What Are Tumor Markers For Breast Cancer

Imaging Tests Have Risks And Costs

The biggest risk is that imaging tests expose you to radiation. The effects of radiation add up over your lifetime and can increase your risk of cancer.

Imaging tests can also show a false positive. This means a test shows something unusual, but after more testing, is not a problem. False positives can lead to stress, more tests, and a delay in getting needed treatment.

Imaging tests can also add thousands of dollars to your treatment costs. Not all insurance companies pay for them for early-stage breast cancer.

Detection Rates At Baseline

CTC and serum marker values at inclusion repartition in percentile, mean, median range are given in Table and Figure . Values for serum markers are expressed in ULNV: upper limit of normal value. Table shows elevated serum marker and CTC incidence rates at baseline: CA 15-3 and CYFRA 21-1 were the two most commonly elevated serum markers. Serum markers and CTC were highly correlated to performance status, number of metastatic sites and to each other. Table shows the percentage of patients who had at least one marker elevated at baseline according to different marker combinations. As expected, this percentage globally increases with the number of markers assessed. However, the combination of CA 15-3 and CYFRA 21-1 retrieved almost the same positivity rate than all four markers .

Table 1 CTC and serum marker values repartition at inclusion

Breast Cancer Tumor Markers Suggested By Healthcare Professionals

The American Society of Clinical Oncology has considered 13 biomarkers that can be used to help in screening, prevention, and treatment of breast cancer. Healthcare professionals might suggest some specific breast cancer tumor markers which are associated with the development of breast cancer. The list includes:

These biomarker tests are recommended by doctors for early detection of breast cancer as well as to measure the treatment progress. If biomarker levels remain high despite treatment, your healthcare professional might go for an alternate treatment plan to produce better results. Sometimes the tests come negative during the disease, showing low levels. Yet, it does not mean your body is cancer-free.

The biomarker tests also act as companion diagnostics. Research and development for novel therapies and biomarkers are well under their way and new methods are experimented on to be used in the healthcare industry. One such diagnostic method is known as a liquid biopsy where tumor material is collected from blood and urine. Recently, the FDA has approved a liquid biopsy test back in 2019, to detect the EGFR gene, a biomarker responsible for telling lung cancer status.

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Tumor Markers: What Role They Play In Breast Cancer Care

Once youve been through a breast cancer diagnosis, treatment and recovery, theres one question that will always be on your mind: Will my cancer return?

You may have heard about, or been asked by family or friends if breast cancer recurrence can be monitored by a blood test. This is a test for tumor markers, which can potentially detect cancer activity in the body.

What Are The Limitations Of Tumor Marker Tests

Tumor marker tests can provide a lot of helpful information, but they arent fail-safe. Just because a person has tumor markers, it doesnt always mean cancer is present or has come back. Conditions besides cancer can raise tumor marker levels. Other limitations include:

• Tumor markers can go up and down over time, making it hard to measure them consistently.

• The level of a tumor maker may not go up until after the cancer is advanced.

• Some cancers dont make tumor markers that can be found with current tests.

• Some people dont have higher tumor marker levels even if the type of cancer they have usually makes tumor markers.

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What If You Have Already Had Breast Cancer

If you had early-stage breast cancer and have no signs that your cancer has returned, you may not need imaging or tumor marker tests. It is not likely that your cancer has returned. These tests usually do not help you live longer. And they can lead to a wrong diagnosis and unneeded treatments.

Usually, the best way to monitor your cancer is to have a mammogram each year and a physical exam every six months. And watch for symptoms, such as a new lump or pain in the breast. Studies show that most breast cancer that returns is found through symptoms, not imaging tests.

Guide To Tumor Markers Used In Cancer

This is a table of the most often used tumor markers, the cancers they can be found with, non-cancerous health issues that can cause them to be high, and the range of normal results.

In cases where the half-life is listed, this should be kept in mind when checking levels. For example, the PSA half-life is 2-3 days, so if the level were checked the day after surgical removal of the prostate, it would still be raised. If the level were checked a week later, the result should be zero, or very close to zero, if no prostate cells remain.

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How Are Tumor Marker Tests Done

There are 3 ways your doctor can test for tumor markers: a blood test, a urine test, or a biopsy. A member of your health care team will send a sample of your blood or urine into a laboratory for analysis. If a biopsy is done, a doctor will remove a small amount of tissue that will be examined by a pathologist under a microscope.;You may need to repeat your tumor marker tests, because your tumor marker levels can change over time.

