ASCO Patient Guide: Tumor Markers for Breast Cancer

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ASCO Patient Guide: Tumor Markers for Breast Cancer

Introduction

2007

To help doctors give their patients the best possible care, the American Society of Clinical Oncology (ASCO) asks its medical experts to develop recommendations for specific areas of cancer care. In 2001, ASCO published a clinical practice guideline about tumor markers for breast and colorectal cancers. The scope of this guideline was expanded and updated in 2007. This patient guide is based on ASCO's recommendations and focuses specifically on breast cancer. The information about tumor markers for colorectal cancer is included in the ASCO Patient Guide: Tumor Markers for Gastrointestinal Cancers.

As you read this guide, please keep in mind that every person treated for cancer is different. These recommendations are not meant to replace your judgment or that of your doctor. The final decisions you and your doctors make will be based on your individual circumstances.

Information in ASCO's patient education materials is not intended as medical advice or as a substitute for the treating doctor's own professional judgment; nor does it imply ASCO endorsement of any product, service, or company.

Last Updated: October 22, 2007

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Background

A tumor marker is a substance found in a person's blood, urine, or the tumor itself. It is produced by the tumor or the body in response to cancer. Your doctor may suggest tumor marker tests at various stages in the diagnosis and treatment of cancer. When used with other medical tests, a tumor marker test can provide helpful information about the cancer and its treatment.

Tumor markers for breast cancer may be used for one or more of the following reasons:

To help plan treatment with regard to one of the following conditions:
- To find out whether a patient has a cancer with a favorable prognosis (the behavior of the cancer and the patient's chance of recovery) and may not need additional treatment
- To predict whether a specific treatment will successfully treat a patient
To check how a patient is doing over time
To learn the risk of developing cancer (not addressed in this patient guide)
To find cancer before there are any signs or symptoms (not addressed in this patient guide)

The following breast cancer tumor markers are discussed in this patient guide:

Estrogen receptor (ER) and progesterone receptor (PR). Breast cancer cells with ER and/or PR depend on estrogen and/or progesterone to grow. Testing for ER and PR is done to find out if a cancer is likely to be successfully treated with hormone therapy, such as tamoxifen (Nolvadex).

Human epidermal growth factor receptor 2 (HER2). This protein is present in large amounts in 20% to 25% of breast cancers. Anti-HER2 treatments block HER2 to stop the growth of cancer cells. Testing for HER2 helps doctors know if a cancer can be treated with anti-HER2 treatments, such as trastuzumab (Herceptin), and in some cases, may suggest whether additional treatment with chemotherapy may be helpful.

Cancer antigen 15-3 (CA 15-3), cancer antigen 27.29 (CA 27.29), and carcinoembryonic antigen (CEA). These tumor markers are found in 50% to 90% of patients with metastatic breast cancer (cancer that has spread outside the breast). However, high levels may also be a sign of another condition that is not cancer. Some doctors monitor these tumor markers to find an early recurrence (the return of cancer after treatment) in patients who do not show any signs of cancer after surgery, radiation therapy, and/or chemotherapy. A doctor may also use this test to learn whether cancer treatment is working.

Urokinase plasminogen activator (uPA) and plasminogen activator inhibitor (PAI-1). Higher-than-normal levels of these tumor markers in the cancer tissue may mean that the cancer is more aggressive (faster growing). Accurate tests of uPA and PAI-1 require a specific way of saving and storing the tissue, so these tests may not be as common as the other tumor marker tests mentioned in this guide. These tumor markers may be used to guide the use of chemotherapy after surgery for patients with node-negative breast cancer (meaning there is no cancer found in the lymph nodes).

Oncotype DX. This is a test that measures multiple genes at once to estimate the risk of breast cancer recurrence for patients with early-stage, ER-positive, node-negative breast cancer. Patients with a low Recurrence Score may only need to be treated with hormone therapy and can avoid chemotherapy.

Last Updated: October 22, 2007

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Recommendations

Different tumor markers are used at different points in the diagnosis and treatment process. The ASCO recommendations for tumor markers for breast cancer include the following:

For patients with newly diagnosed ductal carcinoma in situ (DCIS):

DCIS means that cancer has not spread outside of the ducts in the breast. It is also called noninvasive breast cancer. No tumor marker tests for DCIS are recommended at this time.

For patients with newly diagnosed invasive breast cancer:

ER and PR tests, to help predict response to hormone therapy after surgery
HER2 test, to help predict response to trastuzumab and other anti-HER2 treatments and some types of chemotherapy

Once these tests are done, the cancer is classified as ER-positive (if the tumor has estrogen receptors) or ER-negative (if the tumor does NOT have estrogen receptors); PR-positive (if the tumor has progesterone receptors) or PR-negative (if the tumor does NOT have progesterone receptors); and HER2-positive (if the tumor does have HER2) or HER2-negative (if the tumor does NOT have HER2). For more information about HER2, read the ASCO Patient Guide: HER2 Testing for Breast Cancer.

For patients with node-negative breast cancer:

uPA and PAI-1 tests, if available, to estimate the prognosis. Patients with tumors that do not have uPA and PAI-1 have a very good prognosis and may not need chemotherapy.

For patients with node-negative breast cancer that is ER-positive and/or PR-positive:

Oncotype DX test, to identify patients who may be successfully treated with tamoxifen alone and may not need chemotherapy

For patients with metastatic breast cancer:

ER and PR tests, to help predict response to hormone therapy
HER2 test, to help predict response to trastuzumab and other anti-HER2 treatments
CA 15-3 and CA 27.29, for monitoring treatment; these should be used along with the patient's health history, a physical examination, and diagnostic imaging tests, such as an x-ray, computed tomography (CT) scan, and/or magnetic resonance imaging (MRI).
CEA, for monitoring treatment; this test should be used along with the patient's health history, a physical examination, and diagnostic imaging tests.

For patients with recurrent breast cancer:

HER2 test, to help predict response to trastuzumab and other anti-HER2 treatments and guide the use of specific chemotherapy

Last Updated: October 22, 2007

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