Advancing Screening Protocols: Investigating the Role of Alpha-Fetoprotein Supported by Turkish Ministry of Health Data in Hepatocellular Carcinoma and Germ Cell Tumors

Objectives: This study aimed to deepen our understanding of AFP's role in disease, evaluate its current use as a screening tool for HCC and germ cell tumors, and explore potential improvements in screening protocols to enhance early detection and improve patient outcomes. Methods: The study analyzed the data of AFP test requests between 2017-2021, comprising a total of 15.618.083 tests from 3,213,258 individuals. The AFP levels were determined using the immunoassay method and the results were transferred to the National Health Database, which is referred to as e-pulse by the Ministry of Health. This database encompasses the health records of patients who have sought medical services from all healthcare institutions in Turkey, including their demographic characteristics, laboratory data, medication usage, comorbidities, and other health-related records. Results: The results showed that the average number of tests per person was 4.86, and the number of tests per 100,000 population was 18,899. While the number of AFP tests increased in the earlier years, a noticeable decrease was observed in 2020 and 2021. Comparing genders, the test was more frequently requested for women, with a ratio of 1.46-1.61 for female/male test numbers across the years. AFP testing was most common in the 18-64 age group, followed by patients over 65, while the 0-17 age group had the least number of tests. The study also examined the effectiveness of AFP as a screening tool for HCC. It was found that AFP alone had limitations as a screening test, as its sensitivity varied between 58% and 80%. Conclusion: In conclusion, this study sheds light on the role of AFP as a tumor marker in HCC and germ cell tumors. Although it has limitations as a standalone screening tool, AFP testing, in combination with other diagnostic methods, contributes to the early detection and monitoring of HCC.