There was a similar issue around brain natriuretic peptide (BNP) testing in the past and, with colleagues, we reviewed the evidence and did a proper 'appropriateness study' with GPs.
The real issue here for me is who judges what is 'appropriate testing' - the lab, in isolation from the patient and the primary care evidence, or the GP, in discussion with the patient and with an awareness of the primary care-oriented evidence? I would argue for the latter!
The labs also need to remember that CA125 is a triage test, not a definitive test - the next step in the processing pathway is transvaginal ultrasound.
The Royal College of Pathologists' comment about screening is interesting. They are clearly unaware of the effect taking a family history has on the prior probability of ovarian cancer, and hence the arguments for screening in the context of a strong breast/ovarian family history.
But, of course, my pathology colleagues don't see patients!
Read more about the restrictions: