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Requests for Tumor Marker Tests in Turkey Without Indications and Frequency of Elevation in Benign Conditions

  • Cure, Medine Cumhur (Department of Biochemisty, University of Recep Tayyip Erdogan) ;
  • Cure, Erkan (Department of Internal Medicine, University of Recep Tayyip Erdogan) ;
  • Kirbas, Aynur (Department of Biochemisty, University of Recep Tayyip Erdogan) ;
  • Yazici, Tarkan (Department of Biochemisty, University of Recep Tayyip Erdogan) ;
  • Yuce, Suleyman (Department of Internal Medicine, University of Recep Tayyip Erdogan)
  • Published : 2012.12.31

Abstract

Aims: To investigate the incidence of ordering tests for tumor markers which are used in cancer diagnosis, follow-up treatment and detection of recurrence, the rate of elevation in benign diseases and which clinics order them frequently. Materials and Method: Data for the tumor markers carbohydrate antigen 19-9 (CA 19-9), carcinoembryonic antigen (CEA), cancer antigen 125 (CA 125), cancer antigen 15-3 (CA 15-3) and alpha-fetoprotein (AFP) that were ordered by all the clinics in our Hospital between 2010 and 2011 were screened. When excluding repeated orders the results of 3,416 patients were available. It has been determined that in which benign diseases were the tumor markers frequently ordered and which of these conditions had high levels of them. Results: CA 19-9 was ordered for 1,858 patients 191 (10.3%) were malignant while 1667 (89.7%) were ordered in benign diseases. For CEA the total was 1,710, 226 (13.2%) malignant and 1484 (86.8%) benign, and for CA 125 1267, 111 (8.8%) malignant and 1156 (91.2%) benign. AFP was ordered for 1687 cases, 80 (4.7%) malignant but 1607 (95.3%) benign. CA 15-3 was ordered 1449 times, 174 (12%) for malignant and 1275 (88%) for benign diseases. In all cases, considerable proportions were positive. Conclusions: It was shown that clinicians frequently order tumor markers for benign conditions. The findings of this study has shown that tumor markers are used widely without indications as cancer screening tests.

