Dr Sarah Taylor

It is quite difficult to know quite when to investigate. I think it’s all down to the safety netting. And, a lot of things will get better in a week or two, but if they haven’t, then we do need to think again.

Dr Rebecca Leon

Hi this is GPs Talk Cancer, brought to you by GatewayC. I’m Dr Rebecca Leon, and joining me through this podcast is Dr Sarah Taylor. We are both practicing GPs and GP leads for GatewayC.

We’re both passionate about diagnosing cancer early. And in this podcast, we want to share our clinical experiences with you, so you can make better, faster, and more confident cancer diagnosis in primary care.

So, there’s some official stuff to make you aware of. We know this podcast might be of interest to anybody, but it is really aimed at primary care health professionals.

And although all patient cases are based on real stories from our clinical practice as GPs, they’re fully anonymised with no identifiable patient data. GatewayC is funded by the NHS and is part of The Christie NHS Foundation Trust.

So, official bit done and dusted. The kettle is on and we’re going to sit down with a coffee. With us today, alongside Sarah, we have Ellen, who’s a junior doctor who works alongside us at GatewayC. And she’s actually joining us from Scotland remotely. So, Sarah, how are you? How was your weekend?

Dr Sarah Taylor

Good, thanks.

I was off last week, so I’m just catching up from everything there and yeah, all good thanks.

Dr Rebecca Leon

Great. And Ellen, how’s Scotland?

Dr Ellen Macpherson

Yeah, it’s rainy and windy here, which is typical. But yeah, I quite like it.

Dr Rebecca Leon

Great. Okay, so have you got a drink? Both of you?

Dr Sarah Taylor

Yeah.

Dr Rebecca Leon

Okay. So, in today’s podcast we’re going to be talking about ovarian cancer, and it’s important we throw some stats at this.

This is fresh from the CRUK website, and an interesting finding was the incidence rates in the UK for ovarian cancer are highest in women between the ages of 75 to 79. So those are the patients we should really consider, could this be a possible ovarian diagnosis? And the survival rate with ovarian cancer, for living for 10 years or longer, is around 35%. So there’s still a lot of work to be done.

So, Sarah, let’s go back to the cases. The first case we’re going to be talking about is, I think it was a lady, we’re going to call Sylvia. Are you able to tell us a little bit about her?

Dr Sarah Taylor

Yeah. So, she came in to see me a few weeks ago. She’s in her mid-sixties, was just feeling a little bit off, nothing very specific. But she said she’d had some new onset bloating, and that she was just, she said that she was feeling her clothes were a bit tighter, but she didn’t think she’d put on any weight, and she certainly hadn’t been eating more, and just felt generally a bit off and not quite right. Nothing very specific going on for two or three months.

Obviously, she was a sort of patient that immediately made me a bit concerned that she might have an ovarian cancer, just because she had new onset IBS type symptoms and nothing much else.

She hadn’t, she wasn’t somebody that we’d seen very frequently. She came in fairly infrequently. So, I did CA125, organised the ultrasound simultaneously, which I do, I don’t know whether you do?

Dr Rebecca Leon

I do, yes.

Dr Sarah Taylor

Yeah. And the CA125 came back raised and the ultrasound showed a large complex cyst. And both of them suggested that she was referred on the two week wait. She’s been referred and is just going through the process of actually having further investigations. But I’ve sort of felt she was a, she was a fairly clear one. She absolutely fitted in with the NICE guidelines, you know, new onset IBS symptoms, in somebody who was postmenopausal.

Dr Rebecca Leon

Yeah, absolutely.

I mean, you talk about that she’d put some weight on. A really good question, I find is, about dress sizes, because often they might say something like, “I’ve always been a 10, but I’ve been having to, I’m now only fitting into 12s and 14s, and that’s a subtle change, isn’t it?

Dr Sarah Taylor

Yeah. And I think it’s, yeah, it’s because I think weight is really difficult, isn’t it?

Dr Rebecca Leon

Yeah.

Dr Sarah Taylor

I think that, you know, you see lots of people don’t you, they say they’ve lost weight and they’ve gained weight, and you weigh them and they’re exactly the same as they’ve always been, but I think you’re right. Dress size is a, a slightly different way of measuring things.

Dr Rebecca Leon

And obviously not with ovarian cancer, but with, with the male, if they present with any kind of abdominal bloating, it’s to do with the extra notch on their belt is the other thing as well that we ask.

