Evaluation of Serum Levels of Mammaglobin, Carcinoembryonic Antigen, Prolactin, Estradiol and Free Prostate Specific Antigen As Biomarkers of Breast Cancer

Abstract

Background: Breast cancer is a major health concern worldwide and a leading cause of cancer deaths among women. Successful treatment of this disease lies in early diagnosis. The need for an easier method of diagnosis using serum markers prompted this study. Aim: To estimate the serum levels of mammaglobin-A, carcinoembryonic antigen (CEA), free PSA, 17β-estradiol and prolactin of 130 subjects consisting of 80 breast cancer patients and 50 age-matched controls and evaluate their usefulness as markers of breast cancer. Methods: The samples were estimated using ELISA methods. The breast cancer patients were patients attending the surgery clinic of the University of Uyo Teaching Hospital and the controls were recruited from the city of Uyo. Results: There were significant elevations in the serum levels of mammaglobin ( P < 0.001), prolactin ( P < 0.001), CEA ( P = 0.002) and estradiol ( P = 0.005) in patients when compared with the controls. There was no significant differences ( P = 0.25) in the free PSA levels of patients and controls. Correlation analysis showed that, there were significant positive correlations between prolactin and CEA (r = 0.47, P < 0.001), prolactin and free PSA (r = 0.24, P = 0.03), CEA and free PSA (r = 0.55, P < 0.001). The differences in the BMI ( P < 0.001) and age at menarche ( P = 0.001) were significantly higher in the cancer patients than the controls, while those of age ( P = 0.06) and age at menopause ( P = 0.26) were not significant. Patients with breast lump, breast pains, nipple discharge and excessive alcohol consumption showed significant association with breast cancer status. The categorical risk factors showed no significant association with the biochemical markers levels. The elevation in prolactin levels was significantly higher ( P < 0.001) in clinical stage II breast cancer when compared with stages III and IV. The differences in the prolactin levels of the other biomarkers were not significant. The Receiver Operating Characteristic curve showed that mammaglobin has an 87.5% predictive ability to correctly diagnose breast cancer. The other biomarkers showed poor predictive ability. The ROC curve showed that the predictive ability of MAG-A may be enhanced when measured alongside other biomarkers and risk factors. The observed differences in the elevated levels of MAG-A among the cancer stages were not significant. Though the levels of the other biomarkers are raised, they may not be used independently as diagnostic markers for breast cancer diagnosis due to their low sensitivity and poor predictive ability. Patients with family history of breast cancer had significantly higher CEA level than patients without such history. Conclusion: Mammaglobin has a high sensitivity and predictive ability to correctly diagnose breast cancer. Prolactin level is significantly raised in clinical stage II of breast cancer. Studies should focus on standardizing mammaglobin measurement for its use as marker for diagnosis of breast cancer.