Recurrence of Breast Cancer Among Bangladeshi Women Using Two Serum Protein Tumor Markers, Carcinoembryonic Antigen (CEA) and Carbohydrate Antigen 15-3 (CA15-3): A Prospective Observational Study

Patients with breast cancer may develop recurrence even after adequate primary therapy. Besides clinical examination and imaging, serum protein tumor markers (SPTMs) measurements are used for follow-up. To find out the association of two postoperative SPTMs (e.g., Carcinoembryonic antigen/CEA, Carbohydrate antigen15-3/CA15-3) with the future recurrence of breast cancer among Bangladeshi women. Prospective-observational study was conducted among purposively-selected one hundred Patients (who underwent surgery before six months) during their routine follow-up visit to an oncology/surgical setting in Dhaka Medical College Hospital, Bangladesh. Postoperative CEA (cut-off:5ng/mL) and CA15-3 (30 U/mL) were measured at a single point time by ‘chemiluminescent Immuno assay.' Patients were then followed up for one year to detect any recurrence. Quantitative and categorical variables were compared by Student’s t-test and Fisher’s exact test, respectively. Sensitivity, specificity, and AUC (Area under the curve) of both SPTMs were estimated. Most (64%) of the patients were postmenopausal (Mean-age: 49.8±12.1) with elevated CA15-3 (32%) and CEA (18%). Overall recurrence was 18%, and only CA15-3 was found to be associated with visceral (hepatic and bone) recurrence (P=0.015). The sensitivity and specificity of CEA and CA15-3 were 22.22%, 82.9%, and 66.7%, 75.6%, respectively, while combined sensitivity increased by 6.25%. The AUC of the receiver operating characteristics (ROC) curves were 0.62, 0.82, and 0.88 for CEA, CA15-3, and combination, respectively.  Postoperative CA15-3 has been shown to have the capacity to rule out visceral recurrence with a reasonably high probability. Since the specificity of CA15-3 is pretty good, it may detect early recurrence following primary treatment of carcinoma breast.