My concern with these cases is the false reassurance that may be wrongly inferred on the basis of a CA125 that is not elevated rather than mis-investigation based on an elevated CA125. (I note that labtestsonline says CA125 is not used as a screening test because it is elevated in too many benign conditions with no mention of its poor sensitivity for early disease). If the GP has ovarian cancer as a differential diagnosis then the patient needs a gynae cancer referral whatever the CA125 and will then get a trans-vaginal ultrasound (much clearer than abdominal). I'd recommend to read the case in the BMJ (June 20th) for both the patient's and doctor's perspectives in a single article. We'll have to wait for the outcome of UKCTOCS to know whether screening using the CA125-based algorithm is worthwhile (Lancet Oncology 2009;10(4):327-340). If it is then we're going to have to start paying attention to the performance of CA125 assays within the reference range. I attach the north london cancer network guidelines link for GP referrals - for gynae cancers there is no mention of any lab tests. Does anyone's local cancer network guidelines for GPs differ substanitially from this one?
http://www.nlcn.nhs.uk/ProReferrals
best wishes
Anne
Dr Anne Dawnay PhD FRCPath
Consultant Biochemist
University College London Hospitals
Tel 08451555000 x2954
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