Comparison of serum CEA, PHI, and TPA as tumor markers in breast cancer patients

The purpose of this study was to evaluate the clinical significance of different serum tumor markers in patients with breast cancer who developed recurrent disease. Determined were tissue polypeptide antigen (TPA), carcinoembryonic antigens (CEA), and phosphohexose isomerase (PHI). Serum samples of 411 breast cancer patients with either locoregional or metastatic recurrence were analyzed. Positive rates of all three markers depended on the clinical stage of the disease, with highest rates of elevated titers in advanced disease. In comparison, CEA and TPA are more sensitive markers than PHI. According to the site of recurrence, CEA exhibited the highest rate of elevated titers in patients with bone metastases and PHI in patients with visceral metastases. Using PHI in combination with CEA, sensitivity (ie, at least one marker is elevated) was increased by 6-20% compared to the results obtained with single marker analysis. However, for easier interpretation of the tumor marker results in clinical practice, it may be helpful to employ a product value of CEA and PHI.     

Serum tumor markers in metastatic breast cancer and course of disease

The purpose of this study was to compare the diagnostic significance of serum tumor markers in metastatic breast cancer and to evaluate their usefulness in monitoring palliative treatment. One hundred sixty-two breast cancer patients with various disease involvement have been followed-up by serum beta-human chorionic gonadotrophin (beta-HCG), alkaline phosphatase (AP), phosphohexose isomerase (PHI), carcinoembryonic antigen (CEA), and tissue polypeptide antigen (TPA) analysis for 6 to 29 months. In metastatic disease, rates of elevated tumor marker levels ranging between 44% and 91% were found except for beta-HCG (13%). The low rate of positive beta-HCG values did not suggest that routine estimation may be useful. For the other markers, differences in positive rates were seen when site of metastasis, tumor burden, tumor activity, and stage of disease were taken into account. CEA and TPA were shown to be more sensitive indicators for metastatic disease than AP and PHI. TPA was more sensitive but less specific than CEA; both provided almost identical discrimination. In monitoring palliative treatment, a close correlation was found between the clinical course and changes of CEA. AP and PHI frequently became elevated only in very advanced disease, their elevation supported the clinical evidence of progression.     

A study of sputum beta 2-microglobulin and carcinoembryonic antigen in patients with primary lung cancer

Sputum beta 2-microglobulin (beta 2MG) and carcinoembryonic antigen (CEA) levels were measured by enzyme immunoassay and radioimmunoassay, respectively. Sputum beta 2MG levels in patients with primary lung cancer are significantly higher than in those with benign lung disease or metastatic lung cancer. Sputum CEA levels in patients with primary lung cancer are significantly higher than those in patients with benign lung disease. These results suggest that sputum beta 2MG and CEA may be useful in the diagnosis of primary lung cancer.     

A new biomarker in monitoring breast cancer: CA 549

Serum biomarkers are not very reliable in assessing outcome or predicting recurrence of breast cancer. Clinically, carcinoembryonic antigen (CEA) is widely used and is elevated in a majority of patients with metastatic breast cancer. However, it is falsely elevated in a wide range of nonmalignant conditions and correlates poorly with disease progression. We evaluated a newly described monoclonal antibody, CA 549, in an immunoradiometric assay which uses two monoclonal antibodies directed against tumor and milk fat globule membranes. CA 549 and CEA were studied in 682 patients, 331 of whom had breast diseases and 99 of whom were followed with multiple serum samples. Of 69 patients with benign breast diseases, 1.5% had elevated CA 549, 0% of 30 pregnant women had elevated CA 549, and 26% of patients with nonmalignant liver disease had CA 549 elevation. In metastatic cancer of prostate, ovary, endometrium, colon, and lung CA 549 was elevated in 12% to 50% of cases with levels less than 120 U/mL. In breast cancer, CA 549 was elevated in 11% of 88 patients who received adjuvant chemotherapy and had no evidence of metastasis; in 23% of 16 patients in complete remission after chemotherapy; in 63% of 52 patients in partial remission after therapy; and in 83% of 106 patients with progression of breast cancer compared with 63% with elevated CEA (P = .001). In diseases of the breast, CA 549 has a sensitivity In diseases of the breast, CA 549 has a sensitivity and specificity of 77% and 92% v 61% and 92% for CEA. Of 99 patients serially monitored with clinically documented breast cancer progression, regression, or stability of disease, CA 549 was statistically significantly superior to CEA in monitoring a greater than 25% change in those patients with metastatic progression (P = .03). CA 549 is a new serum marker that should be control tested in prospective clinical trials alone or in conjunction with other markers.     

