Tumour Marker Testing in early-Stage Breast Cancer

A study recently published in the Journal of Clinical Oncology examined the use of serum tumour markers in the follow-up of women who had been diagnosed with early-stage breast cancer in the US.

This group of women are those who have been treated for breast cancer and found not to have any evidence of spread of the cancer at the time of treatment.

The American Society of Clinical Oncology (ASCO) has published guidelines which say that serum tumour markers should not be used in the follow-up of this group of patients. The reason for this is that these women are very unlikely to have residual cancer that could be detectable by serum tumour markers and so any positive test results are much more likely to be false-positive results. These false-positive results will lead to unnecessary further investigations that may be harmful to the person involved and will also cause unnecessary worry and expense.

The research team from the Fred Hutchison Cancer Research Center in Seattle used Medicare reimbursement data to identify over 39,000 women with breast cancer who had been followed for at least two years so they could identify women who had no disease recurrence in that time. They found that over 40% of these women had at least one tumour marker test and many had multiple tests. Those women who were tested were much more likely to have further testing such as expensive imaging investigations and to have unnecessary chemotherapy. The cost incurred in the care of these patients was almost 30% higher than in those patients who did not have tumour-marker testing.

We do not have any studies from Australia to tell us what is happening here so we don’t know if a similar situation exists in Australia. This is another example of unnecessary and potentially harmful use of pathology testing. Studies have shown that patients frequently overestimate the likely benefits of medical interventions and underestimate the potential adverse effects and so are vulnerable to accepting unnecessary interventions. For more information read our article on Validation, Use and Interpretation of Laboratory Tests.

Further reading:
J Clin Oncol abstract
J Clin Oncol editorial

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