Keywords

References

  1. Amayo AA, Kuria JG (2009). Clinical application of tumour markers: a review. East Afr Med J, 86, 76-83.
  2. Amino N, Kuro R, Yabu Y, et al (1981). Elevated levels of circulating carcinoembryonic antigen in hypothyroidism. J Clin Endocrinol Metab, 52, 457-62. https://doi.org/10.1210/jcem-52-3-457
  3. Ballehaninna UK, Chamberlain RS (2011). Serum CA 19-9 as a biomarker for pancreatic cancer-a comprehensive review. Indian J Surg Oncol, 2, 88-100. https://doi.org/10.1007/s13193-011-0042-1
  4. Bast RC Jr, Badgwell D, LuZ, et al (2005). New tumor markers: CA125 and beyond. Int J Gynecol Cancer, 15, 274-81. https://doi.org/10.1111/j.1525-1438.2005.00441.x
  5. Cheung K, Graves CR, Robertson JF (2000). Tumor marker measurements in the diagnosis and monitoring of breast cancer. Cancer Treat Rev, 26, 91-102. https://doi.org/10.1053/ctrv.1999.0151
  6. Christoforidis A, Lefkou E, Vlachaki E, et al (2007). Evaluation of serum tumour markers concentrations in patients with homozygous beta-thalassaemia in relation to demographical, clinical and biochemical parameters. Ann Hematol, 86, 837-41. https://doi.org/10.1007/s00277-007-0348-9
  7. Collazos J, Genolla J, Ruibal A (1992). Preliminary study of alpha-fetoprotein in nonmalignant liver diseases. A clinicobiochemical evaluation. Int J Biol Markers, 7, 97-102.
  8. Dikensoy E, Balat O, Ugur MG, Ozkur A, Erkilic S (2007). Serum CA-125 is a good predictor of benign disease in patients with postmenopausal ovarian cysts. Eur J Gynaecol Oncol, 28, 45-7.
  9. Dogan UB, Gumurdulu Y, Golge N, Kara B (2011). Relationship of CA 19-9 with choledocholithiasis and cholangitis. Turk J Gastroenterol, 22, 171-7.
  10. Duffy MJ (2001). Clinical uses of tumor markers: a clinical review. Crit Rev Clin lab Sci, 38, 225-62. https://doi.org/10.1080/20014091084218
  11. Escudero JM, Auge JM, Filella X, et al (2011). Comparison of serum human epididymis protein 4 with cancer antigen 125 as a tumor marker in patients with malignant and nonmalignant diseases. Clin Chem, 57, 1534-44. https://doi.org/10.1373/clinchem.2010.157073
  12. Forones NM, Queiroz LA, Ferraz ML, Parise ER (1995). Alphafetoprotein in hepatic tumours and benign liver diseases. Rev Assoc Med Bras, 41, 91-3.
  13. Goonetilleke KS, Siriwardena AK (2007). Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer. Eur J Surg Oncol, 33, 266-70. https://doi.org/10.1016/j.ejso.2006.10.004
  14. Harada T, Kubota T, Aso T (2002). Usefulness of CA19-9 versus CA125 for the diagnosis of endometriosis. Fertil Steril, 78, 733-9. https://doi.org/10.1016/S0015-0282(02)03328-9
  15. Howaizi M, Abboura M, Krespine C, et al (2003). A new cause for CA19.9 elevation: heavy tea consumption. Gut, 52, 913-4. https://doi.org/10.1136/gut.52.6.913
  16. Kannagi R (2007). Carbohydrate antigen sialyl Lewis a-its pathophysiological significance and induction mechanism in cancer progression. Chang Gung Med J, 30, 189-209.
  17. Knudsen UB, Tabor A, Mosgaard B, et al (2004). Management of ovarian cysts. Acta Obstet Gynecol Scand, 83, 1012-21. https://doi.org/10.1111/j.0001-6349.2004.00607.x
  18. Kobeisy MA, Morsy KH, Galal M, et al (2012). Clinical significance of elevated alpha-foetoprotein (AFP) in patients with chronic hepatitis C without hepatocellular carcinoma in upper EGYPT. Arab J Gastroenterol, 13, 49-53. https://doi.org/10.1016/j.ajg.2012.06.004
  19. Krupey J, Wilson T, Freedman SO, Gold P, (1972). The preparation of purified carcinoembryonic antigen of the human digestive system from large quantities of tumor tissue. Immunochemistry, 9, 617-22. https://doi.org/10.1016/0019-2791(72)90247-9
  20. Lim YK, Kam MH, Eu KW, (2009). Carcinoembryonic antigen screening: how far should we go? Singapore Med J, 50, 862-5.
  21. Locker GY, Hamilton S, Harris J, et al (2006). ASCO. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol, 24, 5313-27. https://doi.org/10.1200/JCO.2006.08.2644
