Question: I am 52 and a survivor of breast cancer with metastasis to the bone. I take Zomeda once a month and Arimidex. One year ago the tumor marker was down to 44, but it is now up to 82. Do you have any suggestions for decreasing this marker?

Dr. Hibberd's Answer:

Regard these markers with suspicion. Elevations are used to evaluate metastatic disease of the breast and are elevated in 5% of those with stage 1 disease, 29% of those with stage 2, 32% of those with stage 3, and 95% of those with stage 4.

Most patients (96%) who have a baseline increase of more than 25% have recurrent disease. Though they are not specific to recurrence of disease, the elevation of this marker suggests an increased risk for recurrence. This marker is also elevated in carcinoma of the pancreas, ovary, uterus, colon, stomach, and many others as well as in some non-malignant conditions.

We use this marker as a tool to monitor the response of metastatic disease to treatment as well as warn of silent recurrences in patients at risk. So maintain regular surveillance by physical examination, and appropriate imaging.

Remember that recurrences, though most often local to breast tissue, are occasionally in areas remote to the initial site, and common sites of metastasis of breast carcinoma are opposite breast, lung, bone, brain, liver, adrenals, and kidneys. Remember also that patients who have had breast malignancy are at higher risk for other malignancies as well as for recurrences. The most common associated malignancies are those of colon. Avoid smoking at all costs, and be sure to undergo colonoscopy and fecal blood sampling periodically, especially as a victim of breast carcinoma.