Quality statement 1: Symptoms and CA125

Quality statement

Women aged 50 years or over reporting one or more symptoms occurring persistently or frequently that suggest ovarian cancer are offered a CA125 test.

Quality measure

Structure: Evidence of local arrangements to ensure all women aged 50 years and over reporting one or more symptoms occurring persistently or frequently that suggest ovarian cancer are offered a CA125 test.

Process: Proportion of women aged 50 years and over reporting at least one symptom occurring persistently or frequently that suggests ovarian cancer who receive a CA125 test.

Numerator – the number of women in the denominator receiving a CA125 test.

Denominator – the number of women aged 50 years and over reporting at least one symptom occurring persistently or frequently that suggests ovarian cancer.

What the quality statement means for each audience

Service providers ensure systems are in place for women aged 50 years or over reporting one or more symptoms occurring persistently or frequently that suggest ovarian cancer to be offered a CA125 test.

Healthcare professionals offer a CA125 test to women aged 50 years or over reporting one or more symptoms occurring persistently or frequently that suggest ovarian cancer.

Commissioners ensure they commission services that provide CA125 tests for women aged 50 years or over reporting one or more symptoms occurring persistently or frequently that suggest of ovarian cancer.

Women aged 50 years or over with one or more symptoms associated with ovarian cancer that occur often (more than 12 times a month) or for a while (over a month) are offered a blood test called a CA125 test. The CA125 test measures the amount of a protein produced by some ovarian cancers in the blood. Symptoms associated with ovarian cancer include feeling 'bloated', loss of appetite or feeling full quickly, pain in the abdomen or pelvic area, needing to pass urine urgently or more often than usual, and unexplained tiredness, weight loss or changes in bowel habit (for example, constipation or diarrhoea).

Source guidance

NICE clinical guideline 122 recommendations 1.1.1.2, 1.1.1.5, 1.1.2.1 (key priorities for implementation), 1.1.1.3 and 1.2.1.1.

Data source

Structure: Local data collection.

Process: Local data collection. Contained in NICE audit support for ovarian cancer (NICE clinical guideline 122): primary care, criteria 2, 3 and 4.

Definitions

The statement applies to women aged 50 years and over. However women under 50 years should be offered the CA125 test if clinically appropriate.

Symptoms suggestive of ovarian cancer include:

  • persistent abdominal distension (women often refer to this as 'bloating')

  • feeling full and/or loss of appetite

  • pelvic or abdominal pain

  • increased urinary urgency and/or frequency

  • unexplained weight loss

  • unexplained fatigue

  • unexplained changes in bowel habit or

  • symptoms that suggest irritable bowel syndrome if the woman is 50 years or over.

Persistent is defined as at least 1 month.

Frequent is defined as 12 times per month.

Equality and diversity considerations

The statement includes women aged 50 years and over as they have a higher risk of developing ovarian cancer than women aged under 50 years based on the epidemiological profile of the disease. Over 80% of women diagnosed with ovarian cancer are aged over 50 years. The highest age-specific incidence rates are seen for women aged 80–84 years at diagnosis (69 per 100,000), dropping to 64 per 100,000 in women aged 85 and over (Cancer Research UK). However ovarian cancer can occur in women aged under 50 years, and incidence increases with age, with the highest age-specific incidence rates for women under 50 years occurring in those aged 45–49 years at diagnosis (19 per 100,000). Therefore women under 50 years should be offered the CA125 test if clinically appropriate.