Elevated serum carcinoembryonic antigen and prognosis of breast cancer patients postmastectomy.

To evaluate the clinical significance of elevated carcinoembryonic antigen (CEA) titers in the follow-up of patients with breast cancer, 282 patients were analyzed retrospectively. All patients showed elevated CEA titers, ie, titers equal to or above 5 ng/ml on at least one occasion. The time interval from mastectomy ranged from 3 months to 7 years. Recurrent disease became clinically evident in 52% with a mean lead time of 5 months. No recurrence was found in the remaining patients despite a mean observation time of 20 months and repeated intensive search for metastases. However, taking into account the height and the further course of the titers, CEA measurement was helpful in predicting recurrent disease at an early stage. CEA titers above 30 ng/ml and constantly elevated or increasing titers were associated with a high frequency of recurrence. Although no correlation was found between site of recurrence and course of CEA, patients with soft tissue metastases exhibited lower CEA titers as compared with patients with visceral or osseous lesions. Furthermore, CEA titers encountered before clinical detection of recurrence were of prognostic value with regard to survival. Titers above 50 ng/ml and an increasing course of CEA were associated with diminished life expectancy. By summary, serial CEA assays were a helpful laboratory tool for early diagnosis of recurrent breast cancer.