Yeah, as you say, postmenopausal, bloating, getting full early after eating, and you mentioned about IBS. We’ll touch on this a little bit later, but IBS is such a common presentation in general practice, but not so much with post menopause.

Dr Sarah Taylor

I think it’s the new onset, isn’t it? So, I think there are lots of postmenopausal women who have IBS, but often it’s, they’ll come in and they’ve had it for years. Whereas actually I think this lady hadn’t had anything previously. It was a new onset of symptoms and that was what immediately raised the alarm bells.

I think it’s more difficult, you know, we might talk about this a bit later on, in patients who’ve got a long history of IBS, because there’s nothing to say that they’re not going get ovarian cancer either. But it is more difficult, somebody like this who comes in and says, you know, the last two or three months I’ve had this, I’ve never had it before. It’s a fairly straightforward thought process, isn’t it?

Dr Rebecca Leon

And with IBS, we can also think about bowel cancer as a potential, particularly if change in bowel habit, which again can be IBS, bloating, which can also be… Would you suggest for our listeners to maybe go down the colorectal two week route? Or just because bowel cancer is more common? What do you think about that with, with almost, just IBS symptoms?

Dr Sarah Taylor

I suppose I mean, I think we’ll talk about this at some point in the podcast, is I suppose the other thing is to think now that we have the availability of doing FIT, if she had altered bowel habit as well as abdominal pain, bloating, or even just with, without, I think doing the FIT is another test that you can do. So, I think probably over the next few years my practice will change from doing CA125 and ultrasound with some other bloods, you know, to check whether or not she’s anaemic, to actually adding in a FIT test as well.

Dr Rebecca Leon

Yeah, that’d be good practice.

And you mentioned about the CA125, which we have available now in primary care. Tell me about the CA125 and some of the pitfalls.

Dr Sarah Taylor

Oh, well I wrote, this is one of the big impacts when I wrote, because you did the ovarian cancer module, didn’t you? And this was one of the things that probably scared me most from the module was that actually 25% of ovarian cancers don’t have a raised CA125.

And you know, I, we, we talk about this, we talk about the false negative chest X-rays, which I was completely aware of. I wasn’t aware of that, and I think that’s probably influenced my practice, whether it’s influenced yours, just to do the ultrasound at the same time.

Dr Rebecca Leon

Absolutely. So, if you’ve got this feeling that actually this patient may have ovarian cancer, I would suggest you do them both together. Because the other thing as well, CA125 can be raised for other reasons.

Dr Sarah Taylor

A whole host.

I’m hoping, I don’t know whether this might be putting Ellen totally on the spot in the medical student.

Dr Rebecca Leon

She’s done the exams.

Dr Sarah Taylor

She’s much closer to a medical student way than the rest of us. I can’t remember that many other causes of a CA125, but we can, I’m sure we can look them up.

Dr Rebecca Leon

Ellen, do you know any?

Dr Ellen Macpherson

No, not off the top of my head.

Dr Rebecca Leon

That’s fine. Ellen, are you happy to go and have a look at that off mic? And get back to us with some key information.

Dr Ellen Macpherson

Of course. I will look that up now.

Dr Rebecca Leon

Okay, so with the case with Sylvia, I think that gut feeling that you had, that actually this was a fairly barn door, unfortunately, that she was presenting with red flag symptoms for ovarian cancer. And it looks like, you know, she, she’s now being on the right pathway for being treated for that.

Dr Sarah Taylor

Yeah. But your case a few weeks ago was more difficult, wasn’t it?

Dr Rebecca Leon

Yeah, it, yeah, it was actually about, it was slightly, I think I told you about a couple of weeks ago, but it was about six months ago. Of a lady of 36 who was a new patient really, she just moved with her young family into the area. And she also had fairly vague symptoms of ongoing bloating, getting full after eating. She had a 10 month old, so she actually thought it was pregnancy weight she couldn’t get rid of. But she’d actually seen two other of my colleagues in the last three weeks because she’d tried Buscopan, she’d tried peppermint tea, she tried the things that we tried for IBS. But she was, she was concerned, and I wanted to, to really understand her family history. And she told me that her mum had had breast cancer in her early forties, and her maternal aunt, had been diagnosed with ovarian cancer, actually in her mid-twenties, which was really unusual.

