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MicheleS

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Reply with quote  #1 
Hi Edge,

I had my CA 15-3 measured this week.  It was the 1st time this has been run. (My 1st post-chemo sample hemolyzed and wasn't run.)  It was 27.5.  This particular lab's reference range was 0.5-35.  My oncologist said that he's OK with it being "high normal" but plans to repeat the test in 4-6 weeks. 

So, I'm worrying anyway.  I so wanted a value of less than 5 or something similarly low... My fear of mets is pretty bad, even on my best days.  So... what do you think?? Is there cause for concern?

Thanks, Michele
edge

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Reply with quote  #2 

Michele:

 

It would be premature to be concerned at this point.  First, I assume you are on active treatment still - otherwise CA markers are meaningless and their use outside of active disease is against the evidence and against ASCO guidelines.

 

Now, that said, the second point is that a single reading has no meaning or value, even against the laboratory's random threshold: what matters is the marker's trajectory - it must be rising, and significantly so, and consistently so, over several readings, generally three but at least two, consecutive readings (usually 3 months apart).  Finally, from my own experience - and consistent with field experience - I do not take seriously a sporadic reading below 100.  A reading of 27.5 - wholly in isolation - raises no safety signal or alert.

 


Constantine Kaniklidis

Breast Cancer Watch

edge@evidencewatch.com

MicheleS

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Thank you, my dear.  I feel better already. 

FWIW~ I'm post "big chemo" and am on Avastin.  However, rather than go a whole yr on Avastin, I'm stopping after 9 mos (2 more treatments).

But, my oncologist says he does tumor markers every 12 weeks for 3 yrs in his TN patients... even though it isn't the standard of care.  Then every 6 mos frm yrs 3-5.  He feels like it has helped him to *catch* mets earlier rather than later.  What do you think?? (I'll be having PET/CT scans and brain MRIs on that same schedule.)

Thanks again, Edge.  You helped to spare me lots of anxiety over the coming weeks.

edge

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Michele:

 

I am wholly, even ferociously, in favor of aggressive surveillance for any elevated risk cases (TNBC, IBC, MBC, and HER2+ disease) and I must say I commend your oncologist highly, more should follow his lead.  The safest way to protect potentially elevated risk patients it is precisely what your extremely rare oncologist is doing - as I like to say, "quarterly" monitoring gives no significant "quarter" to undetected advancing disease, and it keeps a patient protected against lengthier surprises. 

 

Your onc deserves a medal and obviously cares, and is militant in the care of, his patients.  It is something that I know our always insightful Gina has brought up and pressed for a long time, and often.  It isn't just oncotherapy that saves lives: rigorous, well-planned and consistent monitoring and follow-up is just as critical.

 


Constantine Kaniklidis

Breast Cancer watch

edge@evidencewatch.com

Primel

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Reply with quote  #5 

Hi all, what is the difference between CA 27-29 and CA 15-3??

edge

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Reply with quote  #6 

Primel:

 

Several well-designed studies have shown that an increase in CA 15-3 or CA 27-29 (also known as CA 27.29 and BR 27-29) after primary and/or adjuvant therapy can predict recurrence an average of 5 to 6 months before other symptoms or tests.  This conforms with and is extended by the 2007 ASCO recommendation for CA 15-3 and CA 27-29 to contribute to decisions regarding therapy for metastatic breast cancer. Their guidance, worth understanding and heading:

 

"For monitoring patients with metastatic disease during active therapy, CA 27.29 or CA 15-3 can be used in conjunction with diagnostic imaging, history, and physical examination. Present data are insufficient to recommend use of CA 15-3 or CA 27.29 alone for monitoring response to treatment. However, in the absence of readily measurable disease, an increasing CA 15-3 or CA 27.29 may be used to indicate treatment failure. Caution should be used when interpreting a rising CA 27.29 or CA 15-3 level during the first 4 to 6 weeks of a new therapy, given that spurious early rises may occur."

 

As to the difference between CA 15-3 and CA 27.29, there is very little but there is some provisional evidence to suggest that CA 27.29 might exhibit superior sensitivity and specificity than CA 15-3, which means fewer false positives and false negatives.  But both CA 15-3 and CA 27.29 can sometimes, not often, be elevated in non-breast carcinomas and even in some non-neoplastic conditions, while also not always being elevated in all women with breast cancer.

 

And I should again underline my previous point above: it is widely recognized how to sense a non-false positive result: if the marker indicates well over 100 U/ml on two consecutive readings, rather than hovering over the upper limit of  normal (~38 U/ml), it is highly likely to be associated with true metastatic progression, false positives being commonly encountered in the lower borderline regions. 

 


Constantine Kaniklidis

Breast Cancer Watch

edge@evidencewatch.com

Primel

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La Deesse
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Reply with quote  #7 
Thanks, Constantine... My oncologist always tests CA 27-29, now only every 6 months instead of every 3.  After surgery (double mast, 1.7cm tumor, stage IIa grade 3, 2 SN+, ER+/Pr+), I was at 5, after chemo it wandered between 18 and 23 to go back down all the way to 3, back to 5 in Jan. and up to 10.9 on the 14th of July (Allons enfants... !!!) bloodwork. The onc did not comment any thing, the whole report showed normal throughout. So I won't worry about that figure, then...  for now...
Evkharisto poly :-)
Catherine
chemoabi

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Angel
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Reply with quote  #8 
Hi to all.  I was diagnosed with early mets because my CA15-3 went to 126 and my CEA went up to 18.  I can remember many times I would argue with my ONC about doing tumor markers because so many had told me how unreliable they are, but in my case they were right on target.  As I look back my Ca15-3 was always high normal over the last 4 years but the CEA was always in normal range.

Constantine if you are reading I have a question.  My CA15-3 is going down slowly with Xeloda and Tykerb, but my last visit the CEA went up.  What are your thoughts about this?  I myself am baffled by this whole thing.

Nicki

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NuttyNickiNurse
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Reply with quote  #9 
Tumor markers are funny things. My TMs were always high normal. My former onc used to run them every time I went for a checkup.

Then one visit they went down to the low normal range. We were so happy.
That was when my cancer was back.

Now, my new onc tests for ovarian/colon markers and one breast cancer marker. But he does not do the CA 27/29.


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