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Although the worldwide incidence of breast cancer is increasing, death from this disease is now declining in a number of Western countries.2 This decrease in mortality is likely to result from a combination of mammographic screening and increased use of systemic adjuvant treatments. For optimum care of patients with breast cancer, a multidisciplinary approach is necessary. This approach should involve surgery, histopathology, medical oncology, radiotherapy, radiology and the use of tumour markers.
Tumour markers are substances that can be measured in blood, tumour tissue or other body fluid and that aid cancer detection and/or management. Tumour markers are potentially useful in screening for early cancer (e.g. prostatespecific antigen (PSA) in prostate cancer), aiding diagnosis (tumour markers almost never replace histopathology for the primary diagnosis of cancer), determining prognosis, predicting likely response or resistance to therapy, post-operative surveillance and monitoring therapy in patients with advanced cancer.
For breast cancer, the existing markers are of little value for screening or aiding early diagnosis. In contrast, markers are available for determining prognosis, predicting likely response to therapy, post-operative follow-up and monitoring therapy in metastatic disease. Prognostic and predictive marker use is usually determined on tumour tissue whereas surveillance and monitoring markers are measured in blood. The aim of this article is to review the role of both tissue and serum markers in the care of patients with breast cancer.
Hormone receptors (i.e. oestrogen and progesterone receptors) are carried out in order to determine endocrine-sensitivity of newly diagnosed breast cancers. For hormone receptor-positive patients, endocrine therapy should be administered, i.e. tamoxifen and/or an aromatase inhibitor for postmenopausal patients and tamoxifen and/or ovarian suppression/ablation for premenopausal patients. Hormone receptor-negative tumours should not be treated with endocrine therapy but are candidates for treatment with adjuvant chemotherapy. It is generally recommended that both oestrogen and progesterone receptors be measured together as patients derive maximum benefit from hormone therapy when both receptors are present.