Minutes of evidence from the Health Committee – Beggs questions PHA on Ovarian Cancer Awareness 19/02/2014

Ovarian Cancer Awareness: DHSSPS Officials and Public Health Agency

Mr Beggs: Thank you for the presentation.  The ovarian cancer figures are truly shocking, with a third of women diagnosed at A&E when secondary symptoms show.  I understand that 75% of diagnoses occur when the cancer has already spread.  Therefore, the cancer is more difficult to treat, and the prognosis is not good.  There is then the issue of one third of women initially being misdiagnosed with irritable bowel syndrome.

In 2013, we were advised by Una Crudden and Target Ovarian Cancer that only 58% of GPs in Northern Ireland were aware of the NICE guidance introduced in 2011.  You have come here to tell us that you sent a letter to GPs today.  Can you explain what you did in between?  Why did it take almost a year to contact GPs?

Dr M McCarthy: First, it is not just a letter.  There is a pathway developed that indicates clearly the steps that need to be taken and what is expected of general practitioners, such as how they access the tests and how quickly the tests are to come back.  Although that sounds straightforward, we needed to have quite a bit of engagement with general practitioners and with the hospital and radiology side so that we knew exactly the logistical issues that potentially had to be met.  That engagement itself will have raised awareness of the issue, the tests, in what labs they are done, etc.  What has been done — namely, an increase in awareness — may not be visible, but it has been happening anyway.

GPs have access to the NICE guidance, and the NICE website is easy to use and very interactive.  The steps that we are taking, which are entirely consistent with the NICE advice, will make sure that the 58% of GPs aware of it will increase to something hopefully approaching 100%.  As I mentioned, we have locums coming in and out of general practice and trainee doctors, so we want to make sure that those who are new to general practice are familiar with the pathway.

Engagement takes a bit of time, but it is important that the right people are involved and engaged when we put out something such as the pathway, because it makes a big difference to its acceptance and utilisation.

Mr Beggs: I appreciate that it is important that good guidance goes out and that there is good process, but 120 people have died in that year.  In what way did you contact the 42% of GPs who, according to the survey, were unaware of that NICE guidance prior to today?

Dr M McCarthy: We have not contacted individual GPs, and we do not know who the 42% are, but contacting all GPs is the way of getting the message across and reinforcing it with them.

Mr Beggs: I certainly wish that it had happened before today.  It is good that we have brought you here or it may not even have happened today, so I am pleased that we invited you along.

Mr Gardiner: Hear, hear.

Mr Beggs: My final question concerns information given to us a year ago.  At that stage, 42% of GPs had direct access to specialist ultrasound to assist them in early detection.  What percentage of GPs currently have access to it?

Dr M McCarthy: The GPs can refer for an ultrasound directly to the local trust’s radiology department.  There are two different varieties of ultrasound —

Mr Beggs: My question was what percentage of GPs have access?

Dr M McCarthy: All GPs will be able to request an ultrasound from their trust.

Mr Beggs: How many of them have ultrasound in their own health centre?

Dr M McCarthy: I do not know, but the vast majority of GPs will access ultrasound through radiology departments, and ultrasound will be undertaken by radiographers.  There may be a small proportion that have ultrasound in their practice, but the number will not be significant at all.

Mr Beggs: We were advised a year ago that 42% had direct access.  Are you satisfied that there is appropriate access?  Bearing in mind the delay in women recognising the symptoms of this particular cancer and going to their GP — for example, a quarter of women waited more than three months before doing so, and a third of women, after having visited their GP, waited a further six months or more before they were correctly diagnosed — is there sufficient access to enable its speedy detection?  The cancer is aggressive and very difficult to treat in the latter stages.

Dr M McCarthy: There absolutely should be.  The six months that you have quoted that some women wait between presentation and referral or diagnosis is a key one.  If GPs follow the pathway, as advised by NICE, that six months will decrease, because, at the first sign of suspicion, a simple blood test helps indicate whether further action is needed.  Asking GPs to do that test early will make the difference.  Only if the test is abnormal are we recommending that women go for ultrasound.  The test will be done, and many women will not have any problems with it, as the results will be normal.  They then have a degree of reassurance, and finding out the cause of their symptoms will be the next step.  For women in whom it is raised, they will be referred for ultrasound.  We are asking that, when they are referred, the results of the CA125 blood test be  included in the request, because that helps to alert the hospital that something is going on.  We also ask that the test be requested urgently, because we would like to see women back in two weeks, as we do not want, and cannot have, women waiting months for the test.  That is simply not going to happen.

We are going to be monitoring very carefully what is happening with the number of referrals and the time for testing.  We will be keeping a very close watch on that.  We will be looking at additional training for radiographers and others in the testing to make sure that that capacity is available and people are well trained.

I am confident that we are addressing each of the key issues.  The next issue will be the awareness to help reduce the time that you have quoted — three months — before women even seek advice.  If they are experiencing symptoms for a month or more, we want to encourage them to seek advice.

It is worth remembering that a lot of women may have symptoms of abdominal distention, pain or bowel changes, and that most symptoms will not mean ovarian cancer, but the advice will be that they seek the view of a general practitioner.

Mr Beggs: My question was not about whether women should have speedy access but whether they currently have suitably direct access in each trust area.

Dr M McCarthy: They do, and if they put in an urgent request and provide the CA125, the test result should come back quickly.  However, we monitor that to ensure that it is the case.


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