Medicosnext
Like any other disease, cancer has become more common than we really realize. The National Institute of Cancer estimates 600,920 cancer deaths in 2017 in the US alone.
The only prevention of these ever-escalating deaths due to cancer is to have an effective screening program every nation should put in place. Every citizen needs to be aware of a solid preventive healthcare plan launched by his or her government. Here, I am trying to compile some easy and non-invasive screening innovative markers a clinical laboratory can offer and make mass-screening program a successful one.
Tumor markers have limitations in sensitivity and specificity, so the result may give a dilemma of false positive and false negative. Tumor markers are not necessarily “normal” for the individual patient, even if the values are within the reference range.
Tumor marker levels decrease (following their half-life period) after effective surgery or therapy of the tumor to the individual baseline values of the patient. These individual baseline values and speed of increase of the markers are the relevant basis for a kinetic-based interpretation during follow-up care.
Serological tumor markers normally use serum as an analyte. The method of analysis normally captures the “tumor marker” proteins, or it measures the concentration of the antigen/antibody (substances) in the serum that can indicate certain types of cancer development. The test results are compared with the normal range, if it is raised way higher than the cutoff value. There are quite lot of serological tumor markers available these days for screening.
PSA test
Concentration of prostate-specific antigen (PSA) in the sample is tested in the laboratory. The value coming higher than the normal value, more than 4.0 ng/mL (cutoff value), will be PSA-positive and recommended for further imaging tests, such as transrectal ultrasound, cystoscopy, etc. There is a chance of false elevation because of infection (prostatitis and UTI), and false decrease in PSA test result may happen because of certain conditions like benign prostatic hyperplasia (BPH).
CA 125 in combination with HE4
These are proteins produced by the fallopian tubes. Higher than normal levels of this protein within the blood are often a sign of cancer, especially ovarian cancer. The cutoff for CA125, which was determined from the distribution of values in healthy individuals, is 0-35 units/mL, and for HE4, it is less than 150 picomoles/L. ROMA (Risk of Ovarian Malignancy Algorithm) is a combination of results of HE4 and Ca125, and supposed to be less than 1.14 ROMA score. There is a well-established ROMA calculator to come up with the ROMA score.
Cancer Antigen (CA) 27.29 and CA 15.3
CA 27.29 is an antigen protein that is associated with breast cancer, as it is considered as the unique identifier for screening tumor marker test. Not to have positive result, the test result is expected to come at less than 38-40 U/mL, meaning there is no active breast cancer. Similarly, to know the response of the anti-cancer drug against breast cancer, there is another innovative tumor marker, CA15.3, which has a cut-off of 30 U/mL.
Alpha-fetoprotein (AFP)
This tumor marker is a wide spectrum indicator of internal organs, and its elevated level is indication of cancer of the liver, testicles, ovaries, stomach, pancreas, or brain, and can also be associated with renal cell cancer, Hodgkin’s disease, or lymphoma. The desired value for screening test to be negative is less than 10 ng/mL.
Carcinoembryonic Antigen (CEA)
It is a protein found in many different kinds of cells, and it is associated with cancer cell. Being a wide spectrum indicator, it is associated with colon and rectal cancer, as well as cancers of the pancreas, lung, ovary, and breast. The desirable value for non-smoker adult is less than 2.5 ng/mL, and not exceeding 5.0 ng/mL for smokers.
Carbohydrate Antigen (CA) 19-9
This protein is found highly elevated in pancreatic or gastrointestinal cancer; science has given a very powerful gift for screening cancers with just few milliliters of blood sample.
Lung Cancer
A combination of multiple serological markers can provide a very clear picture on non small cell lung cancer (NSCLC), such as SCC antigen, CEA ProGRP, CYFRA21-1, and NSE.
As a primary marker, CYFRA 21-1 in the lung, together with value > 30 ng/mL, indicates the existence of primary bronchial carcinoma with high probability.
A clear prognostic value in both early and late stages of NSCLC, high serum levels indicate an advanced tumor stage and a poor prognosis. This marker is essentially very useful in monitoring the course of NSCLC and detection of recurrent disease after primary therapy. A successful therapy is accompanied by a rapid fall in the serum level into the normal range.
Complete blood count (CBC)
Sometimes, it is considered as the poor man’s prescription; however, CBC test substantially contributes to rule in various types of blood disease, including blood cancers.
It is important to wear your own shoes while becoming alert, as nobody knows you better than yourself, specially your food habit, work hazards, personal circumstances, family history, etc. Lifestyle and genetic disorder do play a vital role and increase the risk of developing cancer cells.
So, the frequency of screening for cancer, and knowing which specific cancer screening is to be conducted, are dependent on personal circumstances. The American Cancer Society guidelines on cancer screening in adults begin at the age of 21, such as for cervical cancer. Both men and women are at risk of colon cancer after the age of 50, and all males are at risk of prostate cancer around age fifty. It is obvious that early 50 plus is the prime time to begin regular screenings for these cancer types. Forty plus is the prime age to be tested for breast cancer, and a smoker should be screened for lung cancer after the age of fifty-five.
