This is a new guideline from Nice published in March 2024. It looks at identifying and managing a family risk of ovarian cancer.
It is important to remember that this is national guidance and that local referral guidelines may be different and need to be considered when referring patients.
What is new for GPs in this guideline?
- There is quite a long list of what is expected from us in a consultation about ovarian cancer risk. I will list some useful resources to share with patients below.
- We should bear in mind a patient’s emotional health and ask about factors related to this (eg anxiety). NICE advises that we should ask about this at every appointment.
- There is a lower threshold for referral in this new guideline, than we have in our area. For example all those with a first-degree or second-degree family history of ovarian cancer should be referred.
- At risk groups include Sephardi Jewish and Greenlander, as well as Ashkenazi Jewish.
- This isn’t new, but something that I don’t think to tell patients before I refer them. The genetics team will look at several factors when looking at their risk. This includes the presence of any pathogenic variants, but also their family history, their age and any other risk factors that could be present.
What information should we be sharing with patients who are attending to discuss their risk of ovarian cancer?
- The risk of ovarian cancer given their family history (see below).
- That certain groups may have an increased risk of ovarian cancer (eg Ashkenazi Jewish, Sephardi Jewish and Greenlander).
- That people born with male reproductive organs may carry a pathogenic variant.
- That if their family history changes (eg someone develops a cancer), that their risk may change and that they should return to have this reassessed.
- Advice on symptoms to watch out for (see below)
- Advice on other risk factors (see below).
- The referral process, psychological support if required and support groups (see below).
Who should we be referring on for a further assessment of their risk?
We should be referring anyone who:
- Has a first-degree relative with a diagnosis of ovarian cancer.
- Has a second-degree relative with a diagnosis of ovarian cancer (either maternal or paternal). This includes the situation where there is an unaffected intervening blood relative.
- Is from an at risk population (Ashkenazi Jewish, Sephardi Jewish and Greenlander – see below).
- Has been identified through cascade testing (eg they have a relative with a pathogenic variant and have been advised to be tested as a result of this).
- Has had a personal history of ovarian cancer and has not already had mainstream testing.
- Meet the criteria for genetic testing. This section of the guideline is aimed primarily at genetics services and allows them to calculate a risk of having ovarian cancer. If the patient doesn’t otherwise meet the referral criteria, it may be worth looking at, but I think it would be quite hard for us in primary care to work this out.