Human tissue polypeptide antigen in breast cancer.

Serum tissue polypeptide antigen (TPA) and plasma carcinoembryonic antigen (CEA) were simultaneously measured in 108 patients with breast cancer, in 40 healthy women, and in 26 women with benign breast disease. TPA levels were elevated (0.09 microgram/ml or higher) in 53% of 19 patients with primary breast cancer, and CEA levels were elevated (2.5 ng/ml) in 21%. Among 67 patients with metastatic breast cancer, TPA and CEA levels were increased in 70% and 61%, respectively. TPA was positive in 13% and CEA in 8% of the healthy women. CEA levels were not elevated in patients with benign breast disease, but levels of TPA were elevated in 27% of those studied. Elevation of TPA levels was more frequent in patients with visceral metastasis having higher values of the test results. Among 22 women with breast cancer who had no apparent cancer recurrence, TPA levels were elevated in 12 and CEA levels in 6. In another group of 39 patients with metastatic breast cancer who received palliative therapy, a limited correlation was noted between the clinical course of the disease and changes in TPA and CEA values measured in linear fashion. Thus TPA appeared to be equal to CEA as a tumor marker in most areas analyzed.     

术前CEA和CA15-3对乳腺癌的临床应用价值

目的:探讨术前CEA和CA15-3对乳腺癌早期诊断的价值及其与临床病理因素的相关性。方法:回顾性分析2000年-2005年1028例乳腺癌患者的CEA、CA15-3水平以及与临床病理因素的关系。结果:CEA、CA15-3联合检测、CA15-3及CEA单独检测对乳腺癌的早期诊断敏感性均低,分别为20.9%、15.3%、9.5%;CA15-3和CEA联合检测在肝、骨和肺转移的阳性率则分别为86.7%、90.9%、45.5%(P=0.030),CA15-3、CEA单独检测对转移病灶的敏感性无差异(P均>0.05)。CEA、CA15-3单独检测及CEA、CA15-3联合检测的阳性率与乳腺癌的临床分期、T分期、N分期呈正相关性,(P均<0.001)。CEA单独检测的阳性率与年龄>45岁、绝经后、ER阴性、PR阴性、Her2阳性有显著相关性(P均<0.05);除CEA、CA15-3联合检测的阳性率与Her2阳性呈正相关,联合检测及CA15-3单独检测与其他因素无相关性。结论:术前CEA和CA15-3对乳腺癌的早期诊断缺乏敏感性,但可作为预测预后的重要指标。     

TPS in breast cancer--a comparative study with carcinoembryonic antigen and CA 15-3.

The serum levels of tissue polypeptide antigen were determined using the M3 monoclonal antibody (TPS) and compared with the serum levels of carcinoembryonic antigen (CEA) and breast carcinoma antigen 15-3 (CA 15-3) in 96 patients with benign breast tumors, in 25 breast cancer patients with no evidence of disease, in 139 preoperative breast cancer patients and in 298 samples of 25 breast cancer patients during therapy monitoring (4-22 samples per patient). The 95th percentile of TPS in 89 apparently healthy females was 51 U/l. The 95th percentile of TPS in patients with benign breast tumors was 55 U/l. The maximum TPS level in breast cancer patients with no evidence of disease was 56 U/l. In preoperative breast cancer the number of patients with TPS levels above the 95th percentile of TPS in benign breast tumors was significantly higher in stage III breast cancer as compared with stage I+II. This was not established for CEA and CA 15-3. During therapy monitoring TPS followed the course of the disease faster than CEA and CA 15-3 in patients with bone metastases, liver metastases, lung metastases and pleural effusion, with one exception. TPS levels could be correlated with progression of disease in patients with normal and steady levels of CEA and/or CA 15-3.     