So, she had a really strong family history. She was, she was very breast aware. She really, you know, she, she really examined every month and things. But she, when I heard about this significant family history, I did start to think she’s young, but is there something? And I did similar to you, I did an urgent CA125 on the day, did a full host of bloods and sent her for a transvaginal ultrasound. And it unfortunately did come back with an ovarian cancer diagnosis.

And since then, she has now been referred to the genetics team, and she’s now being looked at whether she, there is a genetic link to this. Are you aware of, of the BRCA1, BRCA2s?

Dr Sarah Taylor

I’m aware of the link, but I think that I am probably not as good as I should be about asking about family history. I don’t, it isn’t one of my routine questions. I mean, it used to be when I, a long time ago, when I was a medical student, I used to go through the whole list of things that you were supposed to ask, but I don’t routinely ask about family history. But the more we do and the more we talk about things, and the more links that become apparent, I think that it probably should be much more just one of those things that I always ask.

Dr Rebecca Leon

Absolutely. And, and you know, when we’re talking about the BRCA, I don’t know Ellen, if you want to chip in with anything to do with the BRCA1 and 2? But actually, it’s as high as 15 to 20% of ovarian cancers is hereditary. So, and particularly we know when young people are being diagnosed, there may be a hereditary element. And I think a big thing that we take away from us chatting is, are these kind of educational nuggets, ask about family history, because actually it could put you down a different questioning route.

I mean, as far as the BRCA, there’s been quite a lot in the celebrity world, Angelina Jolie, and she, she made it public talking about that. Are you, are you aware of this, Ellen? Is this something that’s being taught about? And, yeah.

Dr Ellen Macpherson

I certainly, I mean, I’m very aware of that Angelina Jolie effect. And I think patients are quite aware of the risk, the hereditary risk of breast cancer.

Dr Rebecca Leon

Yeah.

Dr Ellen Macpherson

I’m not necessarily sure there’s as much public awareness that, that also gives, confers, a risk for ovarian cancer.

Dr Rebecca Leon

Yep.

Dr Ellen Macpherson

And I think the other thing we sometimes, I don’t think I quite picked up on at medical school, maybe they did teach it and it just didn’t get stuck in my brain. But is to ask about, you know, paternal history of prostate and, [00:12:00] and GI cancer as well. So BRCA does confer some risk to GI cancer as well.

Dr Rebecca Leon

Yeah, yeah.

Dr Ellen Macpherson

And that I think would, is a maybe less, less known, but certainly the, the hereditary nature of breast cancer I think I get. I’ve certainly seen patients who have come in with concerns about their risk of breast cancer.

Dr Rebecca Leon

Absolutely. And I think you make a really good point about the paternal history as well. Or, you know, maternal, but the men, the men in the family, because prostate is involved I think with the BRCA2. And there’s also certain cohorts of patients. So in the Ashkenazi Jewish community actually, one in a hundred are, have got a, a BRCA. So, it’s really important to also look at ethnicity and ask about that as well.

Dr Sarah Taylor

And I suppose there’s that thing as well, isn’t there, about making sure your family history is fairly rigorous and clear. Because, you know, if somebody had a maternal grandmother who had breast cancer in their seventies and a paternal aunt who had ovarian cancer in their fifties, [00:13:00] that probably doesn’t in, confer any increased risk. So again, you know, going back to the GatewayC module that you did, there’s a quite a good bit in there with one of the geneticists where you talk about how to take and record a family history. Which I think is quite a useful thing to do because we don’t want to give people increased anxiety if they don’t have an increased risk, but we do want to identify them. And if we don’t ask, we’ll never know.

Dr Rebecca Leon

Absolutely. And these pedigree diagrams that we talk about during the GatewayC module, it’s if we have a very clear understanding of their family history, then we can refer potentially in parallel to the geneticist, the genetics clinic, and they’re more likely to be seen in triage if you, if you have a, a more concise, detailed history.

Dr Sarah Taylor

Did this lady have a longstanding IBS history?

Dr Rebecca Leon

So, it’s interesting. I mean, She, she mentioned that during stressful times she had IBS type [00:14:00] symptoms, so she used the example of A Levels that she used to, that it was almost her stress trigger, but there was, she’d never really seen us about it, so she’d always managed it herself.

One of her starting and, my colleague had written it in the EMIS notes, had said she thought this was a trigger of her IBS because it was similar-ish, to what she’s had, but she’d never actually seen anybody about it.

