women with an estimated lifetime OC risk of ≥ 10% who were unwilling to undergo risk-reducing surgery, were recruited at 42 NHS hospitals. They underwent 4-monthly multimodal screening with serum CA125 interpreted using ROCA and transvaginal ultrasound. Physician review was scheduled based on risk estimates. Through-out there were regular discussions about the effectiveness of surgery, Women were then followed up for a median of 4 years.
There was a clinically meaningful and significant down staging and higher rates of primary surgery in women being diagnosed with invasive epithelial ovarian cancer during screening in comparison to one year after the end of screening.  The performance characteristics of the screening strategy was encouraging and compliance was high.

Selected publications:

For access to UKFOCSS data and samples please contact Prof. Usha Menon :: u.menon@ucl.ac.uk

GCaPPS - Genetic Cancer Prediction through Population Screening

Following pre-test counselling and informed consent, 1034 Ashkenazi Jewish men and women were randomised to either population based or clinical criteria (family history) based genetic testing for BRCA founder mutations. Participants were followed up for three years after the test result. The study showed that compared to family-history based testing, population-based BRCA founder mutation testing doesn’t harm psychological health (anxiety, depression, health anxiety, distress, uncertainty)  or quality-of-life and identifies 150% additional BRCA carriers. Overall anxiety decreased with time. Long term follow up data shows a reduction in anxiety with population testing compared to family-history or clinical criteria based testing. We found, BRCA testing in the Jewish population is acceptable, feasible, can be undertaken in a community setting. It had high acceptability and was associated with 88% uptake and high satisfaction rates of ~95%. In a non-inferiority cluster-randomised trial we found that DVD-assisted pre-test counselling for population BRCA-testing is an effective, acceptable, non-inferior, time-saving and cost-efficient alternative to traditional genetic-counselling.

Our cost-effectiveness analysis shows, a population-based BRCA testing approach in the Ashkenazi Jewish population, reduces breast and ovarian cancer incidence, leading to up to an additional 33 days gain in life-expectancy and is extremely cost-effective (cost saving) with a discounted incremental cost-effectiveness ratio (ICER) = -£2960/quality adjusted life year (QALY). Probabilistic sensitivity analysis shows this remains cost-effective for 95% simulations at the £20,000/QALY NICE threshold. Our modelling suggests this could lead to 276 fewer ovarian and 508 fewer breast cancer cases in the UK. Overall, reduction in treatment costs could lead to a discounted cost savings of £3.7 million for the NHS.


UKGOSOC - UK Gynaecological Oncology Surgical Outcomes and Complications

UKGOSOC was a prospective audit of complications of major oncology surgery. It was undertaken at 10 gynaecological oncology centres in the UK and included web based data collection on 3000 procedures. It developed benchmarking standards for UK gynaecological oncology centres, established that risk-adjusted complication rates allows fairer institutional comparison and that hospital under-reporting is common for postoperative complications and hence use of patient-reported outcomes is important.


ICBP Module 4 - International Cancer Benchmarking Partnership

The ICBP is a partnership between England, Australia, Canada, Denmark, Northern Ireland, Norway, Sweden and Wales co-ordinated by the Department of Health (DH) in England with support from Cancer Research UK. Module 4 of the ICBP is an international survey on time intervals from onset of symptoms to commencement of treatment in newly diagnosed patients with lung, colorectal, breast, or ovarian cancer. A total of 14 664 eligible patients with CRC diagnosed between 2013 and 2015 were identified, of which 2866 were included in the analyses. It has demonstrated important differences in time intervals between 10 jurisdictions internationally in the four cancers. Previous findings that some cancers may progress even within the relatively short time frame supports the current emphasis on expediting diagnosis of cancer in patients presenting with symptoms.


Research students

NameDegree & Project title
Dr Paul TremblingPhD, Feb 2019, UCL. Quantifying and stratifying chronic liver disease and the use of diagnostic tests to improve early detection
Dr. Darren ThomasPhD, Jan 2019, UCL. Identifying risk factors and biomarkers for colorectal cancer 
Dr Will StottPhD, Nov 2016, UCL. Use of Software Tools to Implement Quality Control of Ultrasound Images in a Large Clinical Trial

Dr Rema Iyer

MD(res) Apr 2016, UCL. Surgical Outcomes in Gyanecological Oncology

Dr Stephanie SmitsPhD, Sep 2014, Cardiff University. Development of an ovarian cancer symptom awareness tool with tailored content for women at increased genetic risk of developing ovarian cancer
Dr Emma LowPhD, Sep 2013, UCL. Gynaecological cancer symptoms: influences on women’s awareness and medical help-seeking
Dr Aarti SharmaPhD, Sep 2013, UCL. Refining Ultrasound Screening in Ovarian Cancer
Dr Ranjit ManchandaPhD, Aug 2013, UCL. A Population Based Approach to Genetic Testing for Cancer Risk Prediction and Management
Dr Evangelia-Ourania FourkalaPhD, Dec 2010, UCL. Risk Factors and Novel Biomarkers in Breast Cancer
Dr Penny AllenPhD, Feb 2010, UCL. Prospective Study of Symptoms of Ovarian Cancer & Postmenopausal Women
Dr Anita LimPhD, Jun 2009, QMUL. Investigating the Potential for Expediting Diagnosis of Ovarian Cancer via Prompt Symptom Recognition & 'Targeted Screening'