Viewpoint: GPs should judge what is 'appropriate' when testing for cancer

Yorkshire GP Dr Nick Summerton, a DH adviser on diagnostics, tells GPonline.com why he believes GPs should have the final say on ordering ovarian cancer tests, as pathologists defend restrictions on GP access.

Dr Nick Summerton: GPs should be allowed to judge if an ovarian cancer test is needed (Photo: UNP)
Dr Nick Summerton: GPs should be allowed to judge if an ovarian cancer test is needed (Photo: UNP)

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!

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