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Had History Of Breast And Thyroid Cancer. Treated With Surgery And Radiation. Recent Serum HCG Beta Subunit Showed Positive. Guide?

Posted on Thu, 4 Jul 2013

Question: I am interested in an add-on to the following question that Dr. XXXXXXX Anvekar had answered on the web; XXXXXXX What causes higher HCG levels post menopause'? His answer included the statement as follows: "It is commonly seen among some normal, non- pregnant, post-menopausal women to have β-hCG levels that are slightly above normal laboratory limits…"

My 66 year old postmenopausal wife has a history of breast (DCIS, 2005) & Thyroid (Papillary 2007) cancers, both treated successfullly with surgery & radiation and no evidence of reoccurrence. A recent serum hCG Beta subunit, Qualitative came back positive. I am hoping to validate Dr. Anvekar's answer that this is normal. All other blood work was normal and there are no problematic symptoms. I therefore have 2 questions for you.

1) Can you provide me with copies or links to Dr. Anvekar's data expressing the normality of the hCG beta subunit? I can find much about hCG and post-menopausal, but have been unsuccessful in locating much on hCG beta.

2) To further validate that she has no problem, I intend to have the following tests run and wonder if you think these are sufficient or have any more tests to suggest.

Serum: hCG, hCG beta subunit QUANTITATIVE;

Urine: HCG, hCG beta subunit QUANTITATIVE.

I am given to under stand that hCG alpha provides no value.

We plan to have this blood work in two days so a quick answer would be appreciated.

Thanks,

XXXXXX

Answered by Dr. Chakravarthy Mazumdar (6 hours later)

Hi,

I would like to draw your attention that HCG is nothing but Beta HCG. Most tests employ a monoclonal antibody, which is specific to the β-subunit of hCG to differentiate this from LH and FSH which are identical. This procedure is done to ensure that these tests do not make false positives by confusing hCG with LH and FSH.

If Beta HCG test is positive in a post menopausal female further testing would be undertaken to rule out tumors. I would not like to scar you about them now. You can talk to your doctor who ordered this. His reasons should be to screen metastasis to the ovary from the breast.

Is he not worried about the slightly elevated level? If not bothered I'd suggest you are doing a futile exercise trying to interpret. It just leads to more testing.

1) I am not sure where Dr. Anvekar had brought these lines from. I do not think he is no longer answering on this platform. Please note that he was quoting only about some non pregnant and post menopausal women. However such women should necessarily screened for other tumors as part of the screening protocols. I leave the rest to the treating doctor since there are no symptoms expressed.

2) It would be fair to continue with the tests that you wanted to as you were already searching around for answers. Serum: hCG, hCG beta subunit QUANTITATIVE; and Urine: HCG, hCG beta subunit QUANTITATIVE.

I am surely available to answer your follow up.

Above answer was peer-reviewed by : Dr. Aparna Kohli

Follow up: Dr. Chakravarthy Mazumdar (2 hours later)

I do not have a doctor involved at present. The hCB beta subunit test was performed by a health service. And it was a beta subunit test, not hCB. I don't understand your intent with saying, " HCG is nothing but Beta HCG." I see much information on hCG and its isoforms. And our test was supposedly specific to the beta subunit. My first question was, that according to Dr. Dr. Anvekar, elevated levels of hCG Beta Subunit are normal in postmenopausal and I was wanting his reference and 'normal' range for the beta subunit. If I had the data he was quoting, then maybe my wife fell in this normal range and I would not be 'scared' as you suggested. I have requested those additional tests and FSH, LH, prolactin, hyperglycosylated hCG, & hCG beta core fragment for the urine. I am hoping these tests will be all negative. I have read that the beta subunit is the cancer marker, not the total hCG. Further, had my wife's elevation been in total hCG (not beta subunit), I would have been less concerned because of all the medical studies affirming elevated total hCG as normal, and the total range numbers published

Answered by Dr. Chakravarthy Mazumdar (18 hours later)

When I said both Serum HCG and Beta HCG qualitative are equal. I mean they are alternative name. They are few more like these
Beta-HCG in blood serum - qualitative;
Human chorionic gonadotrophin - serum - qualitative;
Serum HCG - qualitative;
HCG in blood serum - qualitative

Since the health service had mentioned Beta HCG you are going with that name.

I feel that there is always a little confusion with self interpretation. It is not in the best interest of you and your wife that you prepare to interpret the screening test for yourself. I'd suggest to get involved with a doctor to make things less stressful for you.

Beta HCG or Serum HCG are falsely positive in menopause.

You may want to read this messages. This is taken from this link ( WWW.WWWW.WW ).

Raised serum beta human chorionic gonadotrophin (beta-hCG) not due to pregnancy can occur as a consequence of (1) gestational trophoblastic neoplasia (GTN), (2) non-gestational trophoblastic tumours, (3) a false-positive beta-hCG, (4) the menopause or (5) a high normal level.
Elevated serum and urinary beta-hCG levels in healthy women should be investigated systematically to exclude an underlying malignant process and to avoid inappropriate surgical and medical intervention. Long-term follow-up is required as tumours may not become apparent for many months or years.

Hence I suggest to approach a primary to investigate further.

All the best.

Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Aparna Kohli