Screening for metastases in breast cancer: An assessment of biochemical and physical methods

Abstract

Ten tumor markers were measured in serum or urine at approximately three month intervals in patients with breast cancer following mastectomy but before development of overt metastatic disease. In 23 patients who later had metastases, only three markers, alkaline phosphatase, carcinoembryonic antigen (CEA), and gamma-glutamyl transpeptidase (gamma-GT) were consistently abnormal prior to the development of detectable metastases in more than one patient. In half the patients, a "lead interval" of three months or more was obtained using these three markers and little advantage was obtained by the addition of any other biochemical marker. The value of these three measurements was then assessed in a larger group of patients and compared with other tests for metastases. Alkaline phosphatase, CEA, gamma-GT, clinical examination, and chest x-ray were the best indices of the metastatic state in breast cancer, being collectively abnormal in 98% of patients at first presentation with metastases. The authors recommend screening patients postoperatively with these five tests for metastases; more detailed tests should only be carried out if results of one or more these are abnormal.

Utility of C-erbB-2 in tissue and in serum in the early diagnosis of recurrence in breast cancer patients: comparison with carcinoembryonic antigen and CA 15.3

“…Serial increases of these tumour markers were the first sign of recurrence in two out of every three patients with distant recurrence. These results are similar to those reported in smaller series Staab et al, 1980;Chatal et al, 1981;Coombes et al, 1981) and indicate that tumour marker determinations cannot replace other diagnostic procedures, but are useful tools in early diagnosis of recurrence. There are no studies evaluating c-erbB-2 in the early diagnosis of recurrence.…”

“…The usefulness of CEA and/or CA 15.3 for early detection of recurrence in breast cancer is still unclear. Some authors have indicated that elevations of CEA precede the onset of clinically detectable metastatic disease, whereas others disagree with this finding Chatal et al, 1981;Coombes et al, 1981). Sensitivity of CEA and CA 15.3 in patients with metastatic breast cancer does, however, suggest its possible role in the diagnosis of relapse.…”

Gamma-glutamyltranspeptidase levels as an aid in the management of human cancer

“…Plasma GGTP activity levels were determined for 230 patients with melanoma (839 assays), 132 with breast cancer (443 assays), 32 with lung cancer (96 assays), 28 with lymphoma (61 assays), and 13 with hypernephroma (33 assays). GGTP levels were also determined for I20 healthy controls (262 assays), 15 patients with systemic lupus erythematosis (28 assays), and 10 patients with rheumatoid arthritis ( 1 1 assays). The majority of patients attended hospitals and clinics at the University of Oklahoma Health Sciences Center or were seen as outpatients at the Oklahoma Medical Research Foundation.…”

“…Plasma gamma-glutamyl transpeptidase (GGTP) levels were determined in 120 healthy controls, 435 cancer patients, 15 patients with systemic lupus erythematosis (SLE), and 10 patients with rheumatoid arthritis. The mean and standard error of the mean (SE) of the GGTP values from control and cancer patients are shown in Figure 1.…”

Objective measurement of therapeutic response in breast cancer using tumour markers

“…Combinations of tumour markers, including carcinoembryonic antigen (CEA), have been investigated to increase the sensitivity of detecting metastases by biological markers (Franchimont et al, 1976;Coombes et al, 1977a;Coombes et al, 1977b;Cowen et al, 1978;Cove et al, 1979;Coombes et al, 1981;Bezwoda et al, 1981). A much smaller number of studies have reported on the use of CEA in combination with other biological markers in measuring response (Woo et al, 1978;Waalkes et al, 1978;Haagensen et al, 1978;Silva et al, 1982).…”