Carcinoembryonic antigen screening: how far should we go?

The role of carcinoembryonic antigen (CEA) in screening has been previously investigated and found to be inefficient because of its low sensitivity and specificity. Nevertheless, it is still used as a tumour marker in health screening packages, often for asymptomatic patients. We aimed to review all asymptomatic patients who were referred to our department for raised CEA, to determine if this was indeed associated with significant pathology, and to what extent the asymptomatic patients should be investigated.

All patients with no gastrointestinal symptoms, and whose only indication for endoscopy was a raised CEA level, were entered into the study group. All the investigations were retrospectively reviewed and any pathology was noted.

There were 217 asymptomatic patients who presented for endoscopy and further evaluation due to raised CEA, from December 1998 to August 2004. After the initial investigations, a total of 20 primary and eight metastatic cancers were found. The malignancies detected included 11 colorectal cancers, two stomach cancers, five lung cancers, one periampullary carcinoma and one ovarian teratoma. There were two cases of metastasis in the lungs and six with liver metastasis. In the subsequent median follow-up period of 13 (range 6-97) months, an additional 16 (7.4 percent) primary cancers were detected.

Asymptomatic average-risk patients who present with raised CEA should be investigated endoscopically and radiologically for commonly-associated cancers, and thereafter followed up for at least two years, as up to 7.4 percent present with a subsequent malignancy.