What is the Cancer Antigen 27.29 Test for Breast Cancer?

CA 27.29 for Monitoring Breast Cancer Treatment and Recurrence

What is the CA 27.29 tumor marker test and what information does it give about breast cancer?. Credit: Istockphoto.com/Stock Photo©dmbaker

What is the cancer antigen 27.29 (CA 27.29) tumor marker test for breast cancer? What does the test mean? How can it be used to look for an early recurrence or monitor treatment for metastatic breast cancer? How long after treatment do you need to wait to see if see if these levels have changed?

Cancer Antigen 27.29 (CA 27.29) - Definition

Cancer antigen 27.29 (CA 27.29) is a blood test that is done specifically for people with breast cancer.

  It is one of the breast cancer tumor markers that can be used to monitor the course of the disease. One version of this test is called the "Truquant BR Radioimmunoassay test."

Where Does CA 27.29 Come From?

CA 27.29 is a monoclonal antibody—that is, a specific type of protein which is produced by a gene called MUC-1. These proteins are "glycoproteins" or mucus-containing proteins which are present on the surface of epithelial cells like breast cancer cells.

Breast cancer cells can shed copies of the CA 27.29 protein into your bloodstream. 

When and Why is the CA 27.29 Test Done?

It can help to break down the different ways in which the CA 27.29 biomarker test may be used.

  • Diagnosis - This test is not often done to diagnose breast cancer - at least not alone. It's mentioned here to make note that the CA 27.29 test is the only blood test used specifically to determine the presence of breast cancer cells. If you have or think you may have early stage breast cancer, this test may be performed to help make your diagnosis.
  • To monitor treatments - The CA 27.29 test is often done to monitor your response to breast cancer treatments. If your levels rise, it may indicate that your cancer is progressing or spreading, and it may be necessary to adjust your treatments accordingly. If your levels fall, it may indicate that your treatment is effectively killing your cancer.
  • To look for early recurrence - If your treatment for breast cancer has been completed, this test may be done at regular intervals to detect an early recurrence of your cancer. An elevation of CA 27.29 occurs, on average, around 5 months before a recurrence is evident based on symptoms or imaging studies alone. Despite this, there is still debate over whether or not finding a recurrence of cancer before symptoms make a difference in the treatment and ultimately, the outcome of the disease.
  • To monitor metastatic cancer (status check) - The test may help those with metastatic breast cancer know if their cancer is progressing. That said, elevated levels can linger for some time, and, in one study, 30 percent of people had elevated levels which persisted for two to three months after the onset of effective treatment.

When is the CA 27.29 Test Not Done?

This test is not recommended as a method of screening for breast cancer, or as a way to diagnose breast cancer alone, as it lacks what scientists refer to as predictive value.

How Often is This Test Done?

Physicians vary tremendously in their practice of ordering this test. Some physicians put little emphasis on the test, whereas others routinely order this test on a regular basis.

 

Summary of CA 27.29 Test Benefits

To briefly summarize the value of this test for women with breast cancer, it may provide information and guide you and your doctor as to:

  • Your response to treatment
  • The status of your cancer
  • The possibility of early recurrence

Normal/Abnormal Values

A blood CA 27.29 measurement is ordinarily less than 40 U/ml. With cancer, the value is often greater than 100 U/ml. In general, levels over 100 U/ml usually mean cancer.

Other Cancers and Conditions with CA 27.29

Other cancers, as well as benign condition, may result in an elevated level of CA 27.29. Cancers which may result in an elevated result include:

  • Lung cancer
  • Liver cancer
  • Pancreatic cancer
  • Colon cancer
  • Ovarian cancer
  • Prostate cancer

Benign conditions which can raise CA 27.29 include:

  • Ovarian cysts
  • Benign breast conditions of the breast and kidneys
  • Liver disease such as cirrhosis - In one study, of people who had an elevation of CA 27.29 but did not have cancer, the cause was cirrhosis 25 percent of the time.

Other Tumor Markers Used with Breast Cancer

In addition to CA 27.29, there are other tumor markers which may be used to monitor breast cancer. These include: 

Most often, either the CA 27.29 test or the CA 15-3 test will be ordered, but not both.

Risks of the CA 27.29 Test

The test is a simple blood test so the risks of obtaining the test are small. Possible risks may include anxiety related to an abnormal test or a test result which does not accurately reflect the status of your cancer. Since this test is done as only a part of the workup monitoring cancer, this is often not of great concern. CA 27.29 is not a perfect test, but it is often useful along with other tests, such as imaging, to evaluate recurrence and response to treatment.

Limitations of the CA 27.29 Test

It's important to note the limitations of the CA 27.29 test. In monitoring the treatment of metastatic breast cancer—how this test is most commonly used—it’s important to again note that elevated levels of CA 27.29 may persist for up to three months after treatment has been completed. In other words, if you have the test done a few months after finishing treatment, the levels could still be high even if you are responding well to the treatment.

Since the CA 27.29 test is the only test used specifically to detect the presence of breast cancer cells, it would seem that it would be ordered more often to screen for breast cancer. Yet, as noted, the test lacks predictive value in determining the presence of a breast cancer. Positive predictive value refers to the likelihood that you have a disease if you test positive for the disease. There are many tests in medicine that would seem to make sense as a method of screening for a disease, yet in studies, lack the accuracy to make a difference in survival rates.

The final limitation is when the test is used to find a recurrence. There is much debate over whether finding a recurrence of breast cancer early could make a difference. While, at first glance, it would seem that there would be benefits to this practice, studies have not found that survival rates improve when a recurrence of breast cancer is found early. Part of the confusion lies in the goals of treatment with early stage breast cancer versus metastatic breast cancer. With early stage breast cancer, the goal is usually to treat the disease aggressively in order to cure the cancer (or at least keep it from ever returning.) Aggressive treatment, however, is not the goal with metastatic breast cancer (though this may change in the near future) as it hasn't seemed to make a difference in survival rates. Instead, the goal is to usually use the least amount of treatment possible to control the disease.

Bottom Line on CA 27.20

The CA 27.29 may be used for several different purposes with breast cancer and is the one biomarker used specifically to determine the presence of breast cancer cells. That said, there are other cancers as well as benign conditions which can lead to elevated levels. It is also important to understand the limitations of the test when used to evaluate breast cancer, and the test should always be used in conjunction with other findings such as a physical exam, other blood tests, and imaging studies.

Sources:

American Society of Clinical Oncology. Biomarkers to Guide Treatment of Metastatic Breast Cancer. Updated July 2015. http://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommendations-patients/biomarkers-guide-treatment-metastatic-breast-cancer

Poznak, C., Somerfield, M., Bast, R. et al. Use of Biomarkers to Guide Decisions on Systemic Therapy for Women With Metastatic Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology. 2015. 33(24):2695-2704.

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