Restrict the use of serum tumour marker tests to the monitoring of a cancer known to produce these markers or where there is a strong known underlying predisposition or suspicion.
The measurement of levels of certain tumour biomarkers is known to be helpful in monitoring the progress of specific cancers in response to treatment or in detecting changes in cancer activity or secondary or recurring cancer. In some circumstances they are helpful adjuncts in detecting specific cancers, where there is a strong known underlying predisposition or suspicion, such as in detecting liver cancer in patients with chronic hepatitis C and cirrhosis. However, the testing for a broad range of biomarkers in patients with non-specific symptoms in the hope of finding an undetected cancer is not supported by the evidence from numerous systematic reviews. Tumour markers generally should not be used in the initial diagnostic pathway and are rarely diagnostic due to low sensitivity and specificity.
- Association for Clinical Biochemistry & Laboratory Medicine. Recommendations as a result of the ACB national audit on tumour marker service provision. 2013. Recommendation Document. Available at http://www.acb.org.uk/docs/defaultsource/guidelines/tumour-marker-guidelines.pdf.
- Duffy MJ, McGing P. Guidelines for the use of tumour markers. Association of Clinical Biochemists in Ireland 2010. Available at: www.acbi.ie/Downloads/Guideline-tumour-markets-4th.pdf.
- National Institute of Health and Care Excellence. Diagnosis and management of metastatic malignant disease of unknown primary origin. NICE Clinical Guideline 104.National Collaborating Centre for Cancer 2010. Available at www.nice.org.uk/guidance/cg104.
- Sturgeon CM, Duffy MJ, Stenman UH, et al. National Academy of Clinical Biochemistry laboratory medicine practice guidelines for use of tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers. Clin Chem 2008;54(12):e11-79.
- Sturgeon CM, Hoffman BR, Chan DW, et al. Laboratory Medicine Practice Guidelines for use of tumor markers in clinical practice: quality requirements. National Academy of Clinical Biochemistry 2008. Available at https://www.aacc.org/science-and-research/practice-guidelines/tumor-markers-quality-requirements.
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.
- 4 Restrict the use of serum tumour marker tests to the monitoring of a cancer known to produce these markers or where there is a strong known underlying predisposition or suspicion.
- 5 Do not routinely test and treat hyperlipidemia in those with a limited life expectancy.