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Inappropriate Use of Tumor Markers in Asymptomatic Patients: A Systematic Review and Proposed Follow-Up Algorithm
Silvio Matsas1, Allan Roberto Bueso Pineda2, Sakditad Saowapa3
1Center for Hematology and Oncology Studies and Research (CEPHO), Santo André, SP, Brazil.
Asian Pacific Journal of Cancer Prevention : APJCP
|July 29, 2026
Summary
Routine cancer screening with serum tumor markers like CA 125 in asymptomatic individuals is not supported by evidence. These tests often yield false positives, leading to anxiety and unnecessary procedures without proven mortality benefits.
Area of Science:
- Oncology
- Diagnostic Accuracy
- Evidence-Based Medicine
Background:
- Serum tumor markers (e.g., CA 125, CEA, AFP) are widely available but often misused for screening asymptomatic individuals.
- Guidelines advise against this practice due to risks of false positives, anxiety, and invasive procedures.
Purpose of the Study:
- To systematically review the evidence on the use of serum tumor markers for cancer screening in asymptomatic populations.
- To evaluate the diagnostic accuracy and clinical outcomes associated with these markers.
Main Methods:
- Systematic review of PubMed, Cochrane Library, and LILACS up to May 10, 2025.
- Inclusion of studies reporting diagnostic accuracy or clinical outcomes in asymptomatic individuals.
- Data extraction, risk of bias assessment (ROBINS-I, QUADAS-2), and GRADE certainty of evidence.
Main Results:
- 38 studies were included; CA 125 and CA 19-9 were most frequent.
- Consistently low positive predictive values (PPVs) were observed in general asymptomatic populations.
- False positives led to imaging, procedures, and surgery (up to 15% complication rate); no mortality benefit was shown.
Conclusions:
- Routine serum tumor marker screening in asymptomatic individuals lacks evidence and carries risks.
- A structured follow-up framework is proposed for incidentally elevated markers to reduce interventions and optimize resources.