Digestive Diseases and Sciences

, Volume 56, Issue 8, pp 2396–2403 | Cite as

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

  • Jin Ha Lee
  • Sung Pil Hong
  • Tae Joo Jeon
  • Gun-Hi Kang
  • Won-Choong Choi
  • Soung Min Jeon
  • Chang Mo Moon
  • Jae Jun Park
  • Jae Hee Cheon
  • Tae Il Kim
  • Won Ho Kim
Original Article


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.


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.


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).


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.


Carcinoembryonic antigen Colonoscopy Colorectal cancer 



The authors thank Soung Min Jeon, Chang Mo Moon and Jae Jun Park for their assistence throughout this study.

Conflict of interests

The authors have no commercial associations that might represent a conflict of interest in relation to this manuscript.

Ethics approval

This study was approved by the Human Research Review Committees of Severance Hospital, Yonsei University and Sanggye Paik Hospital, Inje University, Korea.


  1. 1.
    Boulware LE, Marinopoulos S, Phillips KA, et al. Systematic review: the value of the periodic health evaluation. Ann Intern Med. 2007;146:289–300.PubMedGoogle Scholar
  2. 2.
    Han PK. Historical changes in the objectives of the periodic health examination. Ann Intern Med. 1997;127:910–917.PubMedGoogle Scholar
  3. 3.
    Fenton JJ, Cai Y, Weiss NS, et al. Delivery of cancer screening: how important is the preventive health examination? Arch Intern Med. 2007;167:580–585.PubMedCrossRefGoogle Scholar
  4. 4.
    Lee TW, Lee CY, Kim HS, et al. Health promotion health center project. Public Health Nurs. 2007;24:529–537.PubMedCrossRefGoogle Scholar
  5. 5.
    Kim HR, Lee CH, Kim YW, et al. Increased CA 19–9 level in patients without malignant disease. Clin Chem Lab Med. 2009;47:750–754.PubMedCrossRefGoogle Scholar
  6. 6.
    Kim JE, Lee KT, Lee JK, et al. Clinical usefulness of carbohydrate antigen 19–9 as a screening test for pancreatic cancer in an asymptomatic population. J Gastroenterol Hepatol. 2004;19:182–186.PubMedCrossRefGoogle Scholar
  7. 7.
    Lim YK, Kam MH, Eu KW. Carcinoembryonic antigen screening: how far should we go? Singapore Med J. 2009;50:862–865.PubMedGoogle Scholar
  8. 8.
    Sturgeon C. Practice guidelines for tumor marker use in the clinic. Clin Chem. 2002;48:1151–1159.PubMedGoogle Scholar
  9. 9.
    Bast RC Jr, Ravdin P, Hayes DF, et al. 2000 update of recommendations for the use of tumor markers in breast and colorectal cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001;19:1865–1878.PubMedGoogle Scholar
  10. 10.
    Duffy MJ. Carcinoembryonic antigen as a marker for colorectal cancer: is it clinically useful? Clin Chem. 2001;47:624–630.PubMedGoogle Scholar
  11. 11.
    Burt RW. Colon cancer screening. Gastroenterology. 2000;119:837–853.PubMedCrossRefGoogle Scholar
  12. 12.
    Rubio CA, Nesi G, Messerini L, et al. The Vienna classification applied to colorectal adenomas. J Gastroenterol Hepatol. 2006;21:1697–1703.PubMedCrossRefGoogle Scholar
  13. 13.
    Schlemper RJ, Riddell RH, Kato Y, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47:251–255.PubMedCrossRefGoogle Scholar
  14. 14.
    Winawer SJ, Zauber AG, O’Brien MJ, et al. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med. 1993;328:901–906.PubMedCrossRefGoogle Scholar
  15. 15.
    Compton C, Fenoglio-Preiser CM, Pettigrew N, et al. American Joint Committee on Cancer Prognostic Factors Consensus Conference: Colorectal Working Group. Cancer. 2000;88:1739–1757.PubMedCrossRefGoogle Scholar
