Biomarker assessments in asbestos-exposed workers as indicators for selective prevention of mesothelioma or bronchogenic carcinoma: rationale and practical implementations

Our plain-English summary of Biomarker assessments in asbestos-exposed workers as indicators for selective prevention of mesothelioma or bronchogenic carcinoma: rationale and practical implementations, by E. Pluygers, P. Baldewyns, P. Minette, et al (European Journal of Cancer Prevention, 1991).

The study

• Authors: E. Pluygers, P. Baldewyns, P. Minette, M. Beauduin, P. Gourdin, P. Robinet
• Journal: European Journal of Cancer Prevention
• Published: 1991;1(1):57-68
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Asbestos-associated malignancies are one of the major industrial hazards of recent decades and will continue to be so until beyond the end of the century. It has been estimated that, in the United States alone, there will be 131,200 cancer deaths as a result of asbestos exposure. At present the early lesions are detected radiologically, by which time intervention is no longer effective. The aim of this study was to test the value of a battery of serum biomarkers in the early detection of malignancy and in distinguishing between the early stages of mesothelioma and bronchogenic carcinoma. Many of the biomarkers had no discriminating value but on the basis of four such markers (namely TPA, CEA, HA and ferritin) it has been possible to distinguish between the late stages of the two malignancies and asbestosis. The results are discussed in terms of their possible application to the detection of early pre-malignant lesions in a screened population of asbestos-exposed persons, with the aim of attempting to prevent cancer death in such early detected cases.

In plain English

This was a small preliminary study. Without knowing the diagnoses, the authors measured seven markers (CEA, TPA, ferritin, NSE, hyaluronic acid (HA), CA 125 and CA 19.9) in 24 frozen serum samples from asbestos-exposed workers. Most had worked in insulation, asbestos-cement or shipbuilding; the asbestos type was not specified. The workers had mesothelioma, bronchogenic carcinoma (a lung cancer) or asbestosis. Most had already died, indicating advanced disease. All mesothelioma samples had the lowest CEA grade; all seven with CEA above 5 ng/ml were bronchogenic carcinomas. TPA was raised in 20 of 24 samples. Ferritin reached grade 2 or 3 in three cases, all mesothelioma. HA was raised in 11 cases, split evenly between mesothelioma and bronchogenic carcinoma except for one bladder cancer wrongly placed in the asbestosis group. Raised HA came only from cancers, so it was not specific to mesothelioma. Combining TPA, CEA, HA and ferritin, the authors reported identifying 8 of 8 mesotheliomas and 7 of 9 bronchogenic carcinomas. The authors noted the cases were advanced and few. They concluded the markers might be used to monitor exposed workers regularly.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Preliminary blind laboratory evaluation of stored serum samples from asbestos-exposed workers with known diagnoses (case series)
• Who was studied: 24 occupationally asbestos-exposed workers, most from the insulation and asbestos-cement industries and shipbuilding yards. Of these, 8 had mesothelioma, 9 had bronchogenic carcinoma and 7 were in the asbestosis group (one of whom had bladder carcinoma). Most had died by the time the samples were evaluated. Location and dates are not stated beyond 'workers of diverse origin'.
• Exposure: Occupational asbestos exposure. The type of asbestos was not specified. Duration of exposure and smoking status were known for all subjects.
• Main results:
  • In the mesothelioma cases, all CEA values were grade 0 (the lowest grade).
  • All seven cases with CEA above 5 ng/ml (grades 2 and 3) were bronchogenic carcinoma.
  • TPA was raised in 20 of the 24 asbestos-exposed cases.
  • Mean TPA values (U/litre) were 36.5 in controls, 118 in asbestosis, 240 in the group labelled 'asbestosis + bronchial carcinoma', and 358 in mesothelioma.
  • In 13 of the 24 cases, TPA was above 100 U/l, compared with less than 3% of a control population of 650 subjects.
  • At a threshold of grade 2, TPA identified 14 of the 18 malignancies, with four false negatives and four false positives.
  • Ferritin was grade 2 or 3 in three cases, all of them mesothelioma. The authors stated that very high ferritin levels were seen only in mesothelioma cases.
  • HA was above grade 0 in 11 cases, all malignancies. These were evenly distributed between mesothelioma and bronchogenic carcinoma, and a bladder carcinoma inadvertently included in the asbestosis group was also recognized. The authors did not confirm HA as specific to mesothelioma.
  • NSE picked up the single small cell lung cancer case.
  • CA 125 and CA 19.9 were consistently negative in mesothelioma, and the authors judged their usefulness very limited.
  • Combining TPA, CEA, HA and ferritin correctly identified 8 of 8 mesotheliomas and 7 of 9 bronchogenic carcinomas.
  • Of the two unidentified bronchogenic carcinomas, one was later recognized as small cell lung cancer by NSE, and the other was mistaken for mesothelioma.
  • All but one of the bronchogenic carcinoma cases were heavy smokers.
• The authors' conclusion: The authors concluded that, although the results came from advanced cases, the four-marker assay discriminated between mesothelioma and bronchogenic carcinoma well enough that it may be applied to regular monitoring of asbestos-exposed workers. They proposed monitoring ideally from hiring and then every few years.
• Limitations the authors state:
  • The sera came from workers with advanced disease, all of whose malignancies were fatal.
  • The number of cases was small.
  • A case of bladder carcinoma was inadvertently included in the asbestosis group.
  • Asbestosis was assessed by radiology, whereas the cancers were confirmed by pathology.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Biomarker, Mesothelioma, Bronchogenic Carcinoma, Asbestos Exposure, Ferritin.

Related studies

• Biomarker assessments in asbestos-exposed workers as indicators for selective prevention of mesothelioma or bronchogenic carcinoma: rationale and practical implementations — E. Pluygers, P. Baldewyns, et al. (1992)
• Morphology of bronchogenic carcinoma in workers formerly exposed to crocidolite at Wittenoom Gorge in Western Australia — J.E. Baker, D.C. Reutens, et al. (1986)
• Assessment of biomarkers in asbestos-exposed workers as indicators of cancer risk — M. Amati, M. Tomasetti, et al. (2008)
• Association of asbestos and bronchogenic carcinoma in a population with low asbestos exposure — M.L. Warnock, A.M. Churg (1975)
• Asbestosis associated with bronchogenic carcinoma — R. Stoll, R. Bass, et al. (1951)
• Asbestos, an extrinsic factor in the pathogenesis of bronchogenic carcinoma and mesothelioma — W.M. O'Donnell, R.H. Mann, et al. (1966)

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