Health
A moment with Mariam: Meeting CRUK’s new Chief Clinician – Cancer Research UK
You’ve worked at the interface of the clinic and the lab throughout your career. Clinical academic careers face pressures on protected research time, funding and training pathways. What would you say to early-career clinicians and researchers who want to combine patient care with research, and what needs to change to support them?
The system was not designed with the clinical academic in mind. Protected research time can be eroded, funding gaps between training and independence are precarious, and the expectation that you can sustain both a clinical practice and a competitive research programme, often without dedicated support for either, asks a great deal of people. Many talented individuals leave, and that is a loss we have to be honest about.
Seeing patients changes how you do science. It tells you which questions matter, which assumptions don’t hold up against the complexity of real disease, and which findings are likely to translate, and which are not. My own research on tumour evolution only became what it is because I was sitting with patients whose cancers were behaving in ways the textbooks didn’t fully explain.
To early-career researchers I would say: find the environment and the mentors who will actively advocate for your career rather than simply supervise it. Seek out people who will sponsor you, open doors, and support you through the gaps. And cherish your clinical work – it is a scientific asset, rather than a parallel obligation, and will inform your research.
We need more protected training pathways, bridge funding between clinical and research phases of a career, and we need to create genuine leadership opportunities for clinical academics to drive institutional change.
Translating discoveries into patient benefit remains one of the hardest problems in cancer research. From where you now sit, what are the biggest barriers between a promising finding and a change in clinical practice?
This is the question I think about the most. I have spent my career trying to ensure that the biology we discover in the lab doesn’t stop there and finds its way to real benefit for patients. It is harder than it should be, and the barriers are layered.
The first is biological. Cancers are dynamic, evolving systems and need to be studied longitudinally if we are to understand how cancers come to exist, why treatment can fail, how resistance emerges and why some, but not all, cancers can become advanced.
The second is structural. The distance between a compelling preclinical or early clinical finding and a well-powered, appropriately designed trial that could change practice is often significant in time, in funding, and in infrastructure. Investigator-led trials in particular are under-resourced, and the regulatory landscape, especially in a post-Brexit context, adds friction that delays rather than protects. We need more ambitious, adaptive trial designs, better supported and faster to initiate.
The third is implementation. Even when a trial succeeds and the evidence is clear, adopting a new approach into routine clinical practice is a separate challenge that requires its own science, its own investment, and its own infrastructure. We don’t yet treat implementation as a research priority, and we should. The gains from closing that final gap could be as significant as the gains from discovery itself.
Your research has focused extensively on tumour evolution and understanding how cancers change over time. What is the one question around this you’d most like answered?
I would want to know at what point in tumour evolution does the path to a lethal outcome arise, and when can one intervene to prevent this. This likely depends on the tumour type and can be asked of both early and late-stage disease.
Through TRACERx we follow patients from early-stage disease, tracking how their tumours evolve through treatment and over time. Through the PEACE programme we study patients who have died from their cancer, understanding what the final stages of that evolutionary journey look like. Together these programmes give us a vantage point to see the full arc of the disease.
What I most want to understand is the early chapters of that arc: whether there are critical evolutionary events that occur before diagnosis, how early the seeds of metastasis are sown, and whether detecting and targeting those events could change outcomes in a way that treating established metastatic disease cannot. Understanding this could fundamentally change how we think about early detection and interception.
Looking further ahead, what would you most like the cancer research community to have achieved over the next decade?
I would like us to have built a research and clinical ecosystem where the distance between discovery and patient benefit is systematically shorter, not by cutting corners, but by designing the infrastructure, the training, the trial networks, and the partnerships and collaboration that allow excellent science to move efficiently and equitably into practice.
On the science itself, I would want early detection and molecular interception to have moved from promising proof-of-concept into genuine clinical reality for more cancer types. The UK has the datasets, the cohorts, the clinical infrastructure and the scientific talent to lead that effort globally.
I would like the next generation of clinical academics to have a better experience than my generation has. Not an easier one necessarily, the work is demanding and should be, but a better supported one, with clearer pathways, more protected time, genuine mentorship, and a research culture that actively values the combination of clinical practice and discovery science.
