Southampton Academy of Research

Hannah Markham is a Consultant Histopathologist at University Hospital Southampton and holder of a Research Leaders Programme (RLP) fellowship.

She is looking to build on her experience facilitating clinical trials, developing the skills she needs to ask her own research questions and design the studies to answer them.

Pathologists a ‘gatekeeper’ for trials

Many trials, particularly cancer trials, require fresh or formalin-fixed tissue. They may need this to confirm a diagnosis, allow for genomic studies within the tissue, or to assess features of tumour morphology. A number of these could not go ahead without the involvement of a pathologist.

“Essentially a pathologist is almost becoming a gatekeeper to some of these studies,” Hannah explains. “We’re a key link in the chain.”

Despite this, she says that her department has fewer people involved in research than it used to.

“We don’t have many purely academic pathologists at all anymore,” she says.

She has therefore decided to get more involved in research, to ensure that trials which require a pathologist can still go ahead and give patients the chance to take part in them. She applied for her RLP fellowship to ensure she would have the time she needed to achieve this.

“If there’s no real engagement in clinical trials from pathologists, some of these clinical trials may become inaccessible to our patients,” she says. “So that’s why I’m trying to become more involved in research - and having formalised research time in my job plan is driving this.”

Taking advantage of a repository of tissue

While Hannah has been involved in clinical trials at UHS ever since she first became a Consultant Histopathologist in 2011, she says the dedicated time the RLP provides will be invaluable.

“I decided to apply to the RLP because my research involvement lies outside of my normal job plan,” she explains. “I have no dedicated time, which means that very often when I’m asked the question ‘can you help with this trial?’ instinctively I say yes, but it can then take me eight or nine weeks to get around to doing it.”

Hannah says the tissues her department collect and store provide a huge opportunity for research. They have archived tissue going back 30 years, a large amount of linked genomic data, and the ability to collect fresh tissue for research.

Their genomic data mainly comes from their involvement in the 100,000 Genomes Project, a UK-wide initiative to sequence and study the role genes play in health and disease, particularly cancers and rare diseases.

The project has now been completed, and has been transformed into a national cancer testing service. This means that fresh tissue, which in terms of gene integrity is far superior to formalin fixed tissue, is no longer routinely collected.

Hannah is therefore looking to use her RLP fellowship to reopen pipelines used in the 100,000 Genomes Project to collect fresh tissue. She will explore making fresh tissue collection a standard process for certain specimen types, enabling more patients to take part in genetic studies.

Using AI to improve pathology

Hannah plans to use her RLP fellowship to explore the potential of artificial intelligence (AI) to make pathology more streamlined and efficient.

She is currently part of a trial that is looking into whether machine learning, a type of AI, can sift through images of prostate tissue, identify characteristics associated with cancer and highlight these for the pathologist to look at. If successful, this could streamline the process and mean patients receive a diagnosis faster.

Hannah intends to build on this experience throughout her fellowship. She aims to move on to set up clinical trials asking own research questions.

She is also part of the national NCRI clinical studies network for breast cancer, and intends to use this to help more patients get involved in national research projects. In addition, she is intending to undertake a postgraduate certificate in research delivery to gain the skills she needs to design her own research.