Evidence
Surveillance decision
We will not update the guideline on ovarian cancer at this time.
Reason for the decision
Assessing the evidence
The purpose of this exceptional review was to examine any impact on the ovarian cancer guideline following the recent review of diagnosis in secondary care by the NICE diagnostics guidance on tests in secondary care to identify people at high risk of ovarian cancer. No additional evidence published since the last surveillance review of the ovarian cancer guideline in March 2016 was considered by the exceptional review.
Last full surveillance review (March 2016)
The 2016 surveillance review identified 3 areas for update:
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Establishing the diagnosis in secondary care:
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1) For women with suspected ovarian cancer, what serum tumour marker tests should be routinely carried out to aid in diagnosis?
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Detection in primary care:
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2) For women with suspected ovarian cancer, what are the most effective first tests in primary care?
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3) What are the risk factors for ovarian cancer that should be identified in primary care?
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Update area 1: diagnostic tests in secondary care
This area has now been examined by NICE diagnostics guidance on tests in secondary care to identify people at high risk of ovarian cancer. It found that there is currently not enough evidence to recommend the routine adoption of the following tools in secondary care: IOTA ADNEX model, Overa (MIA2G), RMI 1 (at thresholds other than 200 or 250), ROMA or IOTA Simple Rules. It additionally recommends that there is no substantial change in accuracy if the threshold of RMI 1 for referral to a specialist multidisciplinary team is lowered to 200 from the currently recommended threshold of 250 in the NICE guideline on ovarian cancer (NICE guideline CG122). No impact on the ovarian cancer guideline is anticipated.
Update area 2: diagnostic tests in primary care
The review question 'For women with suspected ovarian cancer, what are the most effective first tests in primary care?' was due to be updated only if the recommendations from the NICE diagnostics guidance on tests in secondary care had implications for primary care.
However, the diagnostics guidance concluded that no new tests warranted routine adoption, nor did the threshold of RMI 1 of 250 currently recommended by the ovarian cancer guideline need to change. Therefore, an update of primary care diagnosis within the ovarian cancer guideline is not needed.
Update area 3: identifying risk factors for ovarian cancer in primary care
The proposal to update the review question 'What are the risk factors for ovarian cancer that should be identified in primary care?' was based on comments from 1 stakeholder during the consultation on the 2016 surveillance decision. The comments concerned questioning patients about family history of breast and ovarian cancer. No evidence was identified by surveillance on this issue. This area was not therefore a high priority for update and was included in the 2016 surveillance decision because other areas were also proposed for update. It has now been decided that an update of the ovarian cancer guideline is not currently needed, therefore this area will be considered again at the next surveillance review.
Views of topic experts
Topic experts from the 2016 surveillance review were asked whether they agreed with the decision not to update the ovarian cancer guideline, and to consider risk factors in primary care again at the next surveillance review. Five experts (2 oncologists, a gynaecologist, a radiologist and a GP) replied that they agreed with the decision.
Other clinical areas
This exceptional surveillance review considered only the areas proposed for update in the last surveillance review in March 2016.
Overall decision
After considering all the evidence and views of topic experts, we decided that no update is necessary for this guideline.
See how we made the decision for further information.
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