iran is in the thalassemic belt with a frequency of about 6 -10% in the northern and southern provinces ( 1 ) .
cancer antigen 15.3 ( ca15.3 ) , a product of muc1 gene ; is an epithelial mucin and its high level is associated with breast cancer . in patients with breast cancer ,
evaluation of ca15.3 has not been recommended by national comprehensive cancer network guidelines for surveillance purposes , but its monitoring suggested to detect recurrences of cancer evaluating therapeutic response of advanced disease and the assessment of prognosis in patients with early breast cancer ( 2,3 ) . also it may be high in nonmalignant conditions such as inflammatory processes and some hematologic disorders like sickle cell anemia and thalassemia major ( 4).improving management of thalassemia major has led to increased life expectancy and subsequently increased frequency of age related conditions such as malignancies ( 5 - 7 ) . as a result , some investigators have opted to check serum tumor markers in these patients .
however , they showed an increased frequency of serum ca15.3 independent from the presence of malignancy in these patients .
the suggestive mechanism is erythroid hyperplasia which could result in high level of muc1 expression on bone marrow - appoptosing progenitor cells ( 5 , 8) .
up to our knowledge , evaluation of serum ca15.3 in patients with thalassemia minor has not been conducted .
our hypothesis was that patients with beta - thalassemia minor has a higher serum level of ca15.3 compared to healthy individuals and patients with thalassemia major but with a milder degree .
present study was designed to measure the serum level of ca15.3 in patients with beta - thalassemia minor compared to healthy individuals and to patients with cancer .
also we aimed to determine the frequency of beta - thalassemia minor in a population of young patients with malignancies . 


 in this cross - sectional study , 32 carriers of beta - thalassemia , 25 healthy individuals , and 49 patients with cancer were recruited from february to december 2011 .
carriers of beta - thalassemia were non - randomly selected from the volunteers referred for premarital screening in an outpatient clinic affiliated to shiraz university of medical sciences , southern iran .
all patients with cancer who referred to pediatric hematology - oncology clinic of shiraz university of medical sciences in the study period were recruited .
healthy controls were randomly selected from healthy individuals who referred to pediatric hematology - oncology clinic for checkup examination .
patients with cancer were subdivided to 2 groups of with and without beta - thalassemia minor . in all participants ,
the ca 15.3 was checked by canag ca 15 - 3 eia kit , sweden in all participants .
the protocol for this study was approved by the ethics committee of shiraz university of medical sciences . written informed consent was obtained from all participants or their parents . 
 

test of normality was done by kolmogorov - smirnov test ( ca15.3 , p=0.2 and age , p=0.156 ) .
comparison of serum level of ca15.3 level and age among various groups were done by anova test . to find the statistically significant difference among different groups , post hoc tukey hsd test was performed .
sex distribution was compared among the studied groups using chi - square test , and p value less than 0.05 was considered statistically significant . 


 participants were divided to 4 groups including : group 1 , beta - thalassemia minor ; group 2 : patients with cancer and without beta - thalassemia minor ; group 3 : patients with cancer and beta - thalassemia minor , and group4 : healthy individuals .
comparisons of the mean age and sex ratio as well as mean serum ca 15.3 level among the four groups of participants are shown in table 1 . 
 

* statistically significant , ca ag 15 - 3 , cancer antigen 15.3 
 
 carriers of beta - thalassemia were significantly older than the other groups ( p<0.0001 for comparison of this group with each of the other three groups based on post hoc tukey hsd test ) .
male to female ratio was not significantly different among the studied groups ( p=0.804 ) .
the serum levels of ca 15.3 in all participants were in the normal range ( < 35 u / ml ) and its concentrations shown no significant difference among various groups of the participants ( p=0.723 ) .
age was not significantly correlated with the serum level of ca 15.3 ( r= 0.039 , p=0.702 ) . 
 
 as shown in table 2 , of 49 patients with cancer
, 96% had hematologic malignancies with the highest frequency for acute lymphoblastic leukemia ( 37 patients ) .
acute lymphoblastic leukemia : ( all ) , acute myeloblastic leukemia : ( aml ) , hodgkin lymphoma : ( hl ) , non hodgkin lymphoma : ( nhl ) 
 
 of 49 patients with malignancies 11 ( 22.4% ) diagnosed as thalssemia minor by their cbc and hemoglobin electrophoresis results . 


 we evaluated serum level of ca 15.3 in carriers of beta - thalassemia by comparing them to the three other groups including patients with cancer and those with or without beta - thalassemia minor as well as healthy individuals .
we did not find any significant difference with regard to the ca 15.3 concentrations among the groups .
moreover , we expected that the higher serum level of ca 15.3 in patients with cancer compared to the reference range .
this is in contrast with the results of other reports which showed increased levels of ca 15.3 among patients with solid tumors ( 9 ) .
we could not find any publication that has investigated the serum levels of ca 15.3 in patients with hematologic malignancies .
as we mentioned most of our patients had hematologic malignancies and mostly acute lymphoblastic leukemia .
this result suggests that the ca 15.3 may not be associated with hematologic malignancies and thus it can not be used as a tumor marker . 
 

we found a frequency of 22.4% ( 11 out of 49 ) of beta - thalassemia minor in the group of patients with malignancies . compared to the prevalence rate of about 10% in the general population
therefore the suggestive mechanism could be shorter life span of red blood cells , and theoretically erythroid hyperplasia secondary to ineffective erythropoiesis which could cause errors in cell division leading to hematologic malignancies .
these findings did not support the results of the previous study in our center which showed protective effect of minor thalassemia against childhood malignancies ( 1 ) . 
 

our study was limited due to lack of matched matched of carriers for beta - thalassemia with other groups because most of participants in this group selected from persons who were screened for marriage .
but other groups were selected from younger children and persons referred to pediatric hematology - oncology clinic .
however , we did not find a significant correlation between age and serum ca 15.3 concentration in our participant .
moreover our research was a cross - sectional study and we can not conclude strongly about the relationship between cancer and beta - thalassemia minor . to document the accurate correlation
we need a cohort study for this matter . moreover , during the course of our study , most of our patients in the cancer group had hematologic malignancies . 


 the values of ca 15.3 serum levels were in the normal range for both in carriers of beta - thalassemia and in patients with malignancies .
no correlation was found between ca 15.3 serum level with thalssemia minor or with childhood malignancies .
compared to normal population , a high proportion ( 22.4% ) of thalssemia minor was observed in patients with cancer in our study .
future prospective studies are needed to evaluate the relationship between cancer and beta - thalassemia minor accurately . 

 
 background : high serum level of cancer antigen 15.3 ( ca15.3 ) has been reported in some malignant and nonmalignant conditions including thalassemia major which could have been resulted from ineffective erythropoiesis . 
 we aimed to evaluate the serum level of ca15.3 in carriers of beta - thalassemia by comparing them with cancer patients and healthy individuals . 

 
 methods : this cross - sectional study was done from february to december 2011 in southern iran . 
 participants consisted of 32 subjects with beta - thalassemia minor , 49 with cancer and 25 healthy individuals . 
 the serum levels of ca15.3 were measured and compared in different groups . 

 
 results : the serum levels of ca 15.3 in all participants were in the normal range ( < 35 u / ml ) . also it did not significantly differ among various groups of the participants ( p=0.723 ) . 
 age was not significantly correlated with the serum level of ca 15.3 ( r= 0.039 , p=0.702 ) . 
 the most frequent cancer in the group of patients with malignancies was hematologic malignancies ( 96% ) with the highest frequency for acute lymphoblastic leukemia ( 37 patients ) . 
 frequency of thalassemia minor in patients with cancer was 11 ( 22.4% ) . 

 
 conclusion : no correlation was found between ca 15.3 serum level with beta - thalssemia minor or with childhood malignancies . compared to general population , a high proportion of beta - thalssemia minor was observed in patients with cancer in our study . 
 future prospective studies are needed to evaluate the relationship between cancer and beta - thalassemia minor accurately . 
 
Introduction
Methods
Results
Discussion
Conclusion