Dr Sarah Taylor

Because I think that brings in, doesn’t it? One of the concerns that we always have is that if somebody’s got a diagnosis of IBS,

Dr Rebecca Leon

Yeah.

Dr Sarah Taylor

And it’s coded as IBS, it’s very easy to assume, she’s got a new baby, she’s, you know, I don’t know whether it’s, I can’t remember whether it was her first or a second child.

Dr Rebecca Leon

Her second child.

Dr Sarah Taylor

Yeah. So, you know, she’s probably very busy. It’s very easy to assume, isn’t it? That all of the symptoms just to go oh well.

Dr Rebecca Leon

Yeah, yeah.

Dr Sarah Taylor

She’s young and it’s stressful and, so, what can you remember what made you think differently about this and not think, oh, well, you know?

Dr Rebecca Leon

Well, I think it was the, the third [00:15:00] time she’d been in, in a, in a matter of kind of two and a half weeks. She tried IBS type remedies. So, she’d been, she’d cut out a lot of food groups, she’d tried over the counter Buscopan, she’d been drinking peppermint tea and all these things she said normally helps. So, with her coming for the third time, and then, but you’re absolutely right, it’d almost been coded as IBS. And this is the thing we, we harp on about don’t we, Sarah? That actually the coding element can be helpful in some, in sometimes, but actually in other times it can deflect what is going on because you almost just carry it on. So almost needed a fresh pair of eyes. And with the, with the family history and with her not getting better with, with these particular things, I just started to think about other differentials.

Dr Sarah Taylor

And I suppose if you hadn’t asked about the family history, how, it’s difficult to know, isn’t it? How concerned you might have been and whether you would, what you would’ve done. I mean, I say, she would’ve [00:16:00] presumably have come back.

Dr Rebecca Leon

Yeah, I think, I think we probably would’ve gone down, kind of a scan point of view at some point, ultrasound, abdo, pelvis. But would I have done it as an urgent? Maybe not. So, the family history was, was really important.

But, but again, I think as we do this more and more, we’re seeing patients who are younger, who are fit and well, and they’re getting these difficult diagnoses that actually you need to have an open mind and we have to safety net. And we have to actually say, and I would’ve said that to her, if you’re no better in two weeks, I want you to come back to me. I would’ve even made her an appointment and cancel it if you’re better. But this is what we have to do with patients, that you’ve just got a bit of a niggle that they’re coming back and there’s something going on. Unfortunately for her, it was actually a significant diagnosis.

Dr Sarah Taylor

I think that one of the things, that I was thinking about this as I was driving here, thinking one of the things that actually is really important is just to think about other things.

So, say, you know, saying, just chatting [00:17:00] before we started the podcast about, you know, if you see a child with a fever, you’ve almost before you do anything, you’ve decided you’re going to work out whether or not they’ve got meningitis. And then sometimes you immediately decide, I’m not worried about this child at all.

Dr Rebecca Leon

Yeah.

Dr Sarah Taylor

But if not, if you are still a bit concerned, you’ll work through a whole series of things. But you’ll have thought of that at the very outset, the most serious thing. Similarly with chest pain, you’ll think about is this an MI? Then you might think, is this a pneumothorax? That sort of thing.

I think that we need to do that more with other things that could be symptoms of cancer and sort of say, oh, this isn’t IBS, but could it be a bowel cancer?

Dr Rebecca Leon

Yeah.

Dr Sarah Taylor

Could it be an ovarian cancer? And then work to exclude it. Rather than saying, oh, it’s IBS.

Dr Rebecca Leon

Absolutely. And I, and I think unfortunately, particularly with ovarian cancer, it used to be termed the silent killer, which we don’t really like to use anymore.

And I know a lot of gynaecologists don’t like to use this. But when I was chatting, on the module, with Professor Jason and he said something that I always think about. The pelvis has got a lot of room, so things can move around. And if you have a big ovarian mass sitting there, well actually things move away from it, as in bowel, bladder, uterus. There’s room for it to, to expand without the symptoms presenting till quite late. If you compare that to the head to the brain, the smallest amount of change, pressure, will show symptoms. So, a brain tumour even if it’s very small, may cause pressure type symptoms and then you actually present with that.

