A study looking at genetic testing for ovarian cancer (SIGNPOsT)
Cancer type:
Status:
Phase:
Many factors can affect your risk of getting ovarian cancer and the treatment outcome. Changes in the 
(mutations) are one of these factors.
This study is open to women with:
More about this trial
Research has shown that if your cancer is caused by a genetic change there are some treatments that might work better for you. So knowing whether you have a genetic change could help doctors decide on the best treatment for you.
Genetic testing for ovarian cancer is becoming available within the NHS.
But genetic testing can have an effect on the and emotional (psychological) wellbeing of women.
In this study researchers want to find out more about:
- what effect genetic counselling has on women’s emotional quality of life
- the gene changes women with ovarian cancer have
- whether women with gene changes choose to have screening or treatment to prevent ovarian cancer
- what are the costs of this new genetic testing strategy
They also want to look into the factors that affect the risk of developing ovarian cancer. This includes looking at how gene changes and other factors that might affect:
- the risk of getting it
- treatment
- how well your treatment works (outcome)
They will do this by collecting samples including cancer, blood and genetic information.
The study is open to women who:
- have had genetic testing
- have been offered testing but refused
- haven’t had testing
Who can enter
The following bullet points list the entry conditions for this study. Talk to your doctor or the study team if you are unsure about any of these. They will be able to advise you.
You may be able to join this study if you have one of the following cancers and are at least 18 years old.
Trial design
The team need 1,000 women to join the study.
The team want women who have had genetic testing and women who haven’t. Women who were offered the test but declined it can also take part.
Women who declined genetic testing fill in a questionnaire about their reasons for declining.
Women who had genetic testing
You fill in a questionnaire that asks:
- about your quality of life and emotional wellbeing
- how you feel about the testing process
All women
Everyone fills in a questionnaire about:
- their health
- any history of cancer in their family
You fill in all your questionnaires at:
- 3 months
- 6 months
- 1 year
- then every year to 5 years
You might get the questionnaires through the post or they might be given to you at your clinic appointment. A stamped self addressed envelope for the questionnaires return will be included in those posted to you.
Blood and tissue samples
Everyone gives a blood sample.
The team will also ask everyone for a sample of cancer tissue. This can be from:
- when you had a sample of tissue (biopsy) to diagnose your cancer
- when you had surgery to remove your cancer
- during your treatment or care
The team might do genetic testing on a sample of your tissue. The results of this might influence your treatment options. Your doctor will talk to you about this if this is the case.
They will also use these samples to find out more about ovarian cancer. With your permission these samples will be stored to be used for future research into ovarian cancer.
Hospital visits
There are no extra hospital visits if you take part.
Side effects
The questionnaire for women who had genetic testing asks you to think about your feelings. This might make you feel sad or upset. Talk to a member of the study team, your doctor or nurse if you do. They can help you with further support.
Location
Early results
The research team have published some early (interim) results for the SIGNPOsT trial. They don’t have all the results for the trial yet.
They plan to publish more results at a later date. We hope to update this page once more results are available.
Results
Genetic testing
In 2021, the study team reported on the information about genetic testing that people received, and the genetic changes they found.
A total of 303 women with ovarian cancer had information and counselling about the risks and benefits of having a genetic test. And most women (97%) decided to go ahead with the test.
Some genetic changes (variants) are passed on from parents to children, and are found in every cell of the body. These are called germline changes.
Some genetic changes develop during our lifetime and are not passed on from parents to children. These are only found in some cells of the body. They are called somatic changes.
The team found:
- germline BRCA1 or BRCA2 gene changes in 16 out of 100 samples (16%)
- somatic BRCA gene changes in 8 out of 100 samples (8%)
They also looked for changes in genes called RAD51C, RAD51D and BRIP1. They found these in 2 out of 100 samples (2.3%) in total.
They concluded that it was useful to look for both germline and somatic genetic changes. And that it is more efficient to look for these at the same time.
The team suggested genetic testing for people with ovarian cancer should look at more genes. But they need to look in more detail at how cost effective that would be.
Deciding to have a test
In 2024, the team looked at information people need to help them decide whether to have a genetic test or not.
They tested two leaflets (decision aids). One was shorter with brief information. One was longer and more detailed.
People in both groups were happy with the information but overall, more people found the longer decision aid more useful.
When the team looked in more detail, they found the women who preferred the shorter information:
- were older
- were having treatment
- had more advanced cancer or cancer that had come back
The team also looked at the emotional impact of the decision aids. They found there was little difference in how worried, upset or reassured people were.
The cost of genetic testing
In 2024, the team compared the cost effectiveness of different genetic tests and treatments for ovarian cancer.
They looked at the cost of:
- more widespread genetic testing
- using PARP inhibitors to treat ovarian cancer in poeple with genetic changes
- prevention of breast and ovarian cancer in relatives of people with ovarian cancer and genetic changes
- treatment for ovarian and breast cancer
This included testing for BRCA and other genes in those with a family history, and in all patients. This was for people in the UK and America.
The results showed that looking for multiple genes in people diagnosed with ovarian cancer was cost effective. This is called unselected panel germline testing.
They found that PARP inhibitors worked well for people with ovarian cancer and a BRCA gene change. But they would only be cost effective if the prices were reduced significantly.
The study team suggest that testing should include genes other than BRCA. They say this would help in the prevention and treatment of ovarian cancer.
More detailed information
There is more information about this research in the references below.
Please note, the information we link to here is not in plain English. It has been written for healthcare professionals and researchers.
Implementation of Multigene Germline and Parallel Somatic Genetic Testing in Epithelial Ovarian Cancer: SIGNPOST Study
Dhivya Chandrasekaran and others
Cancers, 2021.Volume 13, issue 17, article number 4344.
Patient decision aids in mainstreaming genetic testing for women with ovarian cancer: A prospective cohort study
Monika Sobocan and others
BJOG: An International Journal of Obstetrics & Gynaecology, 2024. Volume 131, issue 6, pages 848–857.
Cost-Effectiveness of Unselected Multigene Germline and Somatic Genetic Testing for Epithelial Ovarian Cancer
Ranjit Manchanda and others
Journal of the National Comprehensive Cancer Network (JNCCN), 2024. Volume 22, Issue 2D.
Where this information comes from
We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists () and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.
Recruitment start:
Recruitment end:
How to join a clinical trial
Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.
Chief Investigator
Professor Ranjit Manchanda
Supported by
Barts and the London Charity
Barts Cancer Institute
Queen Mary University of London
Barts Health NHS Trust
Barking Havering & Redbridge NHS Trust
North East Thames Regional Genetics Service
Great Ormond Street Hospital
Central Manchester for Genomic Medicine
If you have questions about the trial please contact our cancer information nurses
Freephone 0808 800 4040