A profile of serum CA 15-3, carcinoembryonic antigen,alkaline phosphatase,and γ-glutamyl transferase levels in patients with breast cancer

The CA 15-3 and CEA concentrations and the alkaline phosphatase (ALP) and -γ-glutamyl transferase (Gamma GT) activities of serum from 78 patients with breast cancer have been measured. The patients included 27 with localised breast cancer, 19 who had been treated for breast cancer but were now disease-free, 17 with liver metastases, 8 with bone metastases, and 7 with disseminated breast cancer but with neither metastases to the liver or bone. As an indicator of localised breast cancer the predictive value of an increase in CA 15-3 concentration was 93%. As an indicator of metastatic breast cancer the predictive value of an increased CA 15-3 was 62%, whereas the predictive values of an increase in both CA 15-3 and CEA and an increase in CA 15-3, CEA, and ALP 88% and 100%, respectively. A normal CA 15-3 excluded metastatic breast cancer and a normal γ-GT excluded liver metastases. The four tests together provide a set of markers for use in the follow-up of patients with breast cancer. © 1993 Wiley-Liss, Inc.     

Tumour markers in breast cancer.

The clinical usefulness of 8 potential tumour markers has been evaluated in 69 patients with Stage I and II breast cancer and 57 patients with Stage III and IV. Serum CEA concentrations were raised in 13% of patients with local and 65% of those with advanced breast cancer. In patients with clinical evidence of progression or regression of tumour, serum CEA levels changed appropriately in 83% of cases. Taking 4 of the markers (carcinoembryonic antigen (CEA), lactalbumin, alpha subunit and haptoglobin) serum concentrations of one or more were raised in 33% of patients with local disease and 81% of those with advanced breast cancer. However, marker concentrations were often only marginally raised, and are unlikely to provide sensitive guide to tumour burden. CEA, lactalbumin and alpha subunit were detectable in 68%, 43% and 40% respectively of extracts of primary breast cancers.     

多肿瘤标志物蛋白芯片检测中CA125对恶性肿瘤的诊断价值

  目的  探讨多肿瘤标志物蛋白芯片中糖链抗原CA125对恶性肿瘤的诊断价值。  方法  收集第三军医大学大坪医院可供分析的25 076例多肿瘤蛋白芯片检测结果,分析CA125在不同人群、不同肿瘤中升高情况,以及CA125升高伴随其他检测指标升高在肿瘤中的分布情况。  结果  CA125在恶性肿瘤患者中明显高于良性病变患者及正常体检者,而且卵巢癌最高（51.92%）,其次为胰腺癌（49.25%）和肝癌（42.56%）;同时升高的指标以CEA最为常见,其次为CA199、CA242和Ferritin,CA125/CEA同时升高最常见于结直肠癌（83.87%）,其次为乳腺癌（59.72%）,CA125/CA199同时升高最常见于结直肠癌（90.97%）和胰腺癌（78.63%）,CA125/CA242伴随升高最常见于结直肠癌（92.26%）和胰腺癌（74.81%）,CA125+CEA+CA199及CA125+CEA+CA199+CA242升高均最常见于肺癌。  结论  CA125单项指标升高对卵巢癌、胰腺癌及肝癌的诊断有较高的价值,CA125伴随或联合CEA、CA199、CA242检测有利于提高结直肠癌、胰腺癌、肺癌的诊断阳性率。      

Study on carbohydrate antigen NCC-ST-439 in breast cancer

We evaluated the clinical significance of serum NCC-ST-439 (ST439) in sera from 20 healthy women, 8 patients with benign breast disease and 105 patients with breast cancer (79 primary, 26 recurrent) by using enzyme immuno-assay (EIA). No false positive case was noted in the measuring of ST439 for healthy women and patients with benign breast disease. The positive rates of ST439 were 23% (18/79) in primary breast cancers and 50% (13/26) in recurrent breast cancers. The serum levels of ST439 in stage I breast cancer was significantly higher (p less than 0.05) than those in healthy women, but there was no significant difference among each stage. The serum levels of ST439 were not significantly different among the subsets such as T, n, m and histological types. The high levels of serum ST439 were observed in two cases with mucinous carcinoma. Although there were no relation between ST439 and receptor status, the higher serum levels of ST439 were observed in postmenopausal patients than premenopausal ones. The positive frequency of serum ST439 in stage I and II breast cancers was higher than that of CEA, TPA or CA15-3, while the positive rate in recurrent breast cancer was the lowest among 4 tumor markers. These results suggest that ST439 is a useful tumor marker for not only detecting the recurrence of breast cancer but also diagnosing primary breast cancer in early stage.     

