The Dangers of Using Tumor Markers to Evaluate Nonspecific Symptoms

Abstract

A woman in her 50s with idiopathic dilated cardiomyopathy (ejection fraction, 15%-20%), quiescent celiac disease, chronic diarrhea due to active lymphocytic colitis, and treated hypothyroidism presented with malaise and anorexia of several weeks' duration.She did not have abdominal pain, nausea, vomiting, weight loss, or fever. Given her age and nonspecific symptoms, the clinician was concerned for possible cancer. As part of her initial workup, levels of carbohydrate antigen 19-9, carcinoembryonic antigen, and cancer antigen (CA)-125 were measured. The CA-125 level was elevated, at 210 U/mL (normal, Յ35 U/mL). The patient was referred to a gynecologist owing to concern for ovarian cancer. Pelvic ultrasonography and abdominal computed tomography did not reveal evidence of ovarian cancer.Several months later, the CA-125 level remained elevated, at 188 U/mL. A consulting oncologist believed that given the downtrending CA-125 level, a nonmalignant cause of the symptoms was more likely. Three months later, a third measurement found the CA-125 level to be 66 U/mL, thus negating the need for further testing. The patient's malaise and anorexia were subsequently attributed to her worsening heart failure. The elevated CA-125 level was thought to be secondary to gut edema from heart failure and inflammation from lymphocytic colitis. The use of CA-125 measurement in this clinical setting led to a delay in diagnosing worsening heart failure and to patient harm through radiation exposure and anxiety about a potential cancer diagnosis.

Attitudes and health behaviors of middle-aged and older adults with elevated tumor markers in China

“…Many Chinese people receive the TMs test as part of cancer screening regardless of their needs, which is somewhat blinded. The overuse of the TMs test may bring some unexpected problems, such as overdiagnosis, which may be harmful to the asymptomatic people or patients at low risk of cancer ( Mortaji and Lebduska, 2020 ). After getting abnormal results, even if only slightly elevated, people may develop psychological distress and intend to do more tests or even invasive exams to confirm the diagnosis, which may lead to further health care service and additional medical expenditure.…”

Attitudes and health behaviors of middle-aged and older adults with elevated tumor markers in China

“…The overuse of the TMs test may bring some unexpected problems, such as overdiagnosis, which may be harmful to the asymptomatic people or patients at low risk of cancer. 30 After getting abnormal results, even if only slightly elevated, people may develop psychological distress and intend to do more tests or even invasive exams to con rm the diagnosis, which may lead to further health care service and additional medical expenditure.…”

Neoadjuvant Treatment Options in Soft Tissue Sarcomas

“…There are as of yet no specific biomarkers that would predict patient survival or, even better, indicate the optimal type of therapy. The general importance of using proper markers has been pointed out by Mortaji and Lebduska [118]. Kondo and Kawai suggested investigating (for STS) numerous potentially useful molecular proteomic markers which have contributed to cancer therapy, but they did not follow up on their suggestions [119].…”