Is There Anything Else I Need To Know About Tumor Marker Tests

The information provided by tumor markers may be limited because:

• Some noncancerous conditions can cause tumor markers.
• Some people with cancer don’t have tumor markers.
• Not all types of cancer have tumor markers.

So, tumor markers are not usually used by themselves to diagnose or monitor cancer. But they can be useful when used along with other tests.

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What Are Breast Cancer Tumor Markers

Breast cancer tumor markers are substances, usually proteins or hormones, that are produced by the body in reaction to a tumor or by the tumor itself. They are found in the blood, urine or tissues or in the tumor tissue. Different markers indicate different stages of tumor progression and tumor growth, and they can be used to guide diagnosis and treatment and to predict prognosis.

The first stage of breast cancer detection is the mammogram, ultrasound or breast magnetic resonance imaging exam, all of which are sensitive enough to detect breast cancer before any symptoms are noticeable. If there are any suspicious signs, then a biopsy is carried out, and only then are tests for breast cancer tumor markers given. The tests are not sufficient by themselves, because the proteins and hormones that they detect are sometimes produced in the body by other conditions.

What Do The Hormone Receptor Test Results Mean

A test called an immunohistochemistry is used most often to find out if cancer cells have estrogen and progesterone receptors. The test results will help guide you and your cancer care team in making the best treatment decisions.

Test results will give you your hormone receptor status. It will say a tumor is hormone receptor-positive if at least 1% of the cells tested have estrogen and/or progesterone receptors. Otherwise the test will say the tumor is hormone receptor-negative.

Hormone receptor-positive breast cancer cells have either estrogen or progesterone receptors or both. These breast cancers can be treated with hormone therapy drugs that lower estrogen levels or block estrogen receptors. Hormone receptor-positive cancers tend to grow more slowly than those that are hormone receptor-negative. Women with hormone receptor-positive cancers tend to have a better outlook in the short-term, but these cancers can sometimes come back many years after treatment.

Hormone receptor-negative breast cancers have neither estrogen nor progesterone receptors. Treatment with hormone therapy drugs is not helpful for these cancers. These cancers tend to grow faster than hormone receptor-positive cancers. If they come back after treatment, its often in the first few years. Hormone receptor-negative cancers are more common in women who have not yet gone through menopause.

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Monitoring Response To Therapy In Advanced Disease

Traditionally, International Union against Cancer criteria have been used for assessing response to therapy in patients with advanced breast cancer . UICC criteria include physical examination, measurement of lesions, radiology, and isotope scanning . Multiple studies and 3 multicenter trials , however, have shown that changes in serial concentrations of tumor markers, particularly CA 15-3, correlate with response. In 2 of these multicenter trials, the alterations in tumor marker concentrations were shown to correlate well with UICC criteria . Indeed, the use of markers to monitor therapy has several advantages over conventional criteria, including increased sensitivity, more objective measurement, and more convenience for patients .

On the basis of data from 11 low-level evidence studies , an ASCO Panel concluded that 66% of patients with chemotherapy-induced disease regression exhibited decreases in marker concentrations, 73% of those with stable disease had no significant change in marker concentrations, and 80% with progressive disease displayed increasing concentrations . In most of these studies, a change in CA 15-3 concentration >25% was regarded as a significant alteration.

Predicting Response To Therapy

As with prognostic factors, the available therapy-predictive markers in breast cancer, such as estrogen receptor, progesterone receptor, and HER-2 , all require tumor tissue for analysis. Preliminary findings, however, suggest that high serum HER-2 concentrations are associated with both poor response to endocrine therapy and cyclophosphamide-methotrexate-5-fluorouracilbased chemotherapy but can predict an improved response to a combination of trastuzumab and chemotherapy . These preliminary findings should now be confirmed in a large prospective trial.

CA 15-3 and other MUC-1related markers may also have a role in predicting response to therapy. Ren et al. recently reported that overexpression of MUC-1 in a mouse model system conferred resistance to cis-platinum. This resistance appeared to result from the ability of MUC-1 to inhibit apoptosis. Clearly, studies should now be carried out to determine whether either tumor tissue or serum concentrations of MUC-1related markers predict response/resistance in patients undergoing treatment with platinum-based therapies.

