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This Week in the British Medical Journal: May 23, 2011


In the British Medical Journal this week, gynecological oncologist Adeola Olaitan and general practitioner James Cave respond to the recent release of the National Institute for Health and Clinical Excellence's guidelines on the care of ovarian cancer patients. Olaitan says that if the NICE guidelines are meant to improve outcomes by allowing for earlier diagnosis, then "they are unlikely to succeed." The recommendations for primary care are "flawed," she says, because although the indications for suspecting ovarian cancer are valid, the sequence of diagnostic tests being recommended is "illogical." In particular, testing for the CA125 protein, thought to be an ovarian cancer biomarker, will fail to detect at least 23 percent of women with non-mucinous stage 1 epithelial ovarian cancer, and will fail to detect all of the more rare epithelial ovarian cancers that aren't associated with a raised serum CA125 count. Cave adds the guidelines "suffer" from not having had the input of physicians. They are also "incomplete" and "insecure," he adds. For example, the guidelines don't say how long a woman with an elevated CA125 count should wait before getting an ultrasound — is it urgent or can it wait two weeks? The guidelines also don't say what physicians should do with patients who have an abnormal CA125 count, but a normal ultrasound. "NICE must include GPs when formulating guidance. It should also think through the normal patient and not just let highly specialized secondary care members remain blinkered on the diseased," Cave says.

Also in the British Medical Journal this week, Susan Mayor reports that a recent audit in the UK shows a "major rise" in the number of patients undergoing surgery for lung cancer in the last five years. The audit analyzed data on more than 37,000 patients, and the results showed one in seven patients underwent surgery in 2009, compared with one in 11 in 2004. The audit's authors say the improved surgery rate suggests that more clinicians and hospitals have the needed expertise to assess patients and have access to more "complex surgical techniques often needed in these situations," Mayor says.

And finally in the British Medical Journal this week, Helen Mooney reports that the British government's "radical" plan to get rid of England's NHS cancer networks was reconsidered after the health secretary, Andrew Lansley, "was pressured into a U turn." Clinicians and experts say they're pleased with the decision as the cancer networks are important in providing quality care and treatment for many patients, Mooney adds.

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