Practice Guidelines for Tumor Marker Use in the Clinic‪.‬

Healthcare providers are increasingly embracing the principles of evidence-based medicine, which essentially is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients" (1). Appropriately formulated clinical guidelines or protocols can facilitate an evidence-based approach to medicine (2), and numerous guidelines have been developed across a wide range of clinical areas. Available guidelines address issues ranging from the broad (e.g., how to provide medical or surgical services) to the specific (e.g., which diagnostic or screening test to order). Accompanying a comprehensive discussion of the advantages and disadvantages of clinical guidelines, a useful overview of international activity in this area has recently been published (3). Oncology is one important area in which there is increasing interest in outcome- and evidence-based medicine, and several international, national, and regional expert groups have been working to develop guidelines with the ultimate aim of improving the standard of patient care. Because many different specialties contribute to patient care, a multidisciplinary approach to guideline development is always desirable. Inevitably, however, some guidelines focus primarily on clinical aspects (e.g., surgical or medical procedures), whereas others are more specifically laboratory oriented, but the same general principles apply to the development of both. In this review, I briefly outline these principles before reviewing a selection of currently available guidelines for some commonly measured serum tumor markers and considering how these guidelines might best be implemented and improved. The guidelines are of necessity described only in outline because of space constraints; for more detailed information, the reader should consult the original reports, which are often conveniently provided on the web.