As I said in my previous email, I would simply refer them to follow NICE guidance 122 with hyperlink to it as stated by Jonathan Kay.
DOI: I don't think that NICE 122 algorithm will work in practice. Because, we have suddenly seen a tide of CA125 requests from general practice for all sorts of reasons including patient's anxiety/request, family history, bloating, abdominal/pelvic pain, tiredness...etc. This means that CA125 is not used in a high risk screening strategy and we all know that it has poor positive and negative predictive values for ovarian cancer in such scenario. Similarly, transvaginal ultrasound if used in low risk patient has low positive and negative predictive values.
Regards
Mohammad
--- On Wed, 20/7/11, Dave Hullin (Cwm Taf Local Health Board - Clinical Biochemistry) <[log in to unmask]> wrote:
> From: Dave Hullin (Cwm Taf Local Health Board - Clinical Biochemistry) <[log in to unmask]>
> Subject: Re: CA125 in symptomatic women presenting to primary care
> To: [log in to unmask]
> Date: Wednesday, 20 July, 2011, 14:12
> 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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