NICE NG12 Update, April 2026: What Changed in Suspected-Cancer Referral

NICE reviewed NG12, the guideline on suspected-cancer recognition and referral, on 15 April 2026. Three changes matter for primary care: age-banded CA125 thresholds for ovarian cancer, clearer referral for endometrial cancer in postmenopausal bleeding, and a defined pathway for unexplained weight loss.

This post is a plain-English summary of what changed for busy clinicians. The authoritative source is the NICE guideline itself. We summarise; we do not replace NICE, and nothing here substitutes for clinical judgement on an individual patient. (NICE's current term, "suspected cancer pathway referral," is the referral many clinicians still call the two-week wait.)

Ovarian cancer: CA125 now reads by age

This is the change most likely to alter a decision at the desk. Instead of a single CA125 cut-off for everyone, NICE now sets age-banded thresholds for arranging urgent ultrasound in people aged 40 and over, and steers away from CA125 alone in younger patients.

• Under 40 — do not use serum CA125 in isolation. Consider an urgent, direct-access ultrasound scan of the abdomen and pelvis.
• 40 and over — measure CA125 in primary care, then arrange urgent ultrasound if it reaches the age-specific threshold:

• If the ultrasound suggests ovarian cancer, make a suspected cancer pathway referral.

The point to internalise: the older bands are lower than the familiar 35. A CA125 of, say, 28 in a 65-year-old would once have looked reassuring; under the updated thresholds it warrants urgent imaging.

Endometrial cancer: postmenopausal bleeding

• 55 and over with unexplained postmenopausal bleeding that cannot be attributed to HRT — make a suspected cancer pathway referral for endometrial cancer.
• Under 55 with the same presentation — consider a suspected cancer pathway referral.

Postmenopausal bleeding on HRT still needs a clinical judgement about whether it is genuinely attributable to the HRT; where it is not, the referral criteria apply.

Unexplained weight loss: a defined pathway

• 60 and over with more than 5% mean weight loss over a 6-month period — assess, and offer urgent investigation, a suspected cancer pathway referral, or a non-specific symptoms pathway referral.

This gives an anchor to one of the harder presentations in general practice: the older patient losing weight without an obvious cause, where the right next step has often been left to instinct.

What it means in practice

Two of these are refinements of familiar pathways; the ovarian CA125 change is the one worth a note on the wall. The threshold you act on now depends on the patient's age, and for much of the at-risk range it is lower than the number most of us memorised.

Referral guidance changes rarely make headlines and reliably catch people out at exactly the wrong moment. A weekly read of what actually changed is how an update like this reaches you before a missed referral does — which is what we built The Monday Clinical Brief to do. Our pillar guide on keeping up with the medical literature sets out the wider habit.