Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer

Abstract

Purpose: The primary objective was to determine clinical practice guidelines for the use of tumor marker tests in the prevention screening treatment surveillance of breast colarectal cancers. These guidelines are intended for use in the care of patients outside of clinical trials. Methods: Six tumor markers far colorectal cancer seven for breast cancer were considered. They could be recommended or not for routine use or for special circumstances. In general the significant health outcomes identified for use in making clinical practice guidelines (overall survival disease-free survival quality of life lesser toxicity cost-effectiveness) were used when data were available. Expert consensus was used to inform the recommendations for use of tumor markers when published evidence was insufficient. A computerized literature search was performed using Medline. In addition to reports collected by individual panel members all articles published in the English-speaking literature from January 1989 to April 1994 were collected for review distributed to all members of the Panel. Values for use utility levels of evidence were assigned by the expert reviewers approved by the Panel. Tumor markers were assigned benefit if they had prognostic or predictive value that would lead to the favorable outcomes listed above. Harms considered were inappropriate disease management excess cost without definable benefit. Costs were considered but were never the sole determinant of a recommendation. Results Conclusion: For colarectal cancer it is recommended that carcinoembryonic antigen (CEA) levels be measured preoperatively if it would change surgical management. It is recommended that CEA levels be monitored every 2 to 3 months for ≤ 2 years if resection of liver metastasis would be clinically indicated. The data are insufficient to recommend the routine use of lipidassociated sialic acid (LASA) CA 19-9 DNA index DNA flow cytometric proliferation analysis p53 tumor suppressor gene ras oncogene. For breast cancer estrogen receptor progesterone receptor are recommended to be measured an every primary specimen but on subsequent specimens only if it would lead to a change in management. The data are insufficient to recommend the routine use of DNA index DNA flow cytometric proliferation analysis CA 15-3 CEA c-erbB-2 p53 or cathepsin-D. In the absence of readily measurable disease CA 15-3 CEA levels can be used to document treatment failure. New markers new evidence will be evaluated by annual update of these guidelines.