CEA levels in serum and BAL in patients suffering from lung cancer

Background Carcinoembryonic antigen (CEA) is a tumor marker belonging to the immunoglobulin gene superfamily of adhesion molecules. CEA is synthesized by epithelial and tumor cells. In this study, CEA levels in sera and bronchoalveolar lavage fluid (BAL) were measured in patients with malignant lung cancer and benign lung diseases. Methods In the present study CEA was measured in serum using IRMA methods and in bronchoalveolar lavage of individuals undergoing fiberoptic bronchoscopy. Fifty patients with lung cancer (G1), 20 patients with benign lung lesions (G2), and a control group consisted of 20 individuals (G3) were enrolled in the study. Results We found that serum CEA levels were significantly higher in G1 compared to G2 and G3 (p < 0.01). No significant difference in serum CEA levels was found between smokers and nonsmokers in any of the three groups studied. CEA was significantly higher in G1 BAL (p < 0.05) compared to G2 and G3 BAL. Furthermore, a statistically significant difference was found in CEA levels in BAL between smokers and nonsmokers of G2. Conclusions CEA levels in BAL of normal individuals may be influenced by smoking and other factors that affect lung epithelial cell function. Thus, CEA measurement in BAL alone has little value in the diagnosis of malignancy. BAL CEA levels in smokers of G2 are found significantly higher compared with nonsmokers of the same group and healthy individuals. Smokers of G2 have to be followed up carefully for the possibility of lung cancer growth.     

Comparison of a novel assay for breast cancer mucin to CA15-3 and carcinoembryonic antigen.

PURPOSE: To compare the sensitivity and specificity of an automated microparticle enzyme immunoassay (MEIA) for breast cancer mucin (IMx BCM; Abbott Laboratories, North Chicago, IL) to that of CA15-3 and carcinoembryonic antigen (CEA) for detecting and monitoring breast cancer. MATERIALS AND METHODS: IMxBCM was compared to assays of CA15-3 and CEA in 630 serum specimens from healthy women, and from women with breast cancer, other malignancies, benign breast conditions, or other benign diseases. RESULTS: Analysis of the log-transforms for the three markers in all specimens showed a high correlation of IMxBCM with CA15-3 (r = .78), but not with CEA (r = .25). Based on a receiver-operating-characteristics (ROC)-curve analysis for any given specificity, IMxBCM was found to be a more sensitive marker than either CA15-3 or CEA for distinguishing 105 women with advanced or metastatic breast cancer from 89 healthy women (P = .003 and P = .04, respectively), from 98 women with benign breast conditions (P = .02 and P = .002), or from 191 women with benign diseases (P = .03 and P less than .0001). At 95% specificity, the sensitivities of IMxBCM, CA15-3, and CEA for detecting advanced or metastatic breast cancer were 69%, 51%, and 30%, respectively. Serial serum samples (n = 177) were analyzed in 20 additional metastatic breast cancer patients with measurable disease. Serial IMxBCM levels corresponded with the clinical course of disease in 80%, CA15-3 in 65%, and CEA in 60% of the 20 patients. CONCLUSIONS: Increased sensitivity of IMxBCM, despite a high correlation with CA15-3, suggests that IMxBCM and CA15-3 may recognize distinct epitopes on the same molecule. Although further research is indicated, IMxBCM may provide a promising marker in the clinical management of breast cancer patients.     

Re-evaluation of HER2 status in metastatic breast cancer and tumor-marker guided therapy with vinorelbine and trastuzumab

BACKGROUND: HER2 is overexpressed in 20-30% of breast cancers. Compared to chemotherapy alone, chemotherapy with trastuzumab improves clinical outcome in patients with HER2-positive metastatic breast cancer (MBC). In general, HER2 status in a primary lesion predicts the status of metastases, so that biopsy of metastatic lesions appears unnecessary. CASE REPORT: A 39-year old woman was diagnosed with primary breast cancer in November 2000. Using the method and scoring system of the DAKO Hercep Test, the tumor has shown low HER2 expression (DAKO score 1+). After failure of several chemotherapy regimens for metastatic disease (liver, skeletal), the patient underwent CT-guided needle biopsy of the liver which showed HER2 positive adenocarcinoma (DAKO score 3+). In consequence, the patient was treated with vinorelbine (30 mg/m2 d1,8,15 q4w) and trastuzumab (4 mg/kg loading dose, 2 mg/kg weekly). During a treatment period of 4 months imaging results as well as tumor marker kinetics indicated an excellent response with sustained decrease of tumor markers. A retrospective analysis of the HER2 shed antigen in metastatic stage revealed excessively increased serum levels and supports HER2 overexpression observed in liver metastasis. The kinetics of the HER2 shed antigen during therapy for metastatic disease were found to be in phase with the kinetics of CEA and CA15-3. CONCLUSION: This case report demonstrates that re-evaluation of the HER2 status may be helpful in single patients not sufficiently responding to treatment of metastatic disease. Determination of HER2 overexpression may be facilitated by a determination of the HER2 shed antigen level in peripheral blood.     

