tumour markers: importance in Asia’s

health monitoring

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tumour markers: importance in asia’s
health monitoring
Asian countries in general and China and India in particular, have been countries of economic
interest for the last few years. Economic development has encouraged lifestyle changes which
have resulted in a shift in disease prevalence more typically seen in richer Western Countries. With
improved sanitation, widespread availability of antibiotics and immunization, there has been a drop
in communicable disease incidence and a corresponding rise in the incidence of non
communicable diseases such as cancer suspected to be due dietary changes, increased
sedentary lifestyle, and exposure to pollution amongst other factors. China has seen the
pronounced shift at relatively faster rate than India consistent with the more advanced stages of
economic development.

Cancer claimed the lives of approximately 7.9 million people worldwide in 2007 (13% of all deaths),
according to World Health Organization. A substantial majority of experts have converged upon the
view that the optimal cancer management practice that offers the greatest potential to saves lives,
is inevitably, early detection of cancer. Early detection of cancer enables a higher probability of
effective treatment options prior to the spread or metastasis of the tumour at which point organ
damage is usually irreversible and treatments become substantially more burdensome on the
patient in terms of adverse side effects. This article will introduce the growing importance of tumour
markers and the tale they tell of the economy.

Table 1: Current usage of various tumour markers

Tumour
Main Diseases Current Usage
Markers
CA 125 Ovarian Cancer Monitoring response to treatment and detection of recurrence
Diagnosis of hepatocellular (liver) carcinoma and germ cell
AFP Liver Cancer
carcinoma
Screening test, predictive of response to treatment and
PSA Prostate Cancer
monitoring recurrence
CEA Colon cancer Monitor recurrence
Differentiate benign to malignant tumour but yet to be
CA 19-9 Colon carcinoma
established
CA15-3 Breast Cancer Monitoring course and response to treatment
Pepsinogen
Stomach Cancer Current research
I/II
Neuro Immunohistochemical marker for tumours of CNS,
NSE
blastoma neuroblastomas and APUD tumours
Calcitonin II Thyroid cancer Detection of recurrence

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Clearstate Pte. Ltd, a Singapore based healthcare consultancy has conducted nationwide studies
in China and India on the volume of tumour marker tests carried out in hospitals and laboratories in
both countries.

Table 2: Breakdown of tumour markers tests conducted in hospitals and laboratories

across India and China

Tumour Markers India China

CA 125 18% 19%
AFP 17% 16%
Total PSA 15% 7%
CA 72.4 9% 9%
CEA 8% 6%
Free PSA 8% 6%
CA 19-9 8% 15%
CA15-3 7% 14%
Pepsinogen I/II 4% 1%
NSE 3% 4%
Calcitonin II 3% 3%

The report indicates that tumour marker CA-125 has recorded highest number of tests performed
for both India and China. CA-125 is a mucinous glycoprotein and is known to be elevated in
ovarian cancer patients (80% chance of returning a true positive in ovarian cancer patients). Its
current usage is early detection followed by monitoring treatment response or recurrence of the
cancer. Although ovarian cancer is the second leading gynaecological cause of death in women,
after breast cancer, it is not a leading cancer in China and India. Despite this the study shows that
many Chinese and Indian women have been advised by their physicians to undergo CA-125 tests.

Another particular marker of interest would be total PSA tests; a tumour marker used for screening
for prostate cancer in men. Prostate cancer is known to be more common in developed countries
due to dietary factors and longer life span. Based upon these factors alone expectation would
suggest China, being a more developed country, to have recorded a higher number of total PSA
tests carried out. However, India recorded 100% more total PSA tests carried out than China.

Tumour markers CA19-9 and CA15-3, used for early detection of colon cancer and breast cancer
respectively are both reported at significant higher percentages performed in China as compared
to India. The increased performance of both of these tumour marker tests also continue to
demonstrate the trends seen in more developed economies as colon cancer and breast cancer
have been postulated to be associated with dietary factors, in particular obesity, high alcohol intake
and diabetes; traits that are seen more commonly in developed nations. Specifically CA15-3,
which is used to monitor response to treatment of breast cancer have been associated with women
who have children at a later age and the prolonged intake of birth control pills, very much
applicable to China and the ruling of one child per family in the country.

Another tumour marker that is worth the mention is pepsinogen I/II. There have been studies
suggesting the usage of pepsinogen I/II as a screening test for and a monitor of recurrence to
stomach cancer. Stomach cancer is highly prevalent in countries like Japan, Korea and China with
half the global death toll for stomach cancer accounted in China, a startling proportion, what with

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stomach cancer being recorded as world’s second most common cause of cancer death. The
incidence rate of stomach cancer in China is approximately 90.9 per 100 000 population.

Reflecting the high prevalence rate of stomach cancer in East Asian countries, there is the
likelihood of substantial growth in pepsinogen I/II testing in the years to come.

Tumour markers will continue to play a critical role in the screening and monitoring of cancer.
There will continue to be substantial investment in the development of other promising biomarkers
as well. With the persistent trend towards preventive medicine as oppose to the traditional reactive
medicine, this sector is anticipated to experience high growth rates in the near future.

*The full report, Assay Insights, is available in the proprietary Gateway Database Solutions of
Clearstate Pte. Ltd.

Clearstate Pte. Ltd is a healthcare-focused consulting company based in Singapore.

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