NICE proposes new age thresholds for ovarian cancer referral following blood test

NICE recommends new age-based blood test thresholds to help GPs diagnose ovarian cancer earlier.

GPs should not rely solely on blood testing to rule out ovarian cancer in patients with symptoms who are aged 39 and under, the draft guideline said.

The proposals, published yesterday, said that for this age group, the serum CA125 measurement in isolation is not an accurate indicator of ovarian cancer. Therefore, GPs should ‘consider an ultrasound scan of the abdomen and pelvis for those aged 39 and under with persistent symptoms that suggest ovarian cancer’.

‘Although the risk of ovarian cancer is low, it remains a clinical concern and is often diagnosed late,’ the guideline added.

For women aged 40 and over, the new draft guidance includes a table with suggested thresholds for when to refer for ultrasound based on the serum CA125 measurement (see box).

Under current guidance, all women should be referred for further investigation if their CA125 level reaches 35 IU/ml or above, regardless of age. But NICE said this fixed threshold can miss cancers in older women and trigger unnecessary investigations in younger women – and has therefore lowered thresholds for older patients.

Centre for Guidelines deputy director Eric Power said: ‘The committee’s proposed recommendations will ensure more personalised, targeted testing, so women at greatest risk of ovarian cancer are identified and referred sooner.

‘This tailored approach will mean GPs can make more informed decisions about which patients need urgent investigation, while reducing unnecessary ultrasound scans for younger women, freeing up NHS resources.

‘These updates will ensure that our guideline reflects the latest evidence and will help improve the detection of cancer and ensure those who need it get swift treatment.’

Professor Azeem Majeed, a GP and head of the department of Primary Care and Public Health at Imperial College London, told sister title Pulse: ‘The proposed NICE updates aim to give NHS general practices more precise, evidence-based tools to assess the risk of ovarian cancer. Replacing a single CA125 threshold with age-based thresholds will help GPs identify older women at higher risk more reliably, while reducing unnecessary investigations in younger women who are much less likely to have ovarian cancer. This should support more appropriate referrals and make better use of NHS diagnostic capacity.

‘For women under 40, the draft guidance recognises that CA125 alone is not sufficiently accurate to guide decision-making. Advising GPs to consider arranging an ultrasound scan directly for those with persistent symptoms provides a clearer and more appropriate diagnostic pathway for this age group.’

He added: ‘Overall, the changes are designed to make it easier for GPs to interpret symptoms that are often non-specific, ensuring that women at greatest risk of ovarian cancer are identified earlier while avoiding unnecessary anxiety and testing for those at lower risk.’

There is also a new and updated recommendation on endometrial cancer; and a new and updated recommendation on non-site-specific weight loss.

These are:

• A new age threshold so that people aged 60 and over with unexplained weight loss (greater than 5% over six months) receive an urgent investigation or suspected cancer pathway referral.
• With hormone replacement therapy (HRT) prescriptions in England rising the guideline acknowledges a growing need for clearer evidence on when unexpected bleeding while taking HRT should prompt investigation for endometrial cancer. NICE’s guideline committee has recommended that research is undertaken to fill this gap and help clinicians make better-informed decisions.

The consultation on the draft guidance is open until 2 February, with the final updates to the guideline expected 25 March.

This article was originally published in our sister publication Pulse.