J Korean Acad Fam Med.  1997 Oct;18(10):1006-1016.

Clinical significance of CEA as a screening test for neoplasm

• Won CW
• Kim BS
• Yang DH
• Choi HR
• Lee JY
• Kim CS

Abstract

BACKGROUND: It is necessary for most effective treatment of neoplasms to detect it in early stage. For the purpose we use many screening tests currently, however, the tumor marker have many limitations as a screening test for neoplasm. Nevertheless most of Health screening centers are using CEA as a screening test for neoplasm. So, we began this study for the assessment of validity of CEA as a screening test for neoplasm.
METHODS
The subjects were 4265 persons who visited Health screening center of Kyung hee Medical Center from July 1995 to June 1996. The number of elevated CEA among the subjects was 156. We evaluated the frequencies of factors known as etiologies of increased CEA. We followed up whether neoplasms were developed in normal CEA group. Through the random sampling of normal CEA group, 391 subjects were obtained for statistical analysis by SPSS/PC+. Immunoradiometric assay kit, of Eiken company was used for gauging CEA level and normal level was less than 2.4ng/ml according to manual of manufacturer.
RESULTS
There was no significant difference of CEA according to sex, age. The factors that significantly affect CEA were neoplasms, chronic lung disease, liver cirrhosis. In t,his study, smoking, hypertension, diabetes mellitus, fibrocystic disease, chronic renal failure, alcohol drinking, hepatitis, peptic ulcer disease known as etiologies of elevated CEA in other studies did not show statistical significance. 9 cases of neoplasms were developed in both elevated CEA and normal CEA group during follow up. In former, 4 cases of 9 neoplasms were early stage. In latter, all cases were stage IV and inoperable. Specificity and sensitivity of CEA were each 96.5%, 50.0%. Positive & negative predictive value of CEA were each 5.8%, 99.8%.
CONCLUSIONS
CEA was increased in various benign conditions and even if any neoplasm exists, CEA was not elevated in most of all in early stage. It showed high false positive rate and low sensitivity. Thus, this study showed that it was not valid to use CEA as a screening test for early detection of neoplasms.

MeSH Terms

Alcohol Drinking
Diabetes Mellitus
Follow-Up Studies
Hepatitis
Humans
Hypertension
Immunoradiometric Assay
Liver Cirrhosis
Lung Diseases
Mass Screening*
Peptic Ulcer
Renal Insufficiency, Chronic
Sensitivity and Specificity
Smoke
Smoking
Smoke