Serial tests of carcinoembryonic antigen in patients with breast cancer

Carcinoembryonic antigen (CEA) was performed as part of the follow-up tests in 243 patients who had mastectomy and in 57 patients who had recurrent or metastatic disease. In the former group, 50 patients developed recurrent disease and 48% had elevated CEA levels (greater than 5 ng/ml). Among the 193 patients known to be without recurrence, 12% also had elevated CEA's. Evaluation of 161 CEA tests in 107 patients with known relapse showed that only 8% of those with chest wall recurrences had abnormal CEA's, while 30-81% of those with visceral metastasis had higher levels. If 20 ng/ml of CEA is used as the cut-off point, no patients with chest wall or nodal recurrence had elevated values, while 12-13% of those with bone or lung disease and 29-38% of those with pleura and liver metastasis had higher values. The rate of rise is faster also with visceral metastasis. When the elevated CEA level is greater than 20 ng/ml, and when the metastatic lesion responded to systemic therapy, the rate of fall of CEA levels was similar to the rate of rise prior to treatment, and remained fairly constant for the individual patient.