Topic: Tumor Markers

ASCO guidelines are NOT to do tumor markers, except in stage IV disease (American Society of Clinical Oncologists)

http://www.cancer.net/portal/site/patient/menuitem.169f5d85214941ccfd748f68ee37a01d/?vgnextoid=be3784da6c3a5110VgnVCM100000ed730ad1RCRD 
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What to Know: ASCO's Guideline on Tumor Markers for Breast Cancer

Recommendations

Different tumor markers are used at different points in the diagnosis and treatment process. The ASCO recommendations for tumor markers for breast cancer include the following:

For patients with newly diagnosed ductal carcinoma in situ (DCIS):

DCIS means that cancer has not spread outside of the ducts in the breast. It is also called noninvasive breast cancer. No tumor marker tests for DCIS are recommended at this time.
For patients with newly diagnosed invasive breast cancer:

ER and PR tests, to help predict response to hormone therapy after surgery

HER2 test, to help predict response to trastuzumab and other anti-HER2 treatments and some types of chemotherapy
Once these tests are done, the cancer is classified as ER-positive (if the tumor has estrogen receptors) or ER-negative (if the tumor does NOT have estrogen receptors); PR-positive (if the tumor has progesterone receptors) or PR-negative (if the tumor does NOT have progesterone receptors); and HER2-positive (if the tumor does have HER2) or HER2-negative (if the tumor does NOT have HER2). Learn more ASCO's recommendations for HER2 testing.

For patients with node-negative breast cancer:

uPA and PAI-1 tests, if available, to estimate the prognosis. Patients with tumors that do not have uPA and PAI-1 have a very good prognosis and may not need chemotherapy.
For patients with node-negative breast cancer that is ER-positive and/or PR-positive:

Oncotype DX test, to identify patients who may be successfully treated with tamoxifen alone and may not need chemotherapy
For patients with metastatic breast cancer:

ER and PR tests, to help predict response to hormone therapy

HER2 test, to help predict response to trastuzumab and other anti-HER2 treatments

CA 15-3 and CA 27.29, for monitoring treatment; these should be used along with the patient's health history, a physical examination, and diagnostic imaging tests, such as an x-ray, computed tomography (CT) scan, and/or magnetic resonance imaging (MRI).

CEA, for monitoring treatment; this test should be used along with the patient's health history, a physical examination, and diagnostic imaging tests.
For patients with recurrent breast cancer:

HER2 test, to help predict response to trastuzumab and other anti-HER2 treatments and guide the use of specific chemotherapy

Kira 

I had no idea this was used for early stage! Are you guys in the us?

Well, my onc does do tumor markers for early stage and guess what?  Mine are up during chemo!  I started at 27 and 29 before surgery & chemo and now they are up to 47.5!  I am freaking out, needless to say.  I hope they are NOT reliable in my case. 

My onc does the CA.29 test every three months.  There is no harm in asking if you want them to do it.  That's what I did when I wanted the test to see how well I metabolize the Tamoxifen.  I didn't think my insurance company would cover it based on what the plan said, but was willing to pay out of pocket because I wanted to know.  My onc explained why she doesn't usually do it, but didn't seem to have a problem ordering it when I asked her to.  Insurance did wind up paying.  Good luck.

Sue 

Carcharm - if your onc will not do the tumor marker testing ask your primary doctor.  A gal I work with had cancer years ago and no longer sees an onc.  She asks her primary and gets tested annually.  My onc does the tumor marker - CA27-29 along with a CBC.  There is a book called Life after Breast Cancer that discusses various testing alternatives. 

Weet911 - the book I mentioned above states there are MANY reasons for elevated and fluctuating values, many of the reasons have nothing to do with cancer.  Guess what I took from the book is the results can give false negatives and false positives...and in many cases the false positives - mean more tests necessary to determine reason for elevated results. 

Thanks, Sue.  I see mine Dec. 23rd, so I'll ask too (if my chemo brain remembers!).

Linda

LRM, Even healthy women who have never had breast cancer have a postive response to the CA 27.29 test. That is why numbers up to 38 are considered normal.   Your number of 11 is completely normal!  It can still mean there is no cancer in your body.  Doctors use these tests more to look at the trend of results, rather than for an absolute number.  A consistent increase in the numbers is likely to mean something is going on, but even this doesn't happen in all women with recurrences.  This is part of the reason why the use of tumor markers is controversial.  Many doctors don't use them at all because they can be somewhat unreliable.