Might I ask what advice mailbase readers are giving if the CA-125 is >35 kU/L but the ultrasound subsequently turns out to be normal? If other clinical causes of symptoms aren't apparent the NICE algorithm would "advise the woman to return if symptoms become more frequent and/or persistent". Would a further CA 125 measurement at that stage be contra-indicated on the grounds that at best it couldn't alter the fact that ovarian cancer had already been excluded and at worst it would merely serve to heighten anxiety levels? I suppose what I'm really asking is "does USS have a 100% negative predictive value when it is undertaken in the context of
the NICE diagnostic algorithm?"
Best wishes
Dave
Dr D A Hullin
Department of Clinical Biochemistry
Royal Glamorgan Hospital
Llantrisant
Rhondda-Cynon-Taf
CF72 8XR
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Anne Dawnay
Sent: 20 July 2011 10:51
To: [log in to unmask]
Subject: CA125 in symptomatic women presenting to primary care
I really don't think we should be referring to this as 'screening' - it
isn't. GPs are assessing symptoms all the time and requesting tests that
may be of value in the differential diagnosis - I suppose one could say
they are 'screening' for disease all the time but I don't think that is
a helpful term to use. It is not at all like the colon cancer screening
programme.
The labs in the North Central London sector are pooling data on GP CA125
total requesting numbers and those with results of 35 or more. We're
looking at the pattern from March 1st - looks like we may have had a
peak in the few weeks post guideline (expect lots of women read the
papers and trotted off to their GP) that has now settled - should become
clearer by the end of the month. This is being fed back to gynae onc
ultrasound services that should be seeing the same pattern slightly
later. I believe they are planning some educational sessions in
September.
At UCLH the LIMS automatically appends the following to any primary care
CA125 result - aims to be brief but informative:
www.nice.org.uk/CG122 If symptoms suggest ovarian
cancer and CA125 is 35 kIU/L or more, refer for
ultrasound (NICE 2011). Disease not excluded if
<35 kIU/L, assess clinically.
best wishes
Anne
Dr Anne Dawnay PhD FRCPath
Consultant Biochemist, UCLH
08451555000 ext 2954
Date: Tue, 19 Jul 2011 10:09:59 +0100
From: Jonathan Kay <[log in to unmask]>
Subject: CA125 and screening for ovarian cancer
Thanks, Mike.
But the case for the new approach to screening for ovarian cancer is
well documented in the NICE supporting evidence. For these difficult
calls isn't it now necessary to do this on a basis of decision analysis
and economic analysis?
I think that it's going to work well in practice. The bit I'm worried
about is local variation in process and information management. To the
best of my knowledge it won't have a programme management structure
similar to that which is working well for screening for colorectal
cancer.
Is anyone running local educational sessions on how to do this well?
Jonathan
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