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Are There Different Types Of Tumor Markers

There are different types of tumor markers for different types of cancer. Certain tumor markers are associated with only 1 type of cancer. Other tumor markers are associated with more than 1 cancer. However, many cancers have no known tumor markers, so tumor marker testing may not be an option. Researchers continue to look for new and more effective tumor markers.

Tumor Markers In Breast Cancer Systematic Review

ABSTRACT

Background:Objective:Methodology:Results:

REFERENCES

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Does Every Cancer Type Have A Tumor Marker

There is not a known tumor marker for all types of cancer. Also, tumor markers are not raised in all cases of the cancers they are used for, so they are not helpful for all patients. For example, carcinoembryonic antigen is a tumor marker used in colon cancer, yet only 70-80% of colon cancers make CEA. This means 20-30% of people with colon cancer will not have a raised CEA level. Only 25% of early stage colon cancers have a raised CEA. Because of this, CEA cannot always help find colon cancer in its early stages, when cure rates are best.

The bottom line is, tumor markers can be very helpful in watching a person’s response to treatment and, in some cases, watching for the cancer to return. However, they need to be used along with your healthcare providers exam, any symptoms you are having, and radiology studies .

Do You Need Tests For Later

Imaging tests. If your cancer is stage IIIB or IV, you should get an imaging test to look for cancer in other parts of your body. Treatment can depend on how much and where the cancer has spread.

Tumor marker tests. If you have later-stage breast cancer, your doctor may also use blood tests to look at tumor markers. These tests should be done only when it is known that you have advanced cancer.

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

09/2012

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Why Are Tumor Marker Tests Used

Along with other tests, tumor marker tests can help doctors diagnose cancer and recommend a treatment plan for an individual. Why, when, and how often these tests are done varies greatly from person to person. Rarely, they are used to help screen for a particular type of cancer in people with a high risk of the disease before they have signs and symptoms. But doctors mainly use tumor marker tests to:

• Figure out how well a treatment is working

• Predict a persons chance of recovery

• Predict how likely it is a cancer will come back after treatment and find it if it does

What Do The Results Mean

Depending in what type of test you had and how it was used, your results may:

• Help diagnose the type or stage of your cancer.
• Show whether your cancer treatment is working.
• Help plan future treatment.
• Show if your cancer has returned after you’ve finished treatment.

If you have questions about your results, talk to your health care provider.

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What Is Breast Cancer Staging

To determine the stage of your cancer, doctors look at how large your tumor is, where it is, and if it has spread. They also look at your medical history, physical exams, diagnostic tests, and tests of your tumor and lymph nodes.

• Early-stage breast cancer includes stages 0, I, II and IIIA .
• In stage 0, there are abnormal cells in the ducts or lobes of the breast. They have not broken through the wall of the duct or spread.
• In stages I, II, and IIIA, there is a tumor. It may have spread to lymph nodes under the arm, but it has not spread anywhere else.

Bluecross Blueshield Of Tennessee Medical Policy Manual

Serum Tumor Markers for Breast Malignancies

DESCRIPTION

Serum tumor markers are shed by certain tumors into circulation where they can be detected and measured. Diagnosis of a suspected malignancy requires a marker that is specific for a given tumor. For breast cancer, the serum tumor markers CEA, CA 15-3 and CA 27.29 have been investigated for monitoring advanced disease and to assist in determining whether to continue with a particular type of therapy, terminate its use, or switch to an alternative therapy.

POLICY

• Measurement of serum tumor markers for breast malignancies is considered medically necessary if medical appropriateness criteria are met.

• Expanded serum tumor marker panels involving additional markers are considered investigational.

• Measurement of any other serum tumor markers as a technique to diagnose, determine prognosis, select therapy or monitor for recurrence of breast malignancy is considered investigational.

MEDICAL APPROPRIATENESS

• Measurement of serum tumor markers for breast malignancy is considered medically appropriate if ALL of the following are met:

• Serum tumor markers include ONE or MORE of the following:

• CA 15.3

IMPORTANT REMINDERS

ADDITIONAL INFORMATION;

Data are insufficient to recommend use of CEA, CA 15-3 and CA 27.29 without clinical assessment for monitoring response to treatment.

ORIGINAL EFFECTIVE DATE:;9/1998

ID_BT

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