  22. Malaguarnera G, Giordano M, Paladina I, et al (2010). Serum markers of hepatocellular carcinoma. Dig Dis Sci, 55, 2744-55. https://doi.org/10.1007/s10620-010-1184-7
  23. Marechal F, Berthiot G, Deltour G (1988). Serum levels of CA-50, CA-19-9, CA-125, CA-15.3, enolase and carcinoembryonic antigen in non neoplastic diseases of the lung. Anticancer Res, 8, 677-80.
  24. Pavai S, Yap SF (2003). The clinical significance of elevated levels of serum CA 19-9. Med J Malaysia, 58, 667-72.
  25. Perkins GL, Slater ED, Sanders MD, Prichard JG (2003). Serum tumor markers. Am Fam Physician, 68, 1075-82.
  26. Ryu JS, Lee HJ, Cho JH, Han HS, Lee HL (2003). The implication of elevated carcinoembryonic antigen level in pleural fluid of patients with non-malignant pleural effusion. Respirology, 8, 487-91. https://doi.org/10.1046/j.1440-1843.2003.00502.x
  27. Sajid KM, Chaouachi K, Mahmood R (2008). Hookah smoking and cancer: carcinoembryonic antigen (CEA) levels in exclusive/ever hookah smokers. Harm Reduct J, 5, 19. https://doi.org/10.1186/1477-7517-5-19
  28. Serefhanoglu S, Buyukasik Y, Emmungil H, et al (2010). Identification of clinical and simple laboratory variables predicting responsible gastrointestinal lesions in patients with iron deficiency anemia. Int J Med Sci, 8, 30-8.
  29. Shiota Y, Furuya K, Kitade M, Ueda N, (1989). CEA and CA19-9 in BALF from patients with idiopathic interstitial pneumonia. Nihon Kyobu Shikkan Gakkai Zasshi, 27, 887-93.
  30. Symeonidis A, Kouraklis-Symeonidis A, Apostolopoulos D, et al (2004). Increased serum CA-15.3 levels in patients with megaloblastic anemia due to vitamin B12 deficiency. Oncology, 67, 359-67. https://doi.org/10.1159/000082919
  31. Symeonidis A, Kouraklis-Symeonidis A, Constantinidou I, et al (2006). Increased CA-15.3 levels in the serum of patients with homozygous beta-thalassaemia and sickle cell/betathalassaemia. Br J Haematol, 133, 692-4. https://doi.org/10.1111/j.1365-2141.2006.06121.x
  32. Szubert M, Suzin J, Wierzbowski T, Kowalczyk-Amico K (2012). CA-125 concentration in serum and peritoneal fluid in patients with endometriosis -preliminary results. Arch Med Sci, 8, 504-8.
  33. Topatan B, Basaran A, (2011). CA-125 and heart failure: reiteration and reappraisal. Int J Cardiol, 153, 76-8. https://doi.org/10.1016/j.ijcard.2011.08.054
  34. Topolcan O, Holubec L, Polivkova V, et al (2007). Tumor markers in pleural effusions. Anticancer Res, 27, 1921-4.
  35. Triantafillidis JK, Cheracakis P, Konstantellou E, Hyphantis T, (2002). Increased serum levels of the tumor marker CA 15-3 on patients with pernicious (Biermer) anemia. Oncology, 63, 306-7. https://doi.org/10.1159/000065495
  36. Wagner IC, Guimaraes MJ, da Silva LK, de Melo FM, Muniz MT (2007). Evaluation of serum and pleural levels of the tumor markers CEA, CYFRA21-1 and CA 15-3 in patients with pleural effusion. J Bras Pneumol, 33, 185-91. https://doi.org/10.1590/S1806-37132007000200013
  37. Witherspoon LR, Shuler SE, Alyea K, Husserl FE (1983). Carcinoembryonic antigen: assay following heat compared with perchloric acid extraction in patients with colon cancer, non-neoplastic gastrointestinal diseases, or chronic renal failure. J Nucl Med, 24, 916-21.
  38. Xiaofang Y, Yue Z, Xialian X, Zhibin Y (2007). Serum tumour markers in patients with chronic kidney disease. Scand J Clin Lab Invest, 67, 661-7. https://doi.org/10.1080/00365510701282326
  39. Yu H, Li R, Zhang L, et al (2012). Serum CA19-9 level associated with metabolic control and pancreatic beta cell function in diabetic patients. Exp Diabetes Res, 2012, 745189.
  40. Yue T, Maupin KA, Fallon B, et al (2011). Enhanced discrimination of malignant from benign pancreatic disease by measuring the CA 19-9 antigen on specific protein carriers. PLoS One, 6, 29180. https://doi.org/10.1371/journal.pone.0029180