Background: Ovarian cancer often presents with nonspecific abdominal symptoms, including bloating, cramping, and change in bowel habit. These symptoms mimic irritable bowel syndrome (IBS), but the latter rarely presents for the first time in middle age or older adulthood. For this reason, NICE guidelines recommend testing a CA125 level in women over the age of 50 presenting with symptoms that could be reflective of ovarian cancer. This audit of a primary care practice aimed to assess the proportion of women diagnosed with IBS after age 50 who have had a CA125 level tested within a year of diagnosis

In the electronic medical record (EMIS), patients were filtered by those who were over 50 years old, either alive or deceased, and had a diagnosis of IBS. These results were further refined by those who had ever had a CA125 test and those who had not. Results were manually screened for date of IBS diagnosis and date of CA125 test. Patients were identified as having had an IBS diagnosis after age 50, from the year 2011 forward (the year NICE guidelines recommended CA125 implementation). These records were then broken down into those who had a CA125 test within a year of diagnosis, and those who had not.

188 women over the age of 50 in the practice had a diagnosis of IBS. • 50 patients who had been diagnosed with IBS after age 50 had not had a CA125 test within a year of diagnosis. • 11 of those diagnosed after age 50 had had the test within a year. • The remainder of patients had had CA125 tests at other times. • Of those diagnosed since implementation of the NICE CA125 guidelines in 2011, 26 had not had an appropriate CA125 test, while 6 had.

The majority of female patients diagnosed with IBS after the age of 50 had not had an appropriate CA125 test. • This did not significantly change after the implementation of the 2011 guidelines (Chi2 test p=0.87, ns) • This represents an area of improvement for the practice. • In order to ameliorate this, an EMIS alert will pop up to prompt consideration of a CA125 level in women over 50 with a new IBS diagnosis. • The practice will be re-audited in a year’s time to close the loop.