Cancer Antigen CA 15-3 Levels in Breast Cancer Patients

Cancer Antigen CA 15-3 Levels in Breast Cancer Patients

*Muhammad Basirun¹ Umi Aminatul Qirom² Dadi Santoso³ Eka Riyanti⁴ Nurlaela Ela⁵ Sawiji Amani⁶

^1,4,5,6Nursing Departement, Gombong Muhammadiyah University, Indonesia

²Clinical laboratory Departement, PKU Muhammadiyah Gombong Hospital, Indonesia

*Corresponding Author

DOI: https://doi.org/10.51244/IJRSI.2025.12010029

Received: 21 November 2024; Accepted: 25 November 2024; Published: 05 February 2025

ABSTRACT

Background; Breast cancer is a disease in which certain cells become abnormal and develop abnormally and become tumors in the breast.

Research method: the method used is descriptive by looking at the CA 15-3 level values ​​before and after breast cancer surgery. The sample used was 50 respondents at the Muhammadiyah Kebumen Hospital on outpatient treatment in 2024. The analysis used was frequency distribution analysis and Paired t-test.

Research result; The higher the age of the patient, the more breast cancer there is, reaching 62% or 31 out of 50 respondents, the number of cases above normal is 72% and post-operative cases the value is above normal in 84%. The significance value of CA 15-3 levels before and after mastectomy surgery was obtained at p = 0.003, this means that there is a difference in CA15-3 levels between before and after breast cancer mastectomy surgery.

Conclusion; The CA 15-3 level values ​​before and after breast cancer surgery are mostly still above normal and are a biomarker for breast cancer, although there are differences in the CA 15-3 level values.

Keywords: CA 15-3; cancer; tumor; breast; surgery

INTRODUCTION

Breast cancer or tumor is a disease in which abnormal cells in the breast multiply to form a tumor[1], [2]. The types of cancer markers that are often expressed in breast cancer sufferers are CA 27-29, CA 15-3, CA27.29 and others[3]. This study looked at changes in CA 15-3 levels before and after surgery. A systematic review and meta-analysis of studies suggests that serum CA15-3 values ​​are a marker for monitoring breast cancer progression  [4]. The research results also show that CA 15-3 is useful as a marker for breast tumors as an initial diagnosis[5].

Pre-operative CA 15-3 levels, the normal value of CA 15-3 levels is + 30 UI/mL[29]. Dove (2018) in his study concluded that pre-surgical elevation of CA15-3 was associated with an unfavorable prognosis [6]. The results of the study showed that there was an increase in serum CA15-3 values ​​identified in 47 breast cancer patients[7]. Elevated CA 15-3 values ​​were found to be associated with breast cancer patients [8].    At the time of diagnosis of metastases, 451 of 730 patients or 62% had CA 15-3 values ​​above the upper limit of normal (>30 kU/l), in 269 patients (37%), an increase in CA 15-3 was the first sign leading to metastatic diagnosis[9]. Then the results of a retrospective evaluation of 482 patients showed that CA 15-3 levels before metastasis were significantly increased[5].

On the other hand, the results of the study showed that serum CA 15-3 values ​​decreased after breast surgery compared to pre-operation[10].  The research results of Khan, et al (2016) concluded that gradual measurement of CA 15-3 is more important for detecting recurrence after treatment[10].  Chi-square correlation analysis revealed that an increase in serum CA 15-3 values ​​after surgery was an unfavorable risk factor in patients[11] and if the postoperative CA 15-3 value increases, this indicates the possibility of recurrence[10].

CA 15-3 levels before and after surgery, the increase (≥30 U/mL) of pre-operative CA15-3 was 35.9%, and decreased to 14.3% at 3 months after mastectomy[12]. The results of research that carried out periodic measurements after breast surgery at 1, 3 and 6 months showed that CA 15-3 measurements did not reach a significant difference.[13]. Other studies show that after mastectomy there is a positive correlation with tumor size and also shows that serum CA 15-3 levels decrease[14].

Breast cancer treatment is carried out based on the level and stage of the breast in order to obtain the most personalized and safest therapy. There are several treatments carried out, namely; surgery, radiotherapy, chemotherapy, hormonal and biological[15][16].  There are two types of breast cancer surgery [17] namely breast conservation surgery and only the part of the breast containing the cancer is removed. These breast conserving operations are also described as quadrantectomy, lumpectomy, partial mastectomy and mastectomy[18].

Mastectomy is the complete removal of the breast, removal of the affected lymph nodes involves a lymph node biopsy[19]. According to Guntari G and Suarini N, quoted from research results by Dewi et al. states that mastectomy is a breast removal operation performed at stages II and III[20]. According to Balabram, et al (2013), research was conducted to evaluate patient survival in patients with stage I-III breast cancer who could be operated on in Brazilian public hospitals.[21].

Different research results from 70 women with breast cancer show that there is no significant correlation between CA15-3 and the rate of metastatic spread [22]. This is the reason why a re-assessment of the CA 15-3 value is needed by comparing the values ​​before and after surgery.   There are still conflicting results which show that not all results increase in post-operative CA 15-3 levels, so this study is very important to look at CA 15-3 levels in stage 1, stage 2 and stage III breast cancer patients before and after matectomy surgery.

RESEARCH METHODS

The type and design of this research is observational analytical research with a cross sectional approach. The sample used was 50 respondents with frequency distribution analysis and Paired t-test. Analysis is used to see the value of CA 15-3 levels before and after breast cancer surgery.

