GPs 'refused access' to ovarian cancer scans

Doctors fear lives are being put at risk because GPs are refused access to ovarian cancer scans and patients are forced to wait months to obtain test results.

Ovarian cancer:a quarter of GPs have waited months for scan results
Ovarian cancer:a quarter of GPs have waited months for scan results

A major study of the diagnosis of ovarian cancer in the NHS found one in 10 GPs had requests for vital diagnostic tests refused in the past year.

Almost half of GPs had no access to urgent transvaginal ultrasound, the most accurate tool for detecting ovarian cancer. A quarter of GPs said they had waited up to two months for scan results.

Senior GPs said it was 'inhumane' to make patients wait that long and accused hospitals of blocking tests.

One GP described the disease as the 'forgotten cancer'. The DH said the delays were 'unacceptable'.

Each year, more than 7,000 women are diagnosed with ovarian cancer and 4,300 die from the disease.

The charity Target Ovarian Cancer commissioned Ipsos MORI to survey 402 GPs as part of a wider investigation into ovarian cancer care in the UK (see graphics below).

Three in 10 GPs believe access to tests has improved in recent years, and awareness of symptoms has risen among the profession and the public. But one in 10 GPs reported having a request for a CA125 blood test, abdominal ultrasound or transvaginal ultrasound refused in the past 12 months. Of these, a third said it was due to restrictive local guidelines.

Yorkshire GP Dr Nick Summerton, a DH adviser on diagnostics, said delayed scans would cost lives (see GP expert view). He criticised the 'feudal' system of testing and said radiologists decide whether an ultrasound is worthwhile, rather than trusting the referring GP's judgment.

'I'll say I want to order an investigation. The radiologist will say, "No, you don't, you request it.". No-one should ever be refused a test. The earlier cancer is picked up, the better,' Dr Summerton said.

Exeter GP and academic Professor Willie Hamilton, an adviser to the study, said he was 'disappointed' but 'not surprised' by delays returning test results. However, he said there had been a 'dramatic improvement' in recent years.

Northamptonshire GP Dr Victoria Barber successfully campaigned for greater access to CA125 tests in her region. But requests still 'bounce back' from laboratories if they suspect the test is being used for screening, she said. 'I get that quite a bit, some clerk in ultrasound deciding whether it's urgent. They keep it in the lab until we tell them it's not a screening test.'

She advised GPs facing restrictions to present commissioners with evidence from the study and to seek backing from local gynaecologists and their LMC.

Dr Barber said: 'There's been all this guidance and information for lung and bowel cancer, but ovarian has been the forgotten cancer.'

Annwen Jones, chief executive of Target Ovarian Cancer, said 32% of women are diagnosed in A&E and 75% after the cancer has spread. 'We must improve symptom awareness with women, improve GP knowledge and ensure they have prompt access to diagnostic tests.'

A DH spokesman said: 'It's unacceptable that local arrangements should delay clinically urgent referrals and any GPs who have concerns about how a diagnostic referral is handled should take this matter up with their local provider.'

The DH is investing £750m in cancer care to improve survival rates and save an extra 5,000 lives a year by 2014, including improving GP access to diagnostic ultrasound.

Expert view: The GP - Dr Nick Summerton, Yorkshire GP and DH adviser on diagnostics

'The only way to pick up people with ovarian cancer is to have a low threshold for CA125, because the symptoms are so vague. We should see it like doing an FBC, as a very common investigation.

'But labs don't really understand. They just see it as test numbers dramatically increasing and see a need to control that demand.

'CA125 is only part of the equation in terms of identifying the risk of malignancy. We need transvaginal ultrasound, by someone who knows what they're doing. The problem is there is not enough capacity in the NHS.

'If we want to prevent women from dying prematurely from ovarian cancer, the labs must stop whingeing about CA125 and ministers must improve access to scans.'

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