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The Dangers of Using Tumor Markers to Evaluate Nonspecific SymptomsA Teachable Moment

Educational Objective
To emphasize the importance of using tumor marker testing only in the most appropriate clinical context to avoid patient anxiety and delayed diagnosis.
1 Credit CME

A woman in her 50s with idiopathic dilated cardiomyopathy (ejection fraction, 15%-20%), quiescent celiac disease, chronic diarrhea due to active lymphocytic colitis, and treated hypothyroidism presented with malaise and anorexia of several weeks’ duration. She did not have abdominal pain, nausea, vomiting, weight loss, or fever. Given her age and nonspecific symptoms, the clinician was concerned for possible cancer. As part of her initial workup, levels of carbohydrate antigen 19-9, carcinoembryonic antigen, and cancer antigen (CA)-125 were measured. The CA-125 level was elevated, at 210 U/mL (normal, ≤35 U/mL). The patient was referred to a gynecologist owing to concern for ovarian cancer. Pelvic ultrasonography and abdominal computed tomography did not reveal evidence of ovarian cancer.

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Article Information

Corresponding Author: Parisa Mortaji, MD, 13001 E 17th Pl, Aurora, CO 80045 (parisa.mortaji@cuanschutz.edu).

Published Online: May 11, 2020. doi:10.1001/jamainternmed.2020.1293

Conflict of Interest Disclosures: None reported.

References
1.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology, Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer: Version 3.2019-November 26, 2019. https://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf. Accessed February 13, 2020.
2.
Dochez  V , Caillon  H , Vaucel  E , Dimet  J , Winer  N , Ducarme  G .  Biomarkers and algorithms for diagnosis of ovarian cancer: CA125, HE4, RMI and ROMA, a review.   J Ovarian Res. 2019;12(1):28. doi:10.1186/s13048-019-0503-7PubMedGoogle ScholarCrossref
3.
Ferraro  S , Mozzi  R , Panteghini  M .  Tumor marker ordering: do not lose control: a prospective clinical trial.   Am J Clin Pathol. 2015;144(4):649-658. doi:10.1309/AJCPNZAPJRB3T6KKPubMedGoogle ScholarCrossref
4.
Grossman  DC , Curry  SJ , Owens  DK ,  et al; US Preventive Services Task Force.  Screening for ovarian cancer: US Preventive Services Task Force recommendation statement.   JAMA. 2018;319(6):588-594. doi:10.1001/jama.2017.21926PubMedGoogle ScholarCrossref
5.
Moss  EL , Hollingworth  J , Reynolds  TM .  The role of CA125 in clinical practice.   J Clin Pathol. 2005;58(3):308-312. doi:10.1136/jcp.2004.018077PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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