While some breast oncologists will order tumour markers or imaging studies such as CT scans in people who are thought to be in remission, the recommendation is not to check these in people who’ve had breast cancer but are feeling fine.
Dear Dr. Roach: Please discuss the significance of blood tests to show the level of cancer markers to identify cancer and track the efficacy of treatments. I am 69 and have metastatic breast cancer, diagnosed in July 2022. The primary cancer was treated in 2018-2019 with surgery, chemotherapy and radiation. During treatment, my oncologist ordered bloodwork to monitor the level of CA-15-3 and CA 27.29. When a PET-CT scan showed no traces of cancer, the levels were in the low 20s.
During my three years of remission, my oncologist never checked the levels of the markers, stating that they weren’t diagnostic tools, but rather were used only to show trends during treatment. In July 2022, I had a breathing crisis, and CT scans showed a new mass. At that point, the markers were in the 130 range. I started treatment and regular bloodwork showed those markers decreasing until February 2023. I’m now receiving new treatment to keep the tumour down.
Tumour markers, like CA-15-3 and CA 27.29, are blood tests that tend to correlate with specific cancer activity. Prostate specific antigen, or PSA, in prostate cancer is one of the most commonly known, and it’s one of the few found useful for screening. A healthy person should have very low amounts of the tumour marker, while a person with extensive cancer should have a very high level.
Studies to see whether they help have shown no benefit. There is the potential for harm from unnecessary evaluation for false positive results. The current recommendation is for mammograms and a physical exam and history. New technology called “cell-free DNA” might have the potential to revolutionize both surveillance after treatment and early detection of cancer. Clinical trials are in progress. I suspect we will learn many new lessons about cancer development, similar to the lessons we learned when highly detailed imaging studies such as MRI became available. Let’s hope this new screening and detection tool will lead to improved treatment and cures for early cancers.
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