Tumor markers

Thru several posts on the Breast Cancer forum, I have learned that the Antigen CA 29.27 test is not recommended by you as a reliable tumor marker.

What are the alternatives that you DO recommend? That test is the only test done by the Hospital in Texas where my wife is being treated. What about the AMAS blood test? or Breast thermography (Imaging).

I need to monitor my wife as closely as I can, in order to make sure her cancer is not spreading.

Please help!

Thanks,
edsol1

[CCF-RN,MSN-JS]

Dear edsol1: Below are the recommended breast cancer surveillance guidelines recommended by the American Society of Clinical Oncology.  This information is based on the data from studies and consensus of experts in the field.  The exact follow-up for an individual takes into account the individual's situation and perceived risk.  If the person develops any symptoms, there should be a low threshold for investigating these.  Recommended Breast Cancer Surveillance :

History of Symptoms:
All women should have a careful history every 3 to 6 months for the first 3 years after primary therapy, then every 6 to 12 months for the next 2 years, and then annually.

Physical Examination:
All women should have a careful physical examination every 3 to 6 months for the first 3 years, then every 6 to 12 months for the next 2 years, and then annually.

Breast Self-Examination:
It is prudent to recommend that all women perform monthly breast self-examination.

Mammography:
It is prudent to recommend that all women with a prior diagnosis of breast cancer have yearly mammographic evaluation. Women treated with breast-conserving therapy should have their first posttreatment mammogram 6 months after completion of radiotherapy, then annually or as indicated for surveillance of abnormalities. If stability of mammographic findings is achieved, mammography can be performed yearly thereafter.

Patient Education Regarding Symptoms of Recurrence:
Since the majority of recurrences occur between scheduled visits, it is prudent to inform women about symptoms of recurrence.

Coordination of Care:
The majority of breast cancer recurrences will have occurred within the first 5 years after primary therapy. Subsequent care of the patient following primary treatment should be coordinated and not duplicated. In addition, continuity of care should be encouraged and conducted by a physician experienced in the surveillance of cancer patients and in the examination of women with both irradiated and normal contralateral breasts.

Pelvic Examination:
It is prudent to recommend that all women have a pelvic examination at regular intervals. Longer intervals may be appropriate for women who have had a total abdominal hysterectomy and oophorectomy.

Breast Cancer Surveillance Testing

[surgeon]

To amplify a bit on the marker issue: the question is whether following given markers for a given cancer actually makes a difference in the care of a patient. You said you want to make sure the cancer isn't spreading, and of course that is the bottom line consideration for anyone with cancer. But there are several factors: first, markers are not so accurate that they mean a cancer is or is not spreading. Second, if the cancer were to spread, and if the markers showed it before anything else did, what would the impact be on survival? That is where the data show no impact, and therefore, except in research situations, it's not felt to be of value in managing a cancer patient. It's been shown that symptoms (which is why the above emphasizes history and physical) are as good as -- in fact better than -- any other screening in deciding when further investigation ought to be done. The hard truth is that, at our current levels of understanding and treatment of cancer, once it has spread there is no treatment, begun at any time after the discovery of spread, that can cure it. So when studies are done to determine whether early detection by means other than history and physical can be shown to impact longterm survival, they show no difference. That is not to say that there's no worthwhile treatment when the cancer spreads; in fact, in many people it can be controlled for years and years. It's just that such control is no better if spread is detected at a particular time by a blood test, than at a later time by other means. And given that the tests are not sure-fire in detecting spread, or in ruling it out, they aren't really of use. The rate of discovery of new tests and new treatments is increasing impressively. Much better cancer care is on the horizon -- and it's a lot better now than just a few years ago!

[charwillia]

A related discussion, lab question was started.