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this scatter-gun approach to tumour markers is not only costly, but also dangerous. There is no such thing as 100% sensitivity or specificity in tumour markers, and I do not permit tumour markers from A&E, as the results are not going to be available for decision making (which may well be erroneous anyway) within 4 hours. Abdo pain in isolation is not sufficient justification for any of these in A&E which is not much more than a 'population screen' (how many of you have ever had Abdo pain ?) Population screening with CEA has reported sensitivity of 36 - 43% in several reports. For the non-gamblers, tossing a coin has sensitivity 50 % with best wishes Richard Richard Mainwaring-Burton Consultant Biochemist Queen Mary's Hospital Sidcup, Kent DA14 6LT 020-8308-3084 -----Original Message----- From: Craig Webster [mailto:[log in to unmask]] Sent: 21 April 2004 17:09 To: [log in to unmask] Subject: Re: Assaulting patients with added tests The not doing of tests comes down to whether you are consulting an expert in the laboratory or just ordering a test. If we take the example of tumour markers, one of the most popular requests from A&E at the moment goes along the lines of: Stomach pain ? Cause with U&E, Ca, LFT, Thyroid Function tests, CEA, CA125 (if female), CA199, CA153, PSA, AFP & HCG should we just do this because its been ordered or actually think about the finite resources the NHS has and actually try and direct appropriate investigations? I'm interested because it does seem from some of the arguments that the lab should be a black box and just do what we are told. Regards Craig Craig Webster Principal Clinical Biochemist Nottingham City Hospital -----Original Message----- From: owner-acb-clin-chem-gen [mailto:owner-acb-clin-chem-gen] Sent: Wednesday, April 21, 2004 3:17 PM To: cwebste1 Subject: Re: Assaulting patients with added tests ---------------------- Information from the mail header ----------------------- Sender: Clinical biochemistry discussion list ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/