Under proposed updates from NICE, more cases of ovarian cancer could be identified at an earlier stage by moving away from a uniform blood test threshold and introducing age-specific criteria. The guidance suggests tailoring the interpretation of CA125 test results to a woman’s age rather than applying a single cut-off for everyone.
Ovarian cancer affects approximately one in fifty women during their lifetime, with around 7,000 new diagnoses made each year across the UK. Early detection is challenging because symptoms such as abdominal discomfort, bloating and early satiety are non-specific and commonly associated with other conditions.
At present, women are referred for further assessment if their CA125 level is 35 IU/ml or higher, irrespective of age. This approach can fail to identify cancer in older women, while leading to avoidable investigations in younger patients.
The draft revision to NICE’s suspected cancer guidance proposes age-adjusted CA125 thresholds that better reflect variations in risk across different age groups, with the aim of improving diagnostic precision and reducing delays.
The proposed recommendations include:
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Introducing age-related CA125 thresholds to inform referral decisions for suspected ovarian cancer.
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Advising that CA125 testing alone is insufficiently reliable in women under 40; GPs should consider direct referral for an ultrasound scan if symptoms persist.
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Adding a new referral criterion for individuals aged 60 and over who experience unexplained weight loss of more than 5% within six months, prompting urgent investigation through the suspected cancer pathway.
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Highlighting the need for further research into unexpected bleeding in people using HRT and its potential association with endometrial cancer, particularly as HRT prescribing continues to increase in England.
