Evaluation of Tumor Markers in the Follow-Up of Breast Cancer Patients after Treatment

Purpose: This study evaluates the usefulness of serial CEA, TPA, CA153 and combined modalities in serum levels for screening recurrence in patients with primary breast cancer after surgery, chemotherapy, radiotherapy and hormone therapy. Materials and Methods: CEA, TPA, and CA153 serial serum determinations were performed on 332 patients (median follow-up: 48.9 months) with primary breast cancer. Within the group, there were 195 clinically diagnosed episodes of relapse during follow- up. Comparison among groups by cut-off value, and dynamic changes of 20% and 30% were done. Results: The sensitivity and specificity, determined for circulating tumor markers by cutoff levels were (for CEA)27.91%, 94.38%; (TPA) 63.37%, 53.13%; and (CM 53) 31.40%, 92.50%, respectively. Utilizing 20% dynamic change methods, CEA, TPA and CA1S3 showed sensitivities of 59.30%, 55.23% and 17.44%, and specificities of 18.75%, 38.13% and 99.38%, respectively. Conclusions: In this study, metastatic patients were classified into three categories of sites: viscera, bones and locoregional. Tumor marker sensitivity was clearly related to the site of recurrence; the lowest sensitivity was found in locoregional relapse and the highest was in patients with visceral metastasis, CA153 was more sensitive than CEA in monitoring breast cancer recurrence under cut-off methods but the results were reversed when serum concentration was evaluated by dynamic changes. For single markers, TPA presented the best sensitivity in all fields under cut-off methods, but was surpassed by CEA under dynamic changes for the detection of visceral metastasis. Unlike the other categories, when serum TPA values were determined by dynamic changes, the highest sensitivity was obtained for visceral metastasis detection. Significant elevation predicted new recurrence or tumor regrowth after complete remission. The combined use of CEA, TPA, and CA153 increased the overall sensitivity.