Tests and tools for the detection of ovarian cancer in primary care (PhD)

Introduction

Ovarian cancer is the deadliest form of gynaecological cancer resulting in the deaths of over 4,000 women in the UK each year. The majority of women are not diagnosed until the disease is at an advanced stage, which makes it very difficult to cure.

The ovarian cancer biomarker CA125 can be measured by a simple blood test and is widely used in UK primary care and internationally to investigate women presenting with vague symptoms that could indicate ovarian cancer. Despite NICE recommending CA125 as the first line test in women presenting with symptoms of possible ovarian cancer, no studies have yet evaluated its diagnostic performance in primary care. It is therefore unclear how effective it is at detecting cancer in this setting or how GPs and patients should interpret the results.

This study will use anonymised primary care and cancer registry data from over 120,000 UK women, who have been tested for CA125 in primary care, to investigate the diagnostic performance of CA125.

Aims & objectives

• Evaluate the performance of CA125 for the detection of ovarian cancer in primary care.
• Develop approaches to optimise CA125 performance in primary care.

Outputs & impact

The results of this study will inform guideline development and should help guide GPs and patients to make informed decisions about further investigation and referral for possible ovarian cancer. We intend that this research should contribute to the early diagnosis of ovarian cancer.

Publications

• Funston G, Van Melle M, Ladegaard Baun M-L, Jensen H, Helsper C, Emery J, Crosbie EJ, Thompson M, Hamilton W, Walter F. Variation in the initial assessment and investigation for ovarian cancer in symptomatic women: a systematic review of international guidelines. BMC Cancer, 2019, 19:1028 doi:10.1186/s12885-019-6211-2
• Funston G, Hamilton W, Abel G, Crosbie EJ, Rous B, Walter FM (2020) The diagnostic performance of CA125 for the detection of ovarian and non-ovarian cancer in primary care: A population-based cohort study. PLoS Med 17(10): e1003295. doi:10.1371/journal.pmed.1003295
• Funston G, Hardy V, Abel, G, Crosbie EJ, Emery J, Hamilton W, Walter FM. Identifying Ovarian Cancer in Symptomatic Women: A Systematic Review of Clinical Tools. Cancers 2020, 12, 3686. doi: 10.3390/cancers1212368
• Funston G, Mounce LTA, Price S, Rous B, Crosbie EJ, Hamilton W, Walter FM. CA125 test result, test-to-diagnosis interval and stage in ovarian cancer: a cohort study using electronic health records. BJGP, doi: 10.3399/BJGP.2020.0859
• Funston G, Abel G, Crosbie EJ, Hamilton W, Walter FM. Could Ovarian Cancer Prediction Models Improve the Triage of Symptomatic Women in Primary Care? A Modelling Study Using Routinely Collected Data. Cancers, 2021. doi:10.3390/cancers13122886
• Funston G, Mounce LTA, Price S, Rous B, Crosbie EJ, Hamilton W, Walter FM.  CA125 test result, test-to-diagnosis interval, and stage in ovarian cancer at diagnosis: a retrospective cohort study using electronic health records. British Journal of General Practice, 2021; 71 (707): e465-e472. DOI: 10.3399/BJGP.2020.0859
• Funston G, Crosbie EJ, Hamilton W, Walter FM. Detecting ovarian cancer in primary care: can we do better? British Journal of General Practice 2022; 72 (720): 312-313. doi: 10.3399/bjgp22X719825