The results of the analysis on the pre-operative and post-operative variables CA 15-3 obtained a significance value of p = 0.00, this result is less than p = 0.05 so that these two variables include data that is not normally distributed. Therefore, the research analysis was continued with the Wilcoxon test to determine whether there was a difference and the significance value produced by the variable CA 15-3 pre and post mastectomy surgery.

RESEARCH RESULTS

The characteristics of the respondents are presented in table 1. Data on the characteristics of these respondents include age, location or place of occurrence of mammary tumors including sinistra or dextra, patient’s weight, length of time breastfeeding, level or grade of tumor, number of parturitions or giving birth to children and includes data from pre and operations post from CA-15-3.

Table 1. Characteristics of Respondents (n= 50)

The total respondent data is 50 patients, with patient ages ranging from 30 years to 50 years. Table 1 can be explained as follows; The higher the age of the sufferer, the more breast cancer there is, reaching 62% or 31 out of 50 respondents.

The most common location for breast cancer is the left side, reaching 58% and grade 3, namely 29 cases. Furthermore, data on average levels of Ca15-3 pre and post surgery are shown in table 1, which can be explained as follows; In the average preoperative and post-operative CA15-3 levels, values ​​below normal were not found, while the number of cases above normal was 72% and post-operative cases were 84% of cases above normal.

The significance value of CA 15-3 levels pre and post mastectomy was obtained at p=0.003. This value is less than p ≤ 0.05 which means; There is a difference between CA15-3 levels before and after mastectomy for breast cancer.

DISCUSION

The results of this research can be explained as follows; The average preoperative CA15-3 level and post-operative values ​​below normal were not found and the number of cases above normal in preoperative patients was found to be 72% and post-operatively it increased to 84% of cases above normal values. Indeed, the results of previous studies showed that the average level of CA 15-3 increased in pre-operative breast cancer patients. Elevated serum CA15-3 levels were identified in 47 patients were 60 (13.9%)[7].

At the time of diagnosis of metastasis, previous research results showed that 451 of 730 patients or 62% had CA 15-3 levels above the upper limit of normal (>30 kU/l). In 269 patients (37%), an increase in CA 15-3 was the first sign leading to the diagnosis of metastasis[9]. Elevated levels of CA15-3 were found to be associated with breast cancer patients[8].  Chi-square correlation analysis in previous studies revealed that an increase in serum CA 15-3 levels after surgery was an adverse risk factor in breast cancer patients[11]. Indeed, there are different research results from Porika et al, stating that after 9 days after mastectomy the average CA15.3 level decreased slightly[33]. The results of research by Iaffaioli RV, et al concluded that the CA 15-3 levels of 60 patients before surgery were related to lymph nodes, which is the most important characteristic of breast cancer. CA 15-3 is also associated with tumor size and the number of nodes involved[34]. The results of other studies stated that increasing CA 15-3 levels before surgery was directly related to tumor burden, then comparing CA 15-3 levels after surgery it was found that there was a decrease in CA15-3 levels[10].

The CA-15-3 tumor marker examination is used to detect cancer recurrence[23] and CA 15-3 examination in breast cancer patients is carried out periodically during the treatment period which is useful in monitoring the response to therapy [12][3]. According to Chu and Ryu (2016), the results of their research concluded that there was a significant relationship between changes in CA15-3 levels and the rate of breast cancer recurrence. [24].

Table 2. Hypothesis test results and CA15-3 levels are normal, below normal and above normal

CA 13-5 has been identified as an important marker in cases of breast carcinoma and CA 15-3 has been implicated in breast cancer malignancies.[25]. When cells become malignant, they cause changes to the cell surface so that CA15-3 is distributed from the cancer cells into the blood circulation[26]. High CA 15-3 has been linked to breast cancer cells; it can also be seen in some benign disease conditions[27].

The mean value of CA 15-3 levels in breast cancer patients was 106.38 UI/mL[30].   The test results in this study using the Paired T-test showed that the significance value of CA 15-3 levels before and after mastectomy surgery was p = 0.003 (Table 2), which means there was a difference between CA15-3 levels before and after breast cancer mastectomy surgery. The results of other studies concluded that there was a significant correlation with increasing CA15-3 levels with breast cancer and that the greater the serum marker levels before surgery, the more advanced the tumor stage and CA15-3 levels were related to tumor size.[35]. On the other hand, research shows that patients with CA15-3 (≥21.76) are most likely to experience bone metastases in breast cancer patients[36].

The CA 15-3 value is a cancer marker or biomarker. The results of this study show that the CA15-3 level is above normal both pre-operatively and post-operatively. This is a sign that the CA 15-3 level is high in breast cancer patients. The results of previous meta-analysis studies showed that serum CA15-3 levels are a potential biomarker and are strongly associated with tumor stage and for breast cancer monitoring.[4]. The results of other studies also show an increase in CA15-3 values ​​in breast cancer patients (29.02 ± 1.79 IU/ml)[31]. CA15-3 levels with a cut-off value of 12.48 U/ml are an independent prognostic factor[32].

CONCLUSION

The CA 15-3 level values ​​before and after breast cancer surgery are mostly still above normal and are a biomarker of breast cancer, however there are differences in the CA 15-3 level values ​​before and after surgery.

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Ethical clearance

This research has passed ethical testing in accordance with applicable provisions.