Consensus Report of the 2015 Weinman International Conference on Mesothelioma

Our plain-English summary of Consensus Report of the 2015 Weinman International Conference on Mesothelioma, by M. Carbone, S. Kanodia, A. Chao, et al (Journal of Thoracic Oncology, 2016).

The study

• Authors: M. Carbone, S. Kanodia, A. Chao, A. Miller, A. Wali, D. Weissman, A. Adjei, F. Baumann, P. Boffetta, B. Buck, M. de Perrot, A.U. Dogan, S. Gavett, A. Gualtieri, R. Hassan, M. Hesdorffer, F.R. Hirsch, D. Larson, W. Mao, S. Masten, H.I. Pass, J. Peto, E. Pira, I. Steele, A. Tsao, G.A. Woodard, H. Yang, S. Malik
• Journal: Journal of Thoracic Oncology
• Published: 2016;11(8):1246-1262
• Type of article: Consensus statement
• Cited by: 107 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

On November 9 and 10, 2015, the International Conference on Mesothelioma in Populations Exposed to Naturally Occurring Asbestiform Fibers was held at the University of Hawaii Cancer Center in Honolulu, Hawaii. The meeting was cosponsored by the International Association for the Study of Lung Cancer, and the agenda was designed with significant input from staff at the U.S. National Cancer Institute and National Institute of Environmental Health Sciences. A multidisciplinary group of participants presented updates reflecting a range of disciplinary perspectives, including mineralogy, geology, epidemiology, toxicology, biochemistry, molecular biology, genetics, public health, and clinical oncology. The group identified knowledge gaps that are barriers to preventing and treating malignant mesothelioma (MM) and the required next steps to address barriers. This manuscript reports the group's efforts and focus on strategies to limit risk to the population and reduce the incidence of MM. Four main topics were explored: genetic risk, environmental exposure, biomarkers, and clinical interventions. Genetics plays a critical role in MM when the disease occurs in carriers of germline BRCA1 associated protein 1 mutations. Moreover, it appears likely that, in addition to BRCA1 associated protein 1, other yet unknown genetic variants may also influence the individual risk for development of MM, especially after exposure to asbestos and related mineral fibers. MM is an almost entirely preventable malignancy as it is most often caused by exposure to commercial asbestos or mineral fibers with asbestos-like health effects, such as erionite. In the past in North America and in Europe, the most prominent source of exposure was related to occupation. Present regulations have reduced occupational exposure in these countries; however, some people continue to be exposed to previously installed asbestos in older construction and other settings. Moreover, an increasing number of people are being exposed in rural areas that contain noncommercial asbestos, erionite, and other mineral fibers in soil or rock (termed naturally occurring asbestos [NOA]) and are being developed. Public health authorities, scientists, residents, and other affected groups must work together in the areas where exposure to asbestos, including NOA, has been documented in the environment to mitigate or reduce this exposure. Although a blood biomarker validated to be effective for use in screening and identifying MM at an early stage in asbestos/NOA-exposed populations is not currently available, novel biomarkers presented at the meeting, such as high mobility group box 1 and fibulin-3, are promising. There was general agreement that current treatment for MM, which is based on surgery and standard chemotherapy, has a modest effect on the overall survival (OS), which remains dismal. Additionally, although much needed novel therapeutic approaches for MM are being developed and explored in clinical trials, there is a critical need to invest in prevention research, in which there is a great opportunity to reduce the incidence and mortality from MM.

Copyright © 2016 International Association for the Study of Lung Cancer. All rights reserved.

In plain English

This article was a consensus report, not a new study. It summarized a two-day international meeting held November 9 and 10, 2015, at the University of Hawaii Cancer Center in Honolulu. Invited experts, who are the article's coauthors, came from fields including mineralogy, epidemiology, genetics and clinical oncology. They reviewed four topics: genetic risk, environmental exposure (including naturally occurring asbestos and erionite), biomarkers, and treatment of malignant mesothelioma. Drafts were circulated among participants until a final consensus manuscript was produced. The group supported BAP1 genetic screening for mesothelioma patients with a high-risk family history, but because of cost it was divided on screening all patients. It supported regular skin and eye examinations for people who carry inherited (germline) BAP1 mutations. It listed three signs that environmental or genetic causes may be involved in a population: a male-to-female ratio near 1 to 1, an excess of cases under age 55, and a pleural-to-peritoneal ratio near 1 to 1. The group unanimously supported further validation of early-detection biomarkers and more clinical trials. The authors concluded that reducing exposure has great potential to prevent mesothelioma.

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: Consensus report summarizing presentations and discussions at an expert meeting (not original research)
• Who was studied: A multidisciplinary international group of invited experts (the coauthors) at a conference held November 9 and 10, 2015, at the University of Hawaii Cancer Center, Honolulu
• Exposure: Topics reviewed: genetic risk (germline BAP1 mutations), environmental exposure to commercial asbestos and to naturally occurring asbestos and other mineral fibers such as erionite, biomarkers, and clinical treatment of malignant mesothelioma
• Main results:
  • The group supported BAP1 screening of mesothelioma patients with a high-risk family history of mesothelioma, uveal melanoma, cutaneous melanoma and certain other cancers
  • Because of economic concerns, the group was divided on screening all sporadic mesothelioma cases for BAP1 germline mutations
  • For carriers of germline (inherited) BAP1 mutations, the group supported skin and eye examinations every 6 months after age 30
  • The group listed epidemiological indicators that environmental exposure, genetic risk, or both may cause mesothelioma in a defined population: a male-to-female ratio close to 1:1, an excess of cases in people younger than 55 at diagnosis, and a pleural-to-peritoneal ratio close to 1:1
  • The group supported evaluating environmental exposures in areas of concern using activity-based sampling
  • In an eastern China series reported by Dr. Weimin Mao at the meeting, direct occupational or take-home exposure was documented in only 12% of cases
  • The group unanimously supported continued work to validate biomarkers for early detection of mesothelioma
  • The group unanimously agreed that more research and clinical trials with novel agents and immunotherapies are needed
• The authors' conclusion: The authors concluded that intervention to reduce exposure has great potential to prevent mesothelioma and save lives

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: Mesothelioma, Asbestiform, Lung Cancer, Mineralogy, Epidemiology, Malignant Mesothelioma, Environmental Exposure, Biomarker.

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