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Kilpatrick and Lind, as well as Sturgeon et al (1) in the same issue
of print BMJ, give an excellent account on the interpretation and
appropriateness of requesting serum tumour markers. Despite numerous
guidelines and authoritative recommendations against, many clinicians
continue to put blind faith on panels of tumour markers as opportunistic
screening tools for cancer (2), despite some lack of knowledge as to the
type of malignancy a marker may be of value in (3).
An audit on CA19-9 requests carried out in our hospital over a
month's period (N=48) confirmed similar findings. It showed that 93.2% of
requests were part of a series of tumour markers requested, with 85.4% of
requests used for screening for malignancies. 12.5% of CA19-9 requests
were inappropriately requested for patients presenting with
cardiorespiratory complaints alone, while 6.3% of requests were for
patients presenting with confusion alone. More worryingly, in 35.4% of the
requests of CA19-9, no intra-abdominal imaging investigations were
arranged as first line investigations for suspected pancreatic cancer,
against recommendations by UK guidelines (4).
Therefore, this article was timely to remind clinicians of the
inappropriate reliance on serum tumour markers alone as "magic bullets" to
diagnose or exclude malignancies.
References:
1. Sturgeon CM, Lai LC, Duffy MJ. Serum tumour markers: how to order
and interpret them. BMJ 2009;339:b3527.
2. McDonnell M. An audit of tumour marker requests in Northern
Ireland. Ann Clin Biochem 2004;41(pt5):378-84.
3. McGinley PJ, Kilpatrick ES. Tumour markers: their use and misuse
by clinicians. Ann Clin Biochem 2003;40:643-7.
4. Pancreatic Section, British Society of Gastroenterology;
Pancreatic Society of Great Britain and Ireland; Association of Upper
Gastrointestinal Surgeons of Great Britain and Ireland; Royal College of
Pathologists; Special Interest Group for Gastro-Intestinal Radiology.
Guidelines for the management of patients with pancreatic cancer
periampullary and ampullary carcinomas. Gut. 2005;54 Suppl 5:v1-16.
Competing interests:
None declared
Competing interests:
No competing interests
13 October 2009
Richard Kia
Specialty Registrar in Gastroenterology and General (Internal) Medicine
John Dawson
Arrowe Park Hospital, Arrowe Park Road, Wirral CH49 5PE
Inappropriate reliance on serum tumour markers
Kilpatrick and Lind, as well as Sturgeon et al (1) in the same issue
of print BMJ, give an excellent account on the interpretation and
appropriateness of requesting serum tumour markers. Despite numerous
guidelines and authoritative recommendations against, many clinicians
continue to put blind faith on panels of tumour markers as opportunistic
screening tools for cancer (2), despite some lack of knowledge as to the
type of malignancy a marker may be of value in (3).
An audit on CA19-9 requests carried out in our hospital over a
month's period (N=48) confirmed similar findings. It showed that 93.2% of
requests were part of a series of tumour markers requested, with 85.4% of
requests used for screening for malignancies. 12.5% of CA19-9 requests
were inappropriately requested for patients presenting with
cardiorespiratory complaints alone, while 6.3% of requests were for
patients presenting with confusion alone. More worryingly, in 35.4% of the
requests of CA19-9, no intra-abdominal imaging investigations were
arranged as first line investigations for suspected pancreatic cancer,
against recommendations by UK guidelines (4).
Therefore, this article was timely to remind clinicians of the
inappropriate reliance on serum tumour markers alone as "magic bullets" to
diagnose or exclude malignancies.
References:
1. Sturgeon CM, Lai LC, Duffy MJ. Serum tumour markers: how to order
and interpret them. BMJ 2009;339:b3527.
2. McDonnell M. An audit of tumour marker requests in Northern
Ireland. Ann Clin Biochem 2004;41(pt5):378-84.
3. McGinley PJ, Kilpatrick ES. Tumour markers: their use and misuse
by clinicians. Ann Clin Biochem 2003;40:643-7.
4. Pancreatic Section, British Society of Gastroenterology;
Pancreatic Society of Great Britain and Ireland; Association of Upper
Gastrointestinal Surgeons of Great Britain and Ireland; Royal College of
Pathologists; Special Interest Group for Gastro-Intestinal Radiology.
Guidelines for the management of patients with pancreatic cancer
periampullary and ampullary carcinomas. Gut. 2005;54 Suppl 5:v1-16.
Competing interests:
None declared
Competing interests: No competing interests