Document 37z7zYyMNxJKOrzQK0LbEdvoy

TO: Steve Ashby - LC VCM Interoffice Communication FROM DATE J. R. Drumwright, M.D. November 9, 1984 SUBJ AFP TEST As you are aware, recent newspaper articles have called the publicTs attention to the AFP (alpha-fetoprotein) Test. In some of these articles the AFP Test allegedly was touted to be a "new diagnostic tools for detecting liver cancer". Therefore, interest has been expressed as to why this blood test was not provided routinely as part of the HEI multiphasic surveillance examination to Vista employee. In the interest of clarification, I would like to provide you with medical information regarding the AFP Test. AFP (alpha-fetoprotein) is one of several embryonic antigens which are detectable during the development of the fetus but are normally repressed in adult life. When other diagnostic tests suggest the presence of neoplastic (cancerous) disease, a battery of additional tests to determine the presence of substances such as AFP are frequently requested by the attending physician. Thus far, none of these tests - even with markedly elevated titers have been recommended as a specific marker for any type malignancy. In other words, the overall lack of specificity and sensitivity prohibit the use of these tests as general diagnostic tests for cancer. (Several are quite useful clinically as monitors of the response to or effectiveness of treatment of a specific cancer, however.) Abnormal titers (levels) of AFP are also found in association with several benign (non-malignant) liver conditions including various forms of hepatitis - especially alcoholic and viral. Elevated levels are detected in the serum of maternal patients with fetal distress or death of the fetus. Other types of malignant growth occasionally produce transient elevations of AFP at various states of their growth. A review of several medical references indicates that most clinicians would reserve the use of the AFP Test for part of a definitive diagnostic workup on patients with advanced liver disease which had previously been detected through the usually accepted "screening tests" - specifically patients presenting signs and symptoms of chronic viral hepatitis or cirrhosis. In conclusion, no references were located to even remotely suggest that AFP be used routinely as a screening test for any form of liver cancer - including angiosarcoma. The standard battery of liver function screening tests currently provided as part of the VAB.0001034498 nm T ipaMM HEI muItipbasic medical surveillance exams is deemed appropriate by medical experts. Hopefully this clarifies any problems regarding this test. Please do not hesitate to contact me if I can be of additional assistance. A ajo 001 cc TGG/JJH bcc R. Gant2 G. Belk, R.N. A. Sather G. Monroe, R.N. I). Kuhn VAB.0001034499