Altered haematological parameters and carcinoembryonic antigen levels of breast cancer patients: a study in Calabar, Nigeria Short title: Haematology and CEA changes in breast cancer

Abstract

Introduction: Breast cancer is the most common cancer with high mortality among Nigerian women. Significant illness such as cancer has been known to directly influence blood parameters, therefore, this study assessed changes in haematological parameters and carcinoembryonic antigen levels of breast cancer patients.

Materials and methods: Forty-five breast cancer patients attending clinic at the Oncology Unit, Department of Surgery, University of Calabar Teaching Hospital, were enrolled and age-matched with forty-five control subjects. Demographic and clinical data were obtained from questionnaire administered interview and patients’ case notes. Full blood count was determined using a standard haemoanalyzer while carcinoembryonic antigen level was by Fluorecare immunochromatographic assay. Data analysis was done on statistical package for social sciences (22), with significance set at P < 0.05.

Results: Breast cancer patients and control subjects had a mean age of 47.47±11.70 and 45.44 ± 11.80 years; most of them were married (75.6% and 55.6%) and had children (80% and 55.6%). Majority (75.6%) of breast cancer patients had tumour size of 3 to 7cm with 24.4% having a size of 8 to 12cm. Histological subtypes include invasive ductile carcinoma (71.1%) and non-invasive ductile carcinoma (28.9%). Co-morbidity was present in 22.2% of breast cancer patients and included ulcer (8.9%). high blood pressure (8.9%), human immunodeficiency virus infection (2.2%) and asthma (2.2%). Packed cell volume (0.31±0.02L/L), haemoglobin (98.53±7.20g/L), total white cell count (4.76±1.38 x10⁹/L) and neutrophil count (2.21±1.03 x10⁹/L) were significantly reduced (P<0.05) while carcinoembryonic antigen level (4.94±3.9 ng/ml) was significantly higher (P=0.001) for breast cancer patients versus control (0.37±0.02L/L, 120.16±7.38g/L, 5.61±1.62x10⁹/L, 2 2.97± 0.89x10⁹/L and 2.55±0.32 ng/ml). Histological subtypes and presence of comorbidities did not influence the studied parameters except for carcinoembryonic antigen which was significantly raised (P=0.02) for those with comorbidities versus those without (6.98±5.73ng/ml versus 4.63±1.70ng/ml). Significant positive correlation (r=0.314; p=0.036) was observed between monocyte count and carcinoembryonic antigen and the latter reduced steadily as chemotherapy cycles progressed.

Conclusion: The packed cell volume, haemoglobin, total white cell and neutrophil counts were significantly lower while carcinoembryonic antigen was significantly higher for breast cancer patients versus control. Carcinoembryonic antigen levels improved with progressive chemotherapy hence it is a useful marker for diagnosis and monitoring of treatment for breast cancer. The positive correlation observed between carcinoembryonic antigen and monocyte count suggests that the latter may be useful as a substitute for carcinoembryonic antigen measurements in breast cancer.