Use of serial carcinoembryonic antigen and CA 15.3 assays in detecting relapses in breast cancer patients

SummaryTo evaluate the utility of CEA and CA 15.3 for early diagnosis of recurrence, serial serum determinations of both antigens were performed in 1023 patients (follow-up: 1–10 years, mean 6.2 years) with primary breast cancer (CA 15.3 in 533 cases) and no evidence of residual disease (NED) after radical treatment (radical mastectomy or simple mastectomy and radiotherapy). 246 patients developed metastases during follow-up.Results: CEA and CA 15.3 were elevated (> 10 ng/ml or > 60 U/ml, respectively) prior to diagnosis in 40% (98/246) and 41% (37/91) of the patients with recurrence, with a lead time of 4.9 ± 2.2 and 4.2 ± 2.3 months, respectively. When patients with locoregional recurrences were excluded, sensitivity improved to 46% (CEA) and 54% (CA 15.3), and to 64% with both tumor markers (CEA and/or CA 15.3). Higher levels of both CEA and CA 15.3 at diagnosis of recurrence, higher sensitivity in early diagnosis of relapse, and a higher lead time were found in ER+ (CEA) or PgR+ patients (CA 15.3) than in those that were negative for these receptors in the primary tumor (p < 0.001). Specificity of the tumor markers was 99% for both CEA (777 NED patients) and for CA 15.3 (444 NED patients), respectively. In conclusion, CEA and CA 15.3 are useful tools for early diagnosis of metastases, mainly in those patients with ER+ or PR+ tumors.

[1]  Douglas G. Altman,et al.  Practical statistics for medical research , 1990 .

[2]  Á. Ruibal,et al.  Circulating tumor marker levels in advanced breast carcinoma correlate with the extent of metastatic disease , 1989, Cancer.

[3]  J. Schlom,et al.  Differential reactivity of a novel monoclonal antibody (DF3) with human malignant versus benign breast tumors. , 1984, Hybridoma.

[4]  G. Murphy,et al.  Management and survival of female breast cancer: Results of a national survey by the American college of surgeons , 1980, Cancer.

[5]  N. Zamcheck,et al.  Carcinoembryonic antigen in breast cancer patients: Serum levels and disease progress , 1974, Cancer.

[6]  M S Fox,et al.  On the diagnosis and treatment of breast cancer. , 1979, JAMA.

[7]  A. Cruz,et al.  Results of a 400‐patient carcinoembryonic antigen second‐look colorectal cancer study , 1985, Cancer.

[8]  R. Simon,et al.  Biological markers in breast carcinoma: III. Clinical correlations with carcinoembryonic antigen , 1977, Cancer.

[9]  P. Bruning,et al.  A Sandwich-Radioimmunoassay for a New Antigen (Mam-6) Present in the Sera of Patients with Metastasized Carcinomas , 1985 .

[10]  J. Shuster,et al.  Theoretical and Practical Considerations of the Utility of the Radioimmunoassay for Carcinoembryonic Antigen (CEA) In Clinical Medicine , 1980 .

[11]  R. Legare,et al.  Adjuvant therapy in breast cancer. , 2002, Obstetrics and gynecology clinics of North America.

[12]  D. Wilson,et al.  Carcinoembryonic antigen (CEA) in patients with breast cancer. , 1977, European journal of cancer.

[13]  H. Skipper,et al.  Kinetics of mammary tumor cell growth and implications for therapy , 1971, Cancer.

[14]  Ahlemann Lm,et al.  Serial CEA determinations as an aid in postoperative therapy management of patients with early breast cancer. , 1980 .

[15]  Y. N. Lee.  Carcinoembryonic antigen in patients with breast or colon cancer. , 1978, The Western journal of medicine.

[16]  F. A. Anderer,et al.  Serial carcinoembryonic antigen (CEA) determinations in the management of patients with breast cancer. , 1980, Oncodevelopmental biology and medicine : the journal of the International Society for Oncodevelopmental Biology and Medicine.

[17]  P. Fumoleau,et al.  Use of serial carcinoembryonic antigen assays in detecting relapses in breast cancer involving high risk of metastasis. , 1981, European journal of cancer.

[18]  Á. Ruibal,et al.  Circulating CA 15-3 antigen levels in non-mammary malignancies. , 1989, British Journal of Cancer.

[19]  J H Goldie,et al.  The genetic origin of drug resistance in neoplasms: implications for systemic therapy. , 1984, Cancer research.

[20]  V. Zurawski,et al.  Comparison of circulating CA15-3 and carcinoembryonic antigen levels in patients with breast cancer. , 1986, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  C. Redmond,et al.  Histologic grading of breast cancer. , 1980, Pathology annual.

[22]  N. Zamcheck,et al.  Carcinoembryonic antigen (CEA) levels in benign gastrointestinal disease states , 1978, Cancer.

[23]  T. Powles,et al.  Screening for metastases in breast cancer: An assessment of biochemical and physical methods , 1981, Cancer.

[24]  R. Silvestrini,et al.  Kinetics of human mammary carcinomas and their correlation with the cancer and the host characteristics , 1974, Cancer.

[25]  V. Devita.  The james ewing lecture. The relationship between tumor mass and resistance to chemotherapy. Implications for surgical adjuvant treatment of cancer , 1983, Cancer.

[26]  S. Wells,et al.  Evaluation of carcinoembryonic antigen as a plasma monitor for human breast carcinoma , 1978, Cancer.

[27]  E. Casals,et al.  Value of Determination of CEA and PHI Levels in Breast Tissue: Correlation with Steroid Receptors , 1985 .

[28]  J H Goldie,et al.  Mathematical models of drug resistance and chemotherapy effects. , 1989, Cancer treatment and research.

[29]  G. Falkson,et al.  Role of plasma carcinoembryonic antigen in evaluating patients with breast cancer treated with adjuvant chemotherapy. , 1979, Cancer treatment reports.

[30]  J. Shuster,et al.  Carcinoembryonic antigen (CEA) in clinical medicine. Historical perspectives, pitfalls and projections , 1978, Cancer.