But actually, with pelvic changes, pelvic cysts, pelvic masses, ovarian cancers, actually, it can be significantly large, significantly advanced until actually symptoms present. And that’s always the difficulty with ovarian cancer. So, I mean, they’re often overlooked, and so we just need to try to get to diagnose ovarian cancer to an earlier stage.

Dr Sarah Taylor

Yeah, and I think that it, you know, these women are unlikely to have changes to their periods because the ovarian cancers don’t tend to.

Dr Rebecca Leon

Absolutely.

Dr Sarah Taylor

Or certainly, you know, it’s not anything that’s going to help you, particularly if they’ve got changes to their periods. So, I think it, and a lot of them, as we said, a lot of them are postmenopausal and they’re unlikely to have bleeding. So it, it is difficult and I think it’s just having that high index of suspicion, probably accepting that the tests aren’t a hundred percent effective and doing them, simultaneously and as you say, just safety netting.

Dr Rebecca Leon

Absolutely. Because actually just going back to the IBS thing, which we see so often in general practice. A third of the population have some form of IBS.

So, we have quite a difficult job.

Dr Sarah Taylor

We do.

Dr Rebecca Leon

Ellen, was there anything that you wanted to ask, query, mention?

Dr Ellen Macpherson

Yeah. So, you said, they’re kind of moving away from speaking about it as the, the silent killer.

Dr Rebecca Leon

Yeah.

Dr Ellen Macpherson

Is, is there, what, what’s kind of the reasoning behind that? I mean, my understanding was [00:20:00] that is because it’s not actually silent, it’s just that the symptoms are vague. It’s not that there are no symptoms. Is that right? Or have I got that wrong?

Dr Rebecca Leon

What do you think, Sarah?

Dr Sarah Taylor

I think you’re, I think you’re probably right. I think, yeah, I think when we spoke, we had the face-to-face event and we had the gynaecologist came. She said that upper GI symptoms are something that you should take seriously as an early indicator, didn’t she?

She said that feeling of getting full quickly. And dyspepsia also sometimes are an early indicator of ovarian cancer. But also, as you know, it, it is really difficult, isn’t it? Because it’s, they are all really common and, it is quite difficult to know quite when to investigate. I, I think it’s all down to the safety netting and sort of, a lot of things will get better in a week or two, but if they haven’t, then we do need to think again.

Dr Rebecca Leon

Yeah, yeah. And I think that you’re absolutely right, Ellen, about the silent, whether it’s vague. And I, and [00:21:00] I think the scare mongering with the killer bit, it’s, you know, when you think of whether the killer, I think I, I’ve got thinking about, you know, a big shark or something, you know, it’s like a silent killer coming to get you.

Um, so, sorry, or a whale don’t know. But, it’s, yeah, I think they wanted to get away from the word killer because it’s not great terminology. And, but I just wanted to just mention something because you know I like my fun facts. I suppose it’s not really a fact, it’s more of something that I heard on another podcast. In ancient Greek times that they used to, they were fascinated by the human, but particularly women’s anatomy.

And they felt that the uterus was almost just floating around on its own in the body. And unless it was weighed down by child, or by moistened male seed, then it would float around. Apologies for using that, but that’s exactly how it was, written in the ancient Greek textbooks. And if it wasn’t weighed down, it would float around and it would go even as kind of as high, as high as the hearts.

That’s what they thought. So that’s why it was really important for the fertility of women to make sure that it was weighed down. So anyway.

Dr Sarah Taylor

Perpetually pregnant.

Dr Rebecca Leon

Perpetually pregnant, or trying to get pregnant. Yes, that’s right. So, yes, what a thought.

So as far as the CA125, Ellen, have you managed to find anything?

Dr Ellen Macpherson

I have, yes. And I, I’m sorry, but I don’t think I’m going to be, helping with your, your fear about it being not a very good test. Here are some of the things that have been listed as things that can also elevate your CA125. So epithelial ovarian cancer, so we know that one. Fallopian  tube cancers, endometrial cancers, endometriosis, lung cancers, pancreatic cancer, breast cancer, colon cancer.

What else have we got? Normal pregnancy.

Dr Rebecca Leon

Yeah. Pregnancy. Yeah.

Dr Ellen Macpherson

Pelvic inflammatory disease, menstruation can raise it.

Dr Rebecca Leon

Wow.

Dr Ellen Macpherson

Which is. Not very helpful. Pancreatitis, cholecystitis, cirrhosis, peritonitis. So, the list is very, very long.

