Exclusive: Scan crisis threat to cancer diagnosis

Early detection of cancer is being undermined by pressure on GPs to use fewer tests and a lack of NHS diagnostic capacity, a DH adviser has warned.

Dr Nick Summerton: 'Discouraging use of CA125 ovarian cancer tests flies in the face of what NICE is trying to achieve' (Photograph: UNP)
Dr Nick Summerton: 'Discouraging use of CA125 ovarian cancer tests flies in the face of what NICE is trying to achieve' (Photograph: UNP)

Yorkshire GP Dr Nick Summerton, DH cancer adviser and RCGP clinical champion, said a letter sent to GPs by a cancer network highlighting high use of a blood test for ovarian cancer was 'detrimental' to efforts to improve early diagnosis.

He also warned capacity for colonoscopy was already 'at its limit', ahead of an upcoming bowel cancer awareness campaign. A charity said services were 'overstretched' and called for improved access.

In a letter to practices, seen by GP, the Humber and Yorkshire Coast Cancer Network reported 'a significant increase' in requests for the CA125 ovarian cancer test by primary care.

This rise coincided with new NICE guidelines in April 2011, calling on GPs to test women with persistent abdominal symptoms sooner.

The letter stressed that CA125 is 'by no means a specific or sensitive test on its own', and that GPs should look to ultrasound as well.

It adds: 'It would be worthwhile for GP colleagues to audit the appropriate use of CA125 and also to examine if the increased use of CA125 translates into any early detection of ovarian cancer.'

Dr Summerton said the letter implied GPs were over-using the test. 'It is damaging, by trying to discourage testing in patients with vague symptoms. Discouraging use of CA125 is simply wrong.'

The danger is that GPs may doubt whether they should test patients with very vague symptoms, he said, which would be 'flying in the face of what NICE is trying to achieve' by advocating better access.

He argued that ultrasound capacity is so low that cases would 'backlog' if GPs started using it more frequently for cases with vague symptoms.

Sarah Woolnough, Cancer Research UK's director of policy, said: 'It's extremely worrying to hear some GPs are being pressurised to use these tests less frequently.

'Not only does this contradict the government's cancer strategy but it could mean patients are diagnosed later. This pattern of behaviour needs to be urgently investigated.'

PRESSURE ON TESTS
  • GPs are under pressure to limit use of NICE's first-line ovarian cancer test.
  • Ultrasound services are stretched and could be overwhelmed if GPs divert patients from other test methods.
  • Shortage of colonoscopy services could undermine drive to increase screening under bowel cancer awareness campaign.

Meanwhile, the DH bowel cancer awareness campaign is set to launch on 30 January.

Dr Summerton welcomed the campaign but said it would put further pressure on the already saturated two-week wait referral pathway. Pilots in 2011 saw GP urgent referrals soar by up to 100%.

He said access to diagnostics must improve if the NHS is to save an extra 5,000 lives a year, as pledged by the DH. But he added: 'Whether shrinking budgets can achieve that is another thing.'

Bowel Cancer UK said endoscopy services are already 'over-stretched'. It urged the DH and commissioners 'to invest in adequate endoscopy services and to enable GPs to make full use of them'.

Srdjan Ljubojevic of the Humber & Yorkshire Coast Cancer Network said its letter was sent 'to understand the reason for a significant upturn in the number of GP referrals' and discuss whether levels were 'likely to remain high'.

A NICE spokesman said while no one single test can definitively diagnose ovarian cancer, 'the evidence overwhelmingly shows that the CA125 blood test is the best single test currently available to provide an early indication'.

A GP investigation last year found that PCTs were restricting access to diagnostic scans (GP, 9 September 2011).


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