Why cancer marker blood tests are not meant for routine screening: Ex-AIIMS oncologist explains

These markers are most helpful when someone already has a diagnosed cancer — to track treatment response or detect recurrence.

Since many benign conditions can raise these markers, many people without cancer get abnormal results. This leads to unnecessary anxiety, more tests like scans or biopsies and extra costs

By Dr Arun Kumar Goel

A young sportsperson, 30, got a comprehensive health check-up done with a preventive cancer package testing. The combination included some tumor markers (CEA, CA 19-9) and one of these (CEA) was slightly increased. So alarmed was he that he got additional testing done (CT scan of chest and abdomen), MRI scan and repeat testing of these markers. While the scans came out normal, the CEA marker was still elevated. Such was his anxiety that he came to see me for further evaluation.

Many health check-up packages today include tumor marker blood tests like CA 125, CA 19-9, and CEA and suggest these can detect cancer early. But for most healthy people with no symptoms, these tests are not recommended and can cause more harm than good. What many do not know is that doctors use these tests for monitoring, not screening tumour. These markers are most helpful when someone already has a diagnosed cancer — to track treatment response or detect recurrence — not to screen healthy people. Besides, these tests do not come cheap (between Rs 2,000 to Rs 8,000).

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Why these tests are not useful as routine screening

These tests are not cancer-specific. These markers can rise for many unrelated reasons. For example, CA 125 can go up during menstruation and pregnancy, even when you have fibroids, pelvic inflammation or pancreatitis. CEA may be high in smokers or people with liver and bowel inflammation. CA 19-9 can rise with pancreatitis or bile duct problems, gallstones and diabetes.

There are high chances of false alarms

Since many benign conditions can raise these markers, many people without cancer get abnormal results. This leads to unnecessary anxiety, more tests like scans or biopsies and extra costs. High levels often trigger worry and expensive, invasive follow-up tests (like CTs, biopsies) for conditions that aren’t cancer.

Normal results don’t rule out cancer

Many cancers do not raise these markers early, so having “normal” levels doesn’t guarantee you are cancer-free. Doctors use them best for monitoring, not screening.

Better approaches for routine check-ups

Good health check-ups include tests like blood pressure, blood sugar, cholesterol, liver/kidney function and age-appropriate cancer screenings (like pap smears, mammograms, or colon checks when recommended), rather than indiscriminate tumor markers.

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Adding tumour markers to routine health packages without medical reasons can mislead, stress and cost you more without proven benefit for early cancer detection in healthy individuals.

(Dr Goel is visiting consultant, surgical oncology, Northern Railway Central Hospital)