Dr Sarah Taylor

Okay. Almost feels like a sort of, and anyone else who knows me type of thing, doesn’t it?

Dr Rebecca Leon

I think with the CA125 also if it’s significantly high, sometimes if they’re kind of bobbing around the 40 mark, I’d maybe repeat it in something.

Dr Sarah Taylor

Yeah, I think if you’ve got the ultrasound as well though, I think that that gives you a lot more indication, doesn’t it?

Dr Rebecca Leon

Just, as being Mrs. NICE, Mrs. NICE guidelines.

Dr Sarah Taylor

I know that’s not meant as a compliment either, is it?

Dr Rebecca Leon

What does the NICE guidelines actually say about, should we be doing the scan and the CA125 together, or should one be done first?

Dr Sarah Taylor

I think that’s, I think the CA125 is supposed to be done first.

Dr Rebecca Leon

Yeah, I thought so.

Dr Sarah Taylor

But I think that, practically speaking, I would, I think most people will do them simultaneously.

Dr Rebecca Leon

So, Sarah’s name is now, Mrs. NICE.

Okay. So, I think the two cases have shown that, it was more of a barn door, but again, it was a case that we would see more frequently. Our first case with the postmenopausal and the bloating and actually not diagnosing IBS at such a, an older person, you need to start thinking about other differentials, including ovarian cancer.

And the second case, which was more tricky, was our younger 36 year old with a significant family history.

So, I think it’s important that we wrap this podcast up by talking about some of the key clinical points. Sarah, are you happy to start with the first one?

Dr Sarah Taylor

I think it’s just that awareness, isn’t it? It’s thinking about ovarian cancer, particularly in women over 50 with new onset IBS symptoms, but being aware of it in younger women as well.

And, and I think that, you know, if you’ve seen a patient who you’ve has got some bowel symptoms and you’ve done a FIT and the symptoms are persisting and I think it’s important to think about ovarian cancer as well and to go ahead and investigate.

Dr Rebecca Leon

So, and just to say, with our FIT test, they also suggest that we do a CA125 as part of the bloods. I don’t know whether it’s just in our area?

Dr Sarah Taylor

Certainly, in our area, if you are referring on a non-site specific vague symptoms pathway, in the bloods that are suggested beforehand, CA125 and a FIT will come up.

Dr Rebecca Leon

Great. Okay. So, I just wanted to reiterate about the CA125. It is a great test, but it also has its limitations including that long list that Ellen gave us, which is basically every medical diagnosis.

But also it can be normal in 25% of ovarian cancers. But hopefully by doing the scan in parallel that will help us out. The CA125 is non-specific. So it can be raised by, by lots of other conditions and also non-gynaecological causes, including, I mean, you [00:26:00] mentioned other kind of cancers like lung and colorectal.

Dr Sarah Taylor

And I think the other thing that I think that’s really important from your case picking upon is the, importance of the family history. And if 15 to 20% of ovarian cancers are hereditary, then we need to be asking patients. It just, it’s, it’s that building up of a picture, isn’t it? It’s getting all the information together and this is a key bit of information that I think it’s one of the things that I need to change and ask, even more often than I do. Well, I don’t ask it that often, but I need to ask very frequently.

Dr Rebecca Leon

And finally, you’re never too young. So, saying what Sarah’s saying, particularly with younger patients, ask about family history. Think outside the box. Think about all possible differentials and safety net, and arrange to see the patient with a certain amount of time if you are concerned about them. Okay.

So, thank you for listening today to this podcast from GatewayC. Alongside this podcast, we have a free ovarian module for healthcare professionals, which is available on the GatewayC website. All references to the studies and guidelines we’ve discussed will be in our show notes.

We really look forward to seeing you next time on the podcast where we’ll be discussing lower GI cancers. And I also want to thank our producers, Louise Harbord from GatewayC and Jo Newsome from ReThink Audio. Before we go, I wanted to just clear up and discuss the positive predictive value, which is something that we touch on in a few of the episodes.

The positive predictive value was used to determine the threshold to encourage clinicians to refer on for a suspected cancer pathway or for urgent tests, and this was agreed at 3%. For more information, we have attached the link via the show notes. And this is through the NICE guidelines, and I would encourage all listeners to have a look at this and understand this in more detail.

Please do press the follow button so you can get the podcast direct your feed and we’d love it if you share this podcast with your friends or colleagues. It really helps spread the word.