Several routine physical examination tumor marker tests

There is no uniform fixed number of tumor marker items for routine physical examinations. Basic screening packages usually include 3-5 markers related to high-risk cancer types. Advanced packages for high-risk groups mostly include 8-12 items. Some high-end screening packages can be expanded to more than 15 items. The specific number of items needs to be adjusted based on age, family history, and basic medical history. More is by no means better.

Last week, a reader who was just over 30 sent me a message asking me that my company’s physical examination package only included 3 items, while my best friend’s personal physical examination package listed 11 items. Did the company cut corners? This is actually a question that many people have encountered. After all, when the word "tumor" is mentioned, everyone always feels that the more tests they have, the more at ease they will feel. In fact, this is not the case.

The 3-5 basic items we usually talk about are markers with relatively high specificity corresponding to the types of cancers with the highest incidence in China: for example, alpha-fetoprotein (AFP) for primary liver cancer, broad-spectrum carcinoembryonic antigen (CEA, covering digestive tract cancer, lung cancer, breast cancer, etc.), additional prostate-specific antigen (PSA) for men, and additional testing for women. Check the carbohydrate antigen 125 (CA125) related to ovarian cancer and the carbohydrate antigen 199 (CA199) related to pancreatic cancer. Together, these are the most basic configuration. It is suitable for healthy people under 35 years old, with no family history of cancer, no clear precancerous lesions such as hepatitis and atrophic gastritis. It is the most cost-effective and will basically not miss the high probability of risk.

To be honest, there is no completely unified view in the industry regarding the appropriate number of tests for swollen labels. Most doctors in the clinical oncology department do not recommend that ordinary people blindly add items. After all, the specificity of most tumor markers is not high. Colds, inflammation, staying up late, and drinking alcohol may cause the indicators to rise temporarily. Not long ago, I met a young man born in 1995 in the outpatient clinic. He stayed up three nights to catch up on projects and drank two heavy drinks before the physical examination. It was found that CA724 was twice the critical value. He was so frightened that he couldn't eat for a week. He had a full set of gastrointestinal endoscopy and abdominal CT and there were no problems. In the end, he stayed up all night and increased the risk caused by chronic gastritis. He suffered for nothing and wasted money.

However, there are also scholars engaged in early cancer screening who hold different opinions. They believe that for people with high-risk factors, appropriately increasing the number of items can indeed improve the sensitivity of early screening. There is no need to completely skip the test for fear of false positives. For example, for people with a history of hepatitis B and hepatitis C, it is best to check for abnormal prothrombin (PIVKA-II) in addition to AFP. The accuracy of the two indicators combined to screen for primary liver cancer can be increased to more than 90%, which is much lower than the missed diagnosis rate of AFP alone. ； People with a history of familial intestinal polyps and intestinal cancer can also detect signs of digestive tract tumors earlier by checking CA724 and CA242 in addition to CEA.

If you really have to choose, there is no need to worry about the number of items. If you are under 35 years old and have no high-risk factors, basic 3-5 items are enough ； For those over 40 years old who smoke all year round, it is enough to add squamous cell carcinoma-related antigen (SCC) and cytokeratin 19 fragment (CYFRA21-1) ； For women with breast nodules of grade 3 or above, just add carbohydrate antigen 153 (CA153). There is really no need to check all the dozens of items at the beginning. Not to mention the cost, if you encounter a false positive, the psychological pressure can really take away half of your life.

Finally, I would like to mention that among the cases I have encountered over the years, the most regrettable thing is not that there are too few swollen lesions checked, but that many people think that everything is fine if the swollen lesions are normal, and even refuse to do CT or gastrointestinal endoscopy. Last year, I had a 52-year-old aunt who had a full set of 12 tumor markers within the normal range. However, she had been coughing all year round and refused to take a CT scan. Finally, she delayed the check-up until she coughed up blood. She was already in the middle stage of lung adenocarcinoma. If she had taken a low-dose CT scan half a year earlier, she would not have suffered so much.

To put it bluntly, tumor markers are only an "alarm" to assist screening. They are not a basis for diagnosis, and they cannot cover all cancers. To achieve reliable cancer screening, it is necessary to combine imaging and endoscopic examinations to be reliable.