Tumour markers: their use and misuse by clinicians

Ann Clin Biochem 2003;40:643-647
doi:10.1258/000456303770367234
© 2003 Association for Clinical Biochemistry

 

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Original Articles


Peter J McGinley and
Eric S Kilpatrick


Department of Clinical Biochemistry, Hull Royal Infirmary, Hull HU3 2JZ, UK;
Department of Clinical Biochemistry, Hull Royal Infirmary, Hull HU3 2JZ, UK


Background: Several guidelines exist on the appropriate useof serum tumour markers in the management of patients with cancer.This study audited tumour marker requesting against these guidelinesin a busy teaching hospital over a 12-month period.

Methods: All marker requests from 1 April 2001 to 31 March 2002were collected using the laboratory computer. From one 24-hperiod, the case notes from all hospital requests [excludingprostate-specific antigen (PSA)] were examined.

Results: Tumour marker workload increased by 125% from 1997-98to 2001-02. Of 27 323 tumour marker requests, 7166 were fromgeneral practice, 2312 were requested on hospital admissionbefore further investigation, 612/3636 of CA125 and 98/374 ofCA15.3 requests were on men and 12/11585 PSA requests on women.Of 34 case notes examined, 18 had tumour markers measured beforebiopsy and only nine after. Of 19 patients with ‘normal’ markers,one had malignancy on biopsy and, of 15 with one or more raisedmarkers, four had normal biopsies.

Conclusions: Tumour marker workload is rapidly increasing. Tumourmarkers are frequently and inappropriately requested, eitherbecause they are on patients of the wrong sex, or because theyare taken before a cancer diagnosis is reached. Results fromthese tests can be falsely reassuring or unduly alarming.


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