Original Article

Digestive Diseases and Sciences

, Volume 56, Issue 8, pp 2396-2403

Should a Colonoscopy be Recommended for Healthy Individuals with Increased Carcinoembryonic Antigen Levels? A Case–Control Study

  • Jin Ha LeeAffiliated withDepartment of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine
  • , Sung Pil HongAffiliated withDepartment of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine Email author 
  • , Tae Joo JeonAffiliated withDepartment of Internal Medicine and Division of Gastroenterology, Sanggye Paik Hospital, Inje University College of Medicine
  • , Gun-Hi KangAffiliated withDepartment of Internal Medicine and Division of Gastroenterology, Sanggye Paik Hospital, Inje University College of Medicine
  • , Won-Choong ChoiAffiliated withDepartment of Internal Medicine and Division of Gastroenterology, Sanggye Paik Hospital, Inje University College of Medicine
  • , Soung Min JeonAffiliated withDepartment of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine
  • , Chang Mo MoonAffiliated withDepartment of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine
  • , Jae Jun ParkAffiliated withDepartment of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine
  • , Jae Hee CheonAffiliated withDepartment of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine
    • , Tae Il KimAffiliated withDepartment of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine
    • , Won Ho KimAffiliated withDepartment of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine

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Abstract

Background and Aim

Despite the limitations of screening or early diagnosis of colorectal cancers (CRC), carcinoembryonic antigen (CEA) is frequently measured in practice and during health promotion programs. The aim of this study was to evaluate the role of colonoscopy in healthy individuals with elevated CEA levels.

Methods

From January 2003 to November 2008, 117,731 healthy persons underwent an opportunistic screening program in two health promotion centers; 1,497 subjects (1.3%) showed an elevated CEA level (>5 ng/ml). Among them, 174 patients were recruited to undergo a colonoscopy to determine if colorectal malignancies were present. A total of 372 age- and sex-matched persons were selected as controls from among the healthy subjects who had a normal level of CEA and had received surveillance colonoscopy. The primary outcome was the incidences of CRC in elevated CEA and normal CEA groups. The secondary outcome was the predictive factors of CRC in the elevated CEA group.

Results

The incidence of CRC was higher in the group with higher CEA-levels than in the group with normal CEA levels (4.6 vs. 1.3%; P = 0.031). In the CEA-elevated group, patients with CRCs were diagnosed at more advanced stages than were those in the CEA-normal group. The incidence of colorectal polyps was not different between the two groups. In the CEA-elevated group, anemia was an independent predictive factor of CRCs by multivariate analysis (P = 0.002).

Conclusion

Anemia itself is not a predictive factor of CRC in the entire population, but is an independent predictive factor of CRC in healthy individuals with an elevated level of CEA. Therefore, colonoscopy should be recommended for healthy subjects with an elevated level of CEA accompanied with anemia in the absence of other adenocarcinomas to evaluate the presence of colorectal malignancy.

Keywords

Carcinoembryonic antigen Colonoscopy Colorectal cancer