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Carcinoembryonic Antigen
Abstract
The level of carcinoembryonic antigen (CEA) is often elevated in the serum of patients with cancer. This article reviews the clinical usefulness of this observation. Carcinoembryonic antigen is not useful for detecting asymptomatic cancer; its sensitivity and specificity are not high, particularly for early stages of disease, so in populations with low prevalence of disease there are many false-positive and false-negative results. Similarly, the antigen level cannot, by itself, provide enough diagnostic certainty to confirm or rule out suspected cancer. For some cancers, antigen levels at the time of diagnosis provide more precise prognosis than staging alone, but this information does not lead to more effective treatment. Serial measurement of CEA levels after surgery in patients with colorectal cancer can detect recurrences early, but few lives can be saved by this approach. Thus, CEA assays provide accurate information about some aspects of cancer but rarely lead to better outcomes for patients.
Article and Author Information
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▸From the Departments of Medicine and Epidemiology, The University of North Carolina at Chapel Hill; Chapel Hill, North Carolina.
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▸This paper was commissioned by the Blue Cross-Blue Shield Medical Necessity Project, under auspices of the Society for Research and Education in Primary Care Internal Medicine (SREPCIM), and is the first in a series being published in the Diagnosis and Treatment section. Harold C. Sox, Jr., M.D., is the editor for the series, and these papers are also being reviewed by John M. Eisenberg, M.D., and Sankey V. Williams, M.D., our consultants for Diagnostic Decision papers, as well as by selected manuscript consultants. This series will be published in a collective reprint, the availability of which will be announced later. The reprint will include the introductory article by Dr. Sox, which appears on pages 60-66 in this issue.—The Editor.
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▸Requests for reprints should be addressed to Robert H. Fletcher, M.D., M.Sc.; Box 1, 5034 Old Clinic, Clinical Scholars Program, The University of North Carolina at Chapel Hill; Chapel Hill, NC 27514.
- © 1986 American College of Physicians
