More women with ovarian cancer could be diagnosed earlier under proposed new guidance from NICE, which recommends replacing the current one-size-fits-all blood test threshold with personalised, age-based criteria.
Around 1 in 50 women will develop ovarian cancer in their lifetime, with approximately 7,000 cases diagnosed annually in the UK. The disease is often detected late because symptoms such as bloating, abdominal pain and feeling full quickly can be vague and overlap with other conditions.
Currently, all women are referred for further investigation if their CA125 blood test result reaches 35 IU/ml or above, regardless of age. This fixed threshold can miss cancers in older women while triggering unnecessary investigations in younger women.
The draft update to NICE’s suspected cancer guideline proposes new thresholds that reflect how ovarian cancer risk changes with age, aiming to improve accuracy and speed up diagnosis.
Key Recommendations include:
- Age-based CA125 thresholds to guide referrals for suspected ovarian cancer.
- For women under 40, CA125 testing alone is not sufficiently accurate; GPs should consider arranging an ultrasound scan directly for those with persistent symptoms.
- A new criterion for people aged 60 and over with unexplained weight loss (greater than 5% over six months) to receive urgent investigation or referral via the suspected cancer pathway.
- Recognition of the need for research into unexpected bleeding while on HRT and its link to endometrial cancer, as HRT prescriptions rise in England.
Centre for Guidelines Deputy Director Eric Power commented:
“The committee’s proposed recommendations will ensure more personalised, targeted testing, so women at greatest risk of ovarian cancer are identified and referred sooner.
“This tailored approach will mean GPs can make more informed decisions about which patients need urgent investigation, while reducing unnecessary ultrasound scans, freeing up NHS resources.
“These updates will ensure that our guideline reflects the latest evidence and will help improve the detection of cancer and ensure those who need it get swift treatment.”
GPs and other primary care professionals use NICE guidance to decide when patients with potential cancer symptoms should be referred to specialists. The suspected cancer guideline covers multiple cancer types and supports the identification of around 143,000 cancer diagnoses in England each year.
NICE’s proposed changes aim to make referrals more accurate, reduce unnecessary investigations, and ensure older women at higher risk receive timely care.
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