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Dr Mackay established regional cancer genetics services in East Anglia and North East Thames and developed a remote cancer genetics service, using real time tele-conferencing technology, based in Great Ormond Street Hospital NHS Trust. He holds honorary consultant contracts at several large London teaching hospitals. He is the clinical principal investigator of an evaluation of regular mammography in women under 50 with a family history of breast cancer funded by the NHS Research and Development Programme. He initiated the Genetic Breast Cancer Trial, which is a trial of chemotherapy in women with breast cancer, who carry a faulty breast cancer gene. This is the first randomised trial of chemotherapy based on inherited genetic make-up in the world.