blood test for tumor markers

Saw my MO couple days ago and she says it is not reliable and usually now only done for Stage 3 or 4. I have never had them done but others have. Go figure.

I get the 15-3 every six months. Don't know how long that will last, I'm in my fifth year.

Hi JuniperCat:

This is an area where there are differences in individual practice. Not testing for such markers in the absence of symptoms can be within the standard of care. At the same time, in their best clinical judgment, a physician may feel such testing is warranted in the specific case as noted by SpecialK.

See for example this 2015 guideline (emphasis added):

"American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline Laboratory Tests and Imaging"

http://jco.ascopubs.org/content/early/2015/12/07/J...

"Recommendation 1.3. It is recommended that primary care clinicians should not offer routine laboratory tests or imaging, except mammography if indicated, for the detection of disease recurrence in the absence of symptoms (LOE 2A).

Clinical interpretation. Consistent with ASCO Guidelines and NCCN Guidelines®, routine testing with breast cancer tumor markers or imaging studies (eg, bone scan, chest x-ray, positron emission tomography-computed tomography [CT] scans, MRI scans, bio- markers) should not be performed for screening purposes, because they have not been shown to improve survival outcomes or QoL in asymptomatic patients.9,11 Chest x-rays and advanced body imaging (eg, CT, MRI, positron emission tomography-CT, bone scan) should be ordered only if disease recurrence is suspected.39 Randomized trials in the 1980s that compared clinical follow-up with periodic advanced imaging did not demonstrate a survival advantage with advanced imaging and did show a significant rate of false-positive findings with additional testing.40-42"

Obviously, follow-up breast screening and the modalities used (e.g., mammography) should be tailored to the individual, in light of their risk profile, and in this regard, please also see Recommendation 1.2.

In considering any recommendations in this guideline document, please be sure to read the "Guideline Disclaimer" section and the limitations, which states among many other things, "This information does not mandate any particular course of medical care."

Patients should not hesitate to seek current, case-specific, expert professional medical advice about whether any particular recommendation in the guideline applies to them or if there may be reasons to depart from what is provided in their specific case.

BarredOwl

Stage III here. My MO does CA 15-3 and CEA at each six month follow up. So far, there were no fluctuations in these numbers (knock on wood..)

BarredOwl, thank you for posting an excerpt from 2015 ACS guidelines. What struck me, is that they are referring to randomized trials from the 1980s (!!) to argue no survival benefit with early mets diagnosis. I have heard multiple times about no survival benefit but I didn't know this deduction was based on research that is more than 35 years old and done when very few drugs and treatment options were available for stage IV.

Has anybody come across more recent studies confirming the same conclusion, i.e. no survival benefits if mets treatment is started before the first clinical symptoms appear?

Hi BarredOwl, thank you for looking more into this. 1994 studies are old too - I would say that 20 year old research is outdated for this field in our time and age.

We are not talking about metastatic disease management here. Blood tests for tumor markers help in catching mets before they become symptomatic. However, practitioners say - following the above mentioned guidelines I guess - earlier mets diagnosis does not improve survival. If that conclusion is based on 20+ year old research I may react differently to 'no scans until symptoms appear' when I hear it next time.

BarredOwl, the reference 42 you posted uses a table based on its references 11-14 (Table 1 in the study) for determining that tests aren't helpful. Of those, the most recently published was 2005. I looked at that study, http://link.springer.com/article/10.1007%2Fs10549-..., and it followed 472 patients for 5 years between May 1991 and December 1995 only! Wow.

Hi:

I am not followed by an oncologist or by my breast surgeon any longer (but only by a member of her team), so I am reliant to some extent upon my primary care physician. For me, this is an interesting document covering many aspects of survivorship care.

The intent of my original post was to inform people of the existence of an applicable guideline and its general content. I lack the requisite knowledge base and expertise to evaluate the merits of specific recommendations. I have linked to a few related documents, but I have no idea whether or not there may be more current studies available regarding specific markers and/or specific scanning methods.

I encourage anyone with concerns or questions to follow up with their doctors per my first post: "Patients should not hesitate to seek current, case-specific, expert professional medical advice about whether any particular recommendation in the guideline applies to them or if there may be reasons to depart from what is provided in their specific case." The professionals may also have views on the strength or weakness of the data behind any recommendation, and the scope and strength of validation of any particular test, etc.

BarredOwl

I just discovered that my last CA27-29 test went from 20.8 to 34 (3 months later). I am not happy, terribly anxious, and i don't see my oncologist until the end of July. I think the range is 0-38. Any suggestions? Do I have mets? Very nervous

My CA27-29 went from 11 to 31 in 3 months and then 1.5 months later was 41 -- is this something that I should be concerned about?