More women with ovarian cancer could be diagnosed earlier
under proposed new NICE guidance that replaces a
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 around 7,000 women diagnosed each year
in the UK. The disease is often caught late because symptoms
such as bloating, abdominal pain and feeling full quickly can be
vague and overlap with other conditions.
A draft update to the NICE guideline on suspected
cancer proposes new thresholds for the CA125 blood test
that reflect how ovarian cancer risk changes as women
get older.
A CA125 blood test measures levels of a protein in blood, which
are often elevated in cases of ovarian cancer, and can be used
for monitoring existing cancer or guiding further
investigation.
Currently, all women are referred for further investigation if
their CA125 level 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 guideline also recognises that for women under 40, CA125
testing alone is not sufficiently accurate to guide
decisions. For this group, GPs should consider arranging an
ultrasound scan directly for those with persistent
symptoms.
Eric Power, deputy director, Centre for
Guidelines said: "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 for younger women, 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”.
The updated guideline also proposes:
- A new age threshold so that people aged 60 and over with
unexplained weight loss (greater than 5% over six months) receive
an urgent investigation or suspected cancer pathway
referral.
- With hormone replacement therapy (HRT) prescriptions in
England rising the guideline acknowledges a growing need for
clearer evidence on when unexpected bleeding while taking HRT
should prompt investigation for endometrial
cancer. NICE's guideline committee
has recommended that research is undertaken
to fill this gap and help clinicians make better-informed
decisions.
GPs and other primary care professionals use the NICE guidance to
decide when patients with potential cancer symptoms should be
referred to specialists. The suspected cancer guideline covers
multiple cancer types, helping primary care
professionals identify the 143,000 people diagnosed
with cancer in England each year.
The public consultation on the draft recommendations runs until
Monday, 2 February 2026. Comments can be submitted via
nice.org.uk.
