Intended for healthcare professionals

Rapid response to:

Practice Guidelines

Recognition and initial management of ovarian cancer: summary of NICE guidance

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d2073 (Published 21 April 2011) Cite this as: BMJ 2011;342:d2073

Rapid Response:

Re:Recognition and initial management of ovarian cancer: summary of NICE guidance

These new guidelines suffer from a lack of GP involvement in their
making. They currently are incomplete and this makes them insecure.
There are a number of glaring omissions, some of which I have detailed
below;

Firstly. What timescale is it reasonable for a woman with a raised
CA125 to wait for her ultrasound?

Should it be done within 2 weeks ("I might have cancer then
doctor?"),

urgently ("so its only a small risk but we want to pick it up
early?"),

routine ("so the CA125 test is pretty poor and there is hardly any
risk at all?").

Routine scans in my area can be 12 weeks and I know it will be very
difficult to explain to worried patients with an abnormal cancer test that
their is not a great risk.

Secondly the guidelines offer no help with patients with abnormal
CA125 who have a normal ultrasound.

What should we do next?

Should we repeat it later (if so when?), should we refer to secondary
care? Should we repeat the scan, or should we just say "come back if
symptoms persist, tho' I've no idea what to do when you do?"

The lack of thought over the pathway for the normal patient (which
will make up the bulk of the patients we see in general practice) makes
these guidelines unworkable and full of traps that will lead to more
worry, needless investigations, referrals and probably very little
improvement in the early diagnosis of ovarian cancer.

NICE, you must include GPs in your guidance, and you must think
through the normal, not just let your highly specialised secondary care
members remain blinkered on the diseased.

Competing interests: No competing interests

12 May 2011
James A Cave
GP
Downland Practice