GPs and other primary health care professionals in the UK should offer more blood tests to women with possible symptoms of ovarian cancer, according to new guidelines from National Institute for Health and Clinical Excellence (NICE), the body that recommends medicines and procedures to the National Health Service (NHS).

The new NICE guidance, the first for this disease, aims to improve the detection of ovarian cancer, the fifth most common cancer among women in the UK, where around 6,800 women are diagnosed with the disease every year.

Although chemotherapy and surgery can be effective, women are twice as likely to survive the disease if it is diagnosed early.

GPs should offer the blood test to women, particularly those over 50, who report possible signs and symptoms of ovarian cancer, which include regular bloating, feeling full quite quickly during a meal, a need to urinate urgently or frequently, and pain in the lower abdomen.

The blood test measures a protein called CA (cancer antigen) 125. If the test suggests the CA125 level is a concern (35 IU/ml or greater) then patients should then be offered an ultrasound scan of their abdomen and pelvis, and be referred to a specialist within two weeks should the scan suggest signs of ovarian cancer.

NICE says doctors should also give the test to women over 50 who during the previous year have had symptoms suggestive of irritable bowel syndrome (IBS). The reason is IBS rarely develops for the first time in women of this age group, whereas ovarian cancer, which has similar symptoms, tends to develop at this age.

NICE says by investigating symptoms earlier in this way, the greater the chances of improving survival should women subsequently be diagnosed with the disease.

However, they add a note of caution: it is possible for women with a low CA125 level to still have ovarian cancer, and, for women with high CA125 levels to have ultrasound scans that don’t show cancer.

So, NICE also advises GPs, if there is no other apparent cause of the symptoms, to tell their patients to keep monitoring them and come back if their symptoms persist or become more frequent.

Vigilance can save a woman’s life where ovarian cancer is concerned. One of the reasons the disease is called the “silent killer” is because it can be confused with other conditions like irritable bowel. Another important factor is not to delay seeing the GP.

Linda Facey, who helps develop NICE guidelines, has personal experience of ovarian cancer and stresses the importance of seeking an early diagnosis. She said in a press statement that:

“I found that I was eating much less as I felt full very quickly during meals, but instead of losing weight, I constantly felt bloated and in pain.”

“It’s very easy for women to put their bodies on a backburner as they deal with busy family and working lives, but they should never ignore the possible symptoms,” said Facey, who urges women to go their GP and ask for the blood test if the symptoms have been present for some time.

“This will either help identify the cause early on, or give women the reassurance they may need,” she added.

Although overall survival has improved over the last 35 years, long term rates are still low, according to the latest figures from Cancer Research UK.

For women diagnosed in England during 2003-2007, the five year survival rate is 41% compared to 21% for women diagnosed in England and Wales during 1971-1975. Estimates for Scotland are similar.

The main reason for the still low rate of survival is that the majority (60%) of women with ovarian cancer in the UK are diagnosed with stage III or stage IV, and only around 30% are diagnosed at the earliest stage.

Figures for 2004-2008 show that the five-year survival for patients diagnosed with stage I ovarian cancer is now over 90%.

Fergus Macbeth, director of NICE’s Centre for Clinical Practice, said that the confusion of the somewhat vague symptoms of ovarian cancer with other conditions can result in many women being directed toward the wrong care, or being diagnosed too late, once the cancer is in an advanced stage.

“The stage of the disease at diagnosis is the most important factor in predicting survival,” said Macbeth, who also explained that persistent symptoms are an “important indicator” of ovarian cancer.

He said the CA125 test was “a useful early way of determining if the disease is likely to be present”, and that by “offering it sooner and in primary care, we hope it will lead to earlier diagnoses and treatment”.

The test is already available on the NHS.

The Royal College of Obstetricians and Gynaecologists welcomes the new NICE guidance. Their president Tony Falconer said earlier diagnosis of ovarian cancer was a “fundamental issue” for health practitioners.

“We support the NICE recommendation for GPs to offer the blood test (CA125) to women with suspected symptoms with the follow-up of an ultrasound scan,” he said in a statement.

“This approach will help detect problems at the earlier stages with more rapid referral to gynaecological oncologists. Early therapeutic intervention with surgery and chemotherapy should improve the prognosis for women,” said Falconer.

Clare Gerada, Chair of the Royal College of General Practitioners (RCGP), said that offering the blood test would not create more work for GPs but would help them create the best possible outcome for their women patients.

Cancer Research UK’s ovarian cancer expert, Professor Jonathan Lederman, also endorsed the initiative:

“It’s encouraging to see the early diagnosis of ovarian cancer being taken so seriously and we welcome any steps to help doctors diagnose women at the earliest stage,” said Lederman.

A separate evaluation paralleling the guideline development concluded that the test, which costs about £20, would not be a significant drain on health resources.

The chair of the guideline development panel, Sean Duffy, who is Medical Director of Yorkshire Cancer Network, told the press that by offering this test as part of earlier investigation instead of waiting for hospitals to do them, GPs and other primary care professionals “can play a key role in facilitating earlier diagnoses”.

Another guidance panel member, Charles Redman, a Consultant Gynaecological Oncologist, agrees. He said because women present with symptoms too late, coupled with the general lack of awareness about symptoms, it means far too many women end up being referred after the cancer has progressed to 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,” said Redman.

Cancer Research UK is co-sponsoring a trial to develop a screening programme for ovarian cancer based on the CA125 blood test together with ultrasound scans.

NICE offers tools to help healthcare professionals put the new guidance into practice. These include podcasts, clinical case scenarios and a set of presentation slides.

For more information see NICE clinical guidelines CG 122 Ovarian Cancer.

Sources: NICE, Cancer Research UK

Written by: Catharine Paddock, PhD