0393-6155/124-08$04.00/0 INTRODUCTION Tumor markers have gained considerable popularity in various countries in the last two decades for a num- ber of reasons: i) tumor marker determination is simple and patient acceptance is good; ii) the cost of tumor marker assays is relatively low in comparison with the majority of other diagnostic tools (1); iii) frequently, tu- mor marker levels are effectively associated with the presence of a malignancy. In spite of this, the scientific community has repeatedly advocated a more cautious use of tumor markers, because in several instances their ultimate impact on clinical endpoints (i.e. survival, quality of life, costs) has not been proved (2, 3). In addition, in the last years the restriction of the available resources for health care has become an im- portant problem in several countries (4-6), prompting the appropriate use of diagnostic tests. The preparation and dissemination of clinical practice guidelines seems an effective way to reduce the variability of medical be- havior and to improve the appropriate use of diagnostic tools. However, in the case of tumor markers the role of guidelines is limited by the relative scarcity of the available evidence (2). A huge amount of data has been published as a result of the feasibility of rapid retro- spective evaluations, but in the majority of cases the study design methodology is inadequate to support con- clusive recommendations (2,7). The existence of con- troversies concerning the diagnostic effectiveness of tu- The International Journal of Biological Markers / Vol. 13 no. 3, pp. 124-138 © Wichtig Editore, 1998 How tumor markers are used in the routine follow-up of breast and colorectal cancer. A survey of 29 Italian hospitals M. GION 1 , P. BARIOLI 1 , A. PONTI 2 , V. TORRI 3 , R. MIONE 1 , R. DITTADI 1 1 Center for the Study of Biological Markers of Malignancy and National Center for the Application of Biotechnologies in Oncology, Regional Hospital of Venezia, Venezia 2 Epidemiology and Oncology Prevention Center for the Piedmont Region, Epidemiology Unit, Torino 3 Mario Negri Institute, Milano - Italy ABSTRACT: The impact of tumor markers on the outcome of several malignancies is still under debate. This relative uncertainty leads to a subjective approach to their use. Monitoring the use of tumor markers is a valuable tool to identify the need for educational policies. We conducted a survey to evaluate how tumor markers are routinely used in the follow-up of patients with breast, colorectal and ovarian carcinoma. The former two malignancies are considered in the present paper. We surveyed 35 Italian hospitals; 29 (83%, accounting for 26,622 hospital beds) filled in and returned the questionnaire. Overall, 467,361 tumor marker requests were scruti- nized by the surveyed hospitals. We found a wide variability in the type and number of routinely used markers, the cutoff points chosen, and the clinical decisions taken on the basis of marker results. In addition, we observed a relative lack of communication between clinicians and clini- cal pathologists in around 50% of the surveyed hospitals. In these cases clinical information was not provided to the laboratory and methodological aspects were not communicated to clini- cians. From the findings of the present study we conclude that the cooperation between clini- cians and clinical pathologists must improve before guidelines for the use of tumor marker as- says can be framed and the compliance with these guidelines can be checked. Request forms for tumor marker assays should therefore be designed to contain clinical information and the quali- ty of filling in request forms with clinical data should be carefully monitored. (Int J Biol Mark- ers, 1998; 13: 124-38) KEY WORDS: Tumor markers, Test request, Appropriateness, Clinical guidelines Gion 29-01-1999 15:32 Pagina 124