Prognostic value of pretreatment serum carcinoembryonic antigen and squamous cell carcinoma antigen levels for patients with stage I–III non-small cell lung cancer treated with radiation therapy alone

Background Serum carcinoembryonic antigen (CEA) and serum squamous cell carcinoma antigen (SCC Ag) levels have been reported to be useful as prognostic factors, indicators of clinical response, and predictors for recurrence in patients with lung cancer treated by surgery or chemotherapy. We investigated whether pretreatment serum CEA and SCC Ag levels were useful as independent prognostic factors in patients with stage I to III non-small cell lung cancer who were treated with radiation therapy alone. Methods The serum CEA and SCC Ag levels were measured in 158 and 47 patients, respectively, before radiation therapy. Serum CEA and SCC Ag levels were measured by sandwich radioimmunoassay using the CEA-RIA (radioimmunoassay) kit and the SCC-RIA kit. Results Serum CEA and SCC Ag levels were above reference values in 19% and 30% of the patients, respectively. The 5-year survival rates were significantly better for patients with a nagative SCC Ag result than for those with positive SCC Ag levels (P=0.0001), though no significant difference in survival rates was seen by CEA positivity (P=0.25). SCC Ag positivity (P=0.0006) and stage (P=0.04) were the important prognostic factors, as determined by multivariate analyses. Conclusion Pretreatment serum SCC Ag level may be useful as an independent prognostic factor in patients with stage I to III non-small cell lung cancer who are treated with radiation therapy alone.     

New approaches in the diagnostic procedure of malignant pleural effusions

The content of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (Ca 19-9), carbohydrate antigen 15-3 (Ca 15-3) and the expression of LewisY related carbohydrate antigens in benign and malignant pleural effusion were determined. These included 35 malignant pleural effusions: 13 breast cancers, 12 lung cancers (6 squamous cell carcinomas, 5 adenocarcinomas and 1 microcytoma), 2 mesotheliomas, 1 epithelioma, 1 kidney cancer, 1 hepatocarcinoma, 1 colon carcinoma, 3 lymphomas, 1 osteosarcoma and 9 benign pleural effusions. We showed that pleural fluid content of CEA, Ca 19-9 and Ca 15-3 were higher in malignant than in benign effusions. However CEA levels in squamous lung cancers were very high in both serum and pleural fluids whereas its levels were only slightly above the cut-off in breast cancers and in lung adenocarcinomas. Serum and pleural fluid Ca 15-3 values were higher in breast and in lung cancers with the highest values in the patients with breast cancer. Furthermore, the LewisY related carbohydrate antigens, evaluated by the reactivity of the cell extracts to MAb B3, were expressed only in breast cancers. These data suggest that pleural fluid content of CEA, and Ca 15-3 associated with the immunoblotting of cell extracts with MAb B3 appear to be very useful to improve the diagnosis of malignant pleural effusions.     

Tumor markers (CEA, CA 125, CYFRA 21-1, SCC and NSE) in patients with non-small cell lung cancer as an aid in histological diagnosis and prognosis. Comparison with the main clinical and pathological prognostic factors.

CEA, CA 125, SCC, CYFRA 21-1 and NSE were prospectively studied in 211 patients with non-small cell lung cancer and compared with clinical parameters (age, sex, Karnofsky Index, symptoms and smoking status), histopathological parameters (stage, histology, tumor size and nodal involvement), biological parameters (LDH and albumin) and the therapy used (surgery, chemotherapy or radiotherapy). Tumor marker sensitivity was CYFRA 21-1: 76%, CA 125: 55%, CEA: 52%, SCC: 33% and NSE: 22%. One of the tumor markers was abnormally high in 87% of the patients with locoregional disease and in 100% of the patients with metastases. Except for NSE, all tumor markers showed a clear relationship with tumor stage and histology and therefore enabled a better histological diagnosis. Abnormal CEA serum levels were mainly found in adenocarcinomas, CA 125 in large-cell lung cancers (LCLC) and adenocarcinomas and SCC in squamous tumors. Eighty-five percent of the patients with SCC levels >2 ng/ml had squamous tumors. Likewise, CA 125 levels <60 U/ml or CEA <10 ng/ml excluded adenocarcinoma or LCLC with a probability of 82 and 91%, respectively.     