  16. 16.
    Wei EK, Giovannucci E, Wu K, et al. Comparison of risk factors for colon and rectal cancer. Int J Cancer. 2004;108:433–442.PubMedCrossRefGoogle Scholar
  17. 17.
    Imperiale TF, Glowinski EA, Juliar BE, et al. Variation in polyp detection rates at screening colonoscopy. Gastrointest Endosc. 2009;69:1288–1295.PubMedCrossRefGoogle Scholar
  18. 18.
    Gold P, Freedman SO. Demonstration of tumor-specific antigens in human colonic carcinomata by immunological tolerance and absorption techniques. J Exp Med. 1965;121:439–462.PubMedCrossRefGoogle Scholar
  19. 19.
    Chevinsky AH. CEA in tumors of other than colorectal origin. Semin Surg Oncol. 1991;7:162–166.PubMedCrossRefGoogle Scholar
  20. 20.
    Stevens DP, Mackay IR, Cullen KJ. Carcinoembryonic antigen in an unselected elderly population: a four year follow up. Br J Cancer. 1975;32:147–151.PubMedCrossRefGoogle Scholar
  21. 21.
    Cullen KJ, Stevens DP, Frost MA, et al. Carcinoembryonic antigen (CEA), smoking, and cancer in a longitudinal population study. Aust N Z J Med. 1976;6:279–283.PubMedGoogle Scholar
  22. 22.
    Goldstein MJ, Mitchell EP. Carcinoembryonic antigen in the staging and follow-up of patients with colorectal cancer. Cancer Invest. 2005;23:338–351.PubMedGoogle Scholar
  23. 23.
    Eom BW, Lee HJ, Yoo MW, et al. Synchronous and metachronous cancers in patients with gastric cancer. J Surg Oncol. 2008;98:106–110.PubMedCrossRefGoogle Scholar
  24. 24.
    Lim SB, Jeong SY, Choi HS, et al. Synchronous gastric cancer in primary sporadic colorectal cancer patients in Korea. Int J Colorectal Dis. 2008;23:61–65.PubMedCrossRefGoogle Scholar
  25. 25.
    Tomoda H, Taketomi A, Baba H, et al. Multiple primary colorectal and gastric carcinoma in Japan. Oncol Rep. 1998;5:147–149.PubMedGoogle Scholar
  26. 26.
    Begent RH. The value of carcinoembryonic antigen measurement in clinical practice. Ann Clin Biochem. 1984;21:231–238.PubMedGoogle Scholar
  27. 27.
    Thomas P, Toth CA, Saini KS, et al. The structure, metabolism and function of the carcinoembryonic antigen gene family. Biochim Biophys Acta. 1990;1032:177–189.PubMedGoogle Scholar
  28. 28.
    Doos WG, Wolff WI, Shinya H, et al. CEA levels in patients with colorectal polyps. Cancer. 1975;36:1996–2003.PubMedCrossRefGoogle Scholar
  29. 29.
    Fischbach W, Mossner J. Do size, histology, or cytology of colorectal adenomas and their removal influence serum CEA? Dis Colon Rectum. 1987;30:595–599.PubMedCrossRefGoogle Scholar
  30. 30.
    Slattery ML, Boucher KM, Caan BJ, et al. Eating patterns and risk of colon cancer. Am J Epidemiol. 1998;148:4–16.PubMedGoogle Scholar
  31. 31.
    Center MM, Jemal A, Ward E. International trends in colorectal cancer incidence rates. Cancer Epidemiol Biomarkers Prev. 2009;18:1688–1694.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Jin Ha Lee
    • 1
  • Sung Pil Hong
    • 1
  • Tae Joo Jeon
    • 2
  • Gun-Hi Kang
    • 2
  • Won-Choong Choi
    • 2
  • Soung Min Jeon
    • 1
  • Chang Mo Moon
    • 1
  • Jae Jun Park
    • 1
  • Jae Hee Cheon
    • 1
  • Tae Il Kim
    • 1
  • Won Ho Kim
    • 1
  1. 1.Department of Internal Medicine and Institute of GastroenterologyYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Internal Medicine and Division of Gastroenterology, Sanggye Paik HospitalInje University College of MedicineSeoulRepublic of Korea

Personalised recommendations