Sinn und Unsinn von Tumormarkern in der Krebsfrüherkennung

Zusammenfassung

Serum-Biomarker sollten im Prinzip nur dann als Tumormarker bezeichnet werden, wenn ihr Nachweis beweisend für eine Tumordiagnose wäre. Wegen der zu geringen Spezifität und Sensitivität der heute verfügbaren Tumormarker sind diese entweder ungeeignet oder, unter bestimmten Prämissen, lediglich mit Einschränkungen geeignet zur Früherkennung von Tumoren (Screeninguntersuchungen). Die unreflektierte Bestimmung von Tumormarkern bei asymptomatischen Personen führt regelmäßig zu Überdiagnostik und Übertherapie. Unbestritten ist der Stellenwert bestimmter Biomarker in der Verlaufskontrolle und Differenzialdiagnose von Tumorerkrankungen.

Abstract

The question of when a certain concentration of a serum biomarker turns into a tumor marker, i. e. an objectively verifiable criterion for tumor diagnosis, leads to the analysis of the specificity (a measure of the proportion of correctly identified healthy individuals), sensitivity (a measure of the proportion of correctly recognized cancer patients), and precision (positive predictive value). Or in short: a tumor marker is specific if no healthy individual has one. This constitutes the problem: The serum concentrations of biomarkers of cancer patients and healthy subjects overlap. Healthy individuals occasionally have "tumor markers" and cancer patients in turn sometimes express inconspicuous biomarkers.

Schlüsselwörter

Tumormarker - Biomarker - Screening - Prostatakarzinom - Mammakarzinom - Ovarialkarzinom - Hepatozelluläres Karzinom - Choosing Wisely - Top Five List

Keywords

tumormarker - cancer screening - false positive results - prostate specific antigen - choosing wisely - top five list

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