Significance of tumor markers during the follow-up of women without symptoms after treatment of primary breast cancer.

In Berlin, 23-24 February, 1995, during a "consensus-meeting" several German Oncological Societies ratified their guidelines for the follow-up after primary treatment of breast cancer. In women without symptoms and with no anamnestic or clinical signs for relapse or metastases routine X-ray diagnostics (except mammography), bone scintigraphy, ultrasound and other technical imaging procedures and laboratory evaluation including tumor markers are not obligatory. The relevance of continuously rising tumor markers (e.g. CEA, CA 15-3, MCA) without tumor-related symptoms or manifestation of relapse or metastases is not yet sufficiently studied to give exact information for specific treatment selection. Before this can be done, these factors must not only be shown to be prognostic, their therapeutic relevance must be established by controlled clinical trials. Two examples of such ongoing trials are mentioned. Today's follow-up after curative treatment of local or locoregional breast cancer is symptom-orientated. More data must be accumulated eventually showing, which subgroups of patients could profit from the very early detection of a subclinical metastasizing process. So far these data are lacking, and the use of tumor markers to intensively search for very early metastases does not help the patient or the physician. It gives rise only to unanswerable questions, is costly and time consuming and therefore seems useress.