BlueCross BlueShield of Tennessee Medical Policy Manual

Serum Tumor Markers for Breast Malignancies

DESCRIPTION

Serum tumor markers are substances shed by certain tumors into circulation where they can be detected and measured. Diagnosis of a suspected malignancy requires a tumor marker that is specific for a given tumor. For breast cancer, the serum tumor markers CEA, CA 15-3 and CA 27.29 have been investigated for monitoring advanced disease and to assist in determining whether to continue with a particular type of therapy, terminate its use, or switch to an alternative therapy. 

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION  

Data are insufficient to recommend use of CEA, CA 15-3 and CA 27.29 alone for monitoring response to treatment.

SOURCES 

American Society of Clinical Oncology. (March, 2013). Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. Retrieved December 22, 2017 from www.ascopubs.org.

American Society of Clinical Oncology. (August, 2015). Use of biomarkers to guide decisions on systemic therapy for women with metastatic breast cancer: American Society of Clinical Oncology clinical practice guideline. Retrieved December 22, 2017 from www.ascopubs.org.

Centers for Medicare & Medicaid Services. CMS.gov. National Coverage Determination (NCD) for tumor antigen Immunoassay - CA 15-3/CA 27.29 (190.29). Retrieved January 27, 2016 from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=134&.

Fu, Y., & Li, H. (2016). Assessing clinical significance of serum CA15-3 and carcinoembryonic antigen (CEA) levels in breast cancer patients: A meta-analysis. Medical Science Monitor, 2016, 22, 3154-3162. (Level 1 evidence)

Kos, T., Aksoy, S., Sendur, M.A., Arik, Z., Civelek, B., Kandemir, N., et al. (2013). Variations in tumor marker levels in metastatic breast cancer patients according to tumor subtypes. Journal of B.U.ON, 18 (3), 608-613. Abstract retrieved December 22, 2017 from PubMed database.

National Academy of Clinical Biochemistry. (2009). Use of tumor markers in testicular, prostate, colorectal, breast and ovarian cancers. Retrieved December 22, 2017 from https://www.aacc.org/science-and-practice/practice-guidelines/major-tumor-markers.

National Comprehensive Cancer Network. (2017). NCCN clinical practice guidelines in oncology (NCCN GuidelinesĀ®, Breast cancer - V 3.2017. Retrieved December 22, 2017 from the National Comprehensive Cancer Network. 

Wang, W., Xu, X., Tian, B., Wang, Y., Du, L., Sun, T., et al. (2017). The diagnostic value of serum tumor markers CEA, CA19-9, CA125, CA15-3, AND TPS in metastatic breast cancer. Clinica Chimica Acta, 470, 51-55. Abstract retrieved December 22, 2017 from PubMed database.

ORIGINAL EFFECTIVE DATE:  9/1998

MOST RECENT REVIEW DATE:  5/1/2018

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