The Royal College of Pathologists of Australasia
Recommendations from The Royal College of Pathologists of Australasia about urinary tract infections, PSA testing, vitamin D deficiency screening, serum tumor marker tests and hyperlipidaemia. RCPA is the leading organisation representing pathologists and senior laboratory scientists in Australasia. Its mission is to train and support pathologists and to improve the use of pathology testing to achieve better healthcare.
Do not perform population based screening for Vitamin D deficiency.
The quality of the evidence for the health benefits of an adequate vitamin D status is highly variable. As the main source of vitamin D is UVB sunlight exposure, vitamin D status as assessed by the measurement of 25 hydroxyvitamin D (25OH-D) is correlated with time spent outdoors, exercise and other aspects of a healthy lifestyle including body weight. Vitamin D insufficiency is associated with low levels of exercise, obesity and/or reduced sun light exposure, such as occur more commonly in the elderly, the overweight, the frail and unwell or institutionalised and where there are occupational, racial or cultural reasons. In individuals at risk of vitamin D deficiency, measurement of 25OH-D is an appropriate, case-finding strategy. Routine screening of healthy infants, children and adults (including pregnant women) for vitamin D deficiency is currently not recommended.
- Ajuria-Morentin I, Mar-Medina C, Bereciartua-Urbieta E et al. Lack of transferability between different immunoassays and LC-MS/MS for total 25-hydroxyvitamin D measurement and disagreement defining deficiency. Scand J Clin Lab Invest 2013;73(1):82-6.
- Autier P, Boniol M, Pizot C, et al. Vitamin D status and ill health: a systematic review. The Lancet Diabetes & Endocrinology 2014;(2):76-89.
- Bolland MJ, Grey A, Gamble GD et al. The effect of vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta-analysis. The Lancet Diabetes & Endocrinology 2014;2(4):307-20.
- Cavalier E, Lukas P, Crine Y, et al. Evaluation of automated immunoassays for 25(OH)-vitamin D determination in different critical populations before and after standardization of the assays. Clin Chim Acta 2014;(431):60-5.
- Glendenning P, Chew GT. Controversies and consensus regarding vitamin D deficiency in 2014: whom to test and whom to treat? Med J Aust 2015;202(9):470-1.
- Meyer HE, Holvik K, Lips P. Should vitamin D supplements be recommended to prevent chronic diseases. BMJ 2015;(350):321.
- Schleicher RL, Sternberg MR, Lacher DA, et al. The vitamin D status of the US population from 1988 to 2010 using standardized serum concentrations of 25-hydroxyvitamin D shows recent modest increases. Am J Clin Nutr 2016;104(2):454-61.
- Theodoratou E, Tzoulaki I, Zgaga L, et al. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ 2014;348:g2035.
A list of ten items was compiled after reviewing international literature associated with the Choosing Wisely campaign in Northern America. The College’s advisory committees were canvassed for further relevant evidence based literature and their expert opinions were sought.
The ten items were then adopted as a College Position Statement titled ‘Inappropriate Pathology Requesting’. This list was then sent to RCPA Fellows and Trainees based in Australia to rank the top five tests to include in the Australian Choosing Wisely initiative. The five items selected were approved by both the RCPA's Board of Professional Practice and Quality and the RCPA Board of Directors.
- 1 Do not perform surveillance urine cultures or treat bacteriuria in elderly patients in the absence of symptoms or signs of infection.
- 2 Do not perform PSA testing for prostate cancer screening in men with no symptoms and whose life expectancy is less than 7 years.
- 3 Do not perform population based screening for Vitamin D deficiency.
Restrict the use of serum tumour marker tests to the monitoring of a cancer known to produce these markers. There may be a role, however, for tumour marker measurement in the initial investigation and assessment of high risk or symptomatic individuals.
- 5 Do not routinely test and treat hyperlipidemia in those with a limited life expectancy.