肿瘤标志物诊断肺癌转移的临床价值

目的:检测肿瘤标志物在肺癌与肺癌并转移患者中的水平差异,并分析其鉴别诊断价值。方法:纳入388例肺癌患者及67例肺癌并转移患者,采集血液样本,采用凝集素亲和方法检测肿瘤异常蛋白（TAP）,采用化学发光免疫分析法检测糖类抗原125（CA125）、癌胚抗原（CEA）、细胞角蛋白19片段（CYFRA21-1）、糖类抗原50（CA50）、铁蛋白(FRT)、神经元特异性烯醇化酶（NSE）、鳞状细胞癌抗原（SCC）。比较上述肿瘤标志物在肺癌与肺癌并转移患者中的水平差异,利用受试者工作特征曲线（ROC）,分析肿瘤标志物对两组患者的鉴别诊断价值。利用Logistic回归分析鉴定肺癌转移的风险因素。Spearman相关性分析患者肿瘤标志物之间的相关性。结果:CEA、CYFRA21-1及NSE在肺癌并转移患者中的水平明显高于肺癌患者（P＜0.05）,而其他肿瘤标志物在两组患者之间无明显差异（P＞0.05）。与各自的参考区间相比,TAP在肺癌及肺癌并转移患者中的阳性率最高（>98%）,SCC阳性率最低（<10%）,其他指标的阳性率介于10%~65%。肺癌并转移患者CEA阳性率明显高于肺癌患者（62.69% vs 43.8%,P＜0.05）。ROC分析结果显示,CEA对两组患者的鉴别效能最优（特异性:82%、敏感性:42%）。联合指标分析显示,与其他指标联合并不能明显提升CEA的鉴别诊断价值（P＞0.05）。Logistic回归分析显示,CEA是肺癌转移的风险因素。相关性分析显示,在肺癌与肺癌并转移患者中,各肿瘤标志物之间的相关性不一致。结论:与肺癌患者组相比,肺癌并转移患者中的CEA阳性率及水平均明显升高,对肺癌转移的诊断具有一定的临床意义。     

Breast cancer mucin: an automated assay to detect mucus glycoproteins.

Episialin, a mucus glycoprotein, is a well-known tumor-associated antigen used in a variety of tests to detect the presence of adenocarcinoma. With the introduction of the microparticle-captured enzyme immunoassay (MEIA), a new technique was introduced. We compared this assay with our standard method to detect adenocarcinomas, the measurement of carcinoembryonic antigen (CEA). In breast cancer, the breast cancer mucin (BCM) assay was more often positive in metastatic disease but was not better than CEA in stages I-III. In lung carcinomas, BCM and CEA gave similar results while in colorectal carcinoma, CEA was superior. BCM gave similar results to CA 15.3 in a group of breast cancer patients.     

Evaluation of MSA as a serum marker in breast cancer: a comparison with CEA

In a blind study, 518 serum samples were assayed for serum levels of mammary serum antigen (MSA) by an enzyme immunoassay (EIA) using the 3E1.2 monoclonal antibody. Using 300 IU as the arbitrary cut off to distinguish normal from abnormal individuals, 75% of patients with primary Stage I carcinoma of the breast (n = 12), 89% of those with Stage II (n = 9) and 93% of those with Stage IV (n = 57) had elevated levels of MSA. A relationship was observed between the level of MSA and stage of disease, and therefore with the extent of tumour burden. Levels of MSA were also determined in a series of 19 patients undergoing chemotherapy for breast cancer. Over a 2-24 month period, the change of MSA levels corresponded with the clinical course of the disease in 17 (89%) cases. MSA levels were also raised in some patients with ovarian, colon, lung and kidney cancer, but the average level was lower than in patients with breast cancer. A comparison of CEA and MSA levels in these patients revealed that MSA was a substantially better marker for breast cancer than CEA. The results of this study demonstrate that MSA levels are elevated in patients with breast cancer and may provide a useful means of following the clinical course of patients with this disease.