THE IMPLICATIONS OF NICE GUIDELINE 122 ON THE DETECTION OF OVARIAN CANCER

Abstract

Background: In April 2011, the National Institute of Clinical Excellence (NICE) in the UK introduced the guidance 122. The key recommendation was “GPs should perform a blood test to measure serum CA125 levels in women who present with symptoms that might indicate ovarian cancer”. Objective: To investigate how the introduction of the NICE guideline in April 2011 has affected the number of serum CA125 levels being taken in primary care, the financial implications of this, and whether it has affected the number of cases of ovarian cancer being diagnosed per year in the South East of Scotland. Data analysis and collection: Retrospective study based on data collected from the database of the biochemistry laboratories in South East Scotland for 48 months prior to 2011 and 36 months after 2011. Ovarian cancer incidence data for the said periods were obtained from the South East Scotland Cancer Network (SCAN). We excluded data for the year 2011 from our analysis as we considered this a transitional year following the guideline introduction. Results: The number of CA125 requests after the introduction of the guideline has more than doubled from an average of 3782 per year before 2011 to an average of 8631 per year after 2011. However the number of ovarian cancers detected remained essentially the same with 195 cases per year before 2011 and 189 cases per year after 2011. Conclusion: The increase in CA125 requests has not resulted in an increase in the number ovarian cancer cases detected. In addition there are financial implications (cost of tests, ultrasound and possible CT imaging). Furthermore this can cause unnecessary patient anxiety in false positive tests.