NICE ovarian cancer guideline needs 'greater clarity'
By Alisdair Stirling
The RCGP has asked for 'greater clarity' on NICE guidance that urges GPs to offer women with suspected ovarian cancer a blood test before referring them.
RCGP chair Dr Clare Gerada told Pulse the guideline was 'a good place to start', but said GPs would need further guidance on how often to use the tests and what constituted a negative result.
The new guideline from NICE is designed to help improve survival rates for ovarian cancer, as out of 6,800 women diagnosed with the disease each year only around a third are still alive after five years.
It advises GPs to offer women - particularly those over 50 - a blood test to measure the level of a protein called CA125 if they present with any of the following symptoms on a regular basis: bloating, feeling full quickly, lower abdominal pain and needing to urinate urgently or frequently.
If CA125 levels are over 35IU/ml, women should then be offered an ultrasound scan of their abdomen and pelvis. If this suggests ovarian cancer, they should then be referred to see a hospital specialist within two weeks under the existing national target set by the Department of Health.
However GPs are concerned that the symptoms listed in the guidelines are very common and - as the guidelines state - fewer than one in 100 women with these symptoms are likely to have ovarian cancer. With tests for CA125 costing about £20 each, the guidelines could lead to GPs having to order and carry out massive numbers of tests.
Dr Gerada said she welcomed the guidelines because they helped get the message over that ovarian cancer can be picked up early and that it need not be seen as a 'silent killer'. But she added: 'My first thought is how often are we meant to do this test? Having read the guidelines, I´m still not clear.'
'These are very common symptoms and if a patient presents every year with the same symptoms, do you do the test again? I think the college will ask for clarity on these issues. As a woman over 50, it's nice to see these guidelines being issued and I'm glad that my GP will be thinking this way, but as a GP I want NICE to give me greater clarity.'
Dr Craig Dobson, a GP in Hull and senior lecturer in medical education at Hull York Medical School who was involved with drawing up the guidelines, said: 'Ovarian cancer is difficult to diagnose from the symptoms alone.'
'It is important for GPs to remember that irritable bowel syndrome rarely presents for the first time in women over 50.'
'Conversely, most ovarian cancers present in women over the age of 50. Recurrent or prolonged symptoms require a diagnosis at any age.'NICE ovarian cancer guidelines need 'greater clarity'