Women should be offered a blood test for ovarian cancer
Women who present to their GP with symptoms of ovarian cancer should be offered a simple blood test in an attempt to diagnose the “silent killer” early on, says NICE.
In the first ever clinical guideline for ovarian cancer, NICE recommends that initial investigations be carried out in general practice so that women can be referred to hospital specialists sooner and begin treatment earlier.
Ovarian cancer is the fifth most common cancer in women with around 6,800 women being diagnosed every year in the UK.
Although chemotherapy and surgery can be effective treatments, women have a greater chance of surviving the cancer if it is picked up early.
GPs and practice nurses should offer women, particularly those over the age of 50, a blood test to measure the level of a protein called CA125 if they present with frequent symptoms of bloating, feeling full quickly, lower abdominal pain and needing to urinate urgently or frequently.
Women with high levels of CA125, 35 IU/ml or greater, should then be offered an ultrasound scan of their abdomen and pelvis.
If this suggests ovarian cancer, they should then be referred to see hospital specialists within two weeks.
Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE said: "Ovarian cancer is commonly referred to as the "silent killer" as its symptoms are considered vague, and so can be confused with other conditions, like irritable bowel syndrome.
“This misconception can lead to many women being referred to inappropriate care pathways or being diagnosed once the cancer is at an advanced stage. The stage of the disease at diagnosis is the most important factor in predicting survival.
"While the symptoms are nonspecific, their persistence can be an important indicator of the disease. Our guideline highlights some effective initial investigations that GPs and other healthcare professionals can undertake if ovarian cancer is ever a possibility.
“In particular we recommend a specific blood test as a useful early way of determining if the disease is likely to be present. This test is already available on the NHS, but by offering it sooner and in primary care, we hope that it will lead to earlier diagnoses and treatment,” said Dr Macbeth.
Mr Sean Duffy, Medical Director of Yorkshire Cancer Network and Chair of the Guideline Development Group said: "GPs and other primary care professionals can play a key role in facilitating earlier diagnoses by carrying out some of the initial investigations that would otherwise take place in hospitals, such as blood tests.”
Mr Charles Redman, a Consultant Gynaecological Oncologist and Guideline Developer added: "Delayed presentation coupled with a lack of awareness around the possible symptoms, unfortunately mean that far too many women are being referred to hospitals for suspected ovarian cancer once their disease is already at an advanced stage. This is frustrating as the stage of the disease at its diagnosis is crucial in determining which treatments can then be offered.”
During the development of the guideline an economic evaluation was carried out to explore the impact of introducing CA125 testing in primary care. This concluded that introducing the test, which costs around £20, would not have a huge impact on health resources.
Dr Clare Gerada, Chair of the Royal College of General Practitioners (RCGP), added that carrying out the blood test in primary care would not increase GPs' workloads but would help to achieve the best possible outcomes for women.
27 April 2011