Current status of screening for malignant pleural mesothelioma

Our plain-English summary of Current status of screening for malignant pleural mesothelioma, by H.I. Pass, M. Carbone (Seminars in Thoracic and Cardiovascular Surgery, 2009).

The study

• Authors: H.I. Pass, M. Carbone
• Journal: Seminars in Thoracic and Cardiovascular Surgery
• Published: 2009;21(2):97-104
• Type of article: Review
• Cited by: 48 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma is characterized by its association with asbestos, its long latency period, and the propensity for the diagnosis to be obtained in the later stages of the disease. Because the high-risk cohorts for mesothelioma are fairly well defined by the association with asbestos, and the exposure is usually in the workplace, it is hypothesized that early detection of the disease could (1) find patients at an earlier, more treatable stage and (2) result in prolonged survival over the present median 12 months from the start of therapy. Many studies have used standard chest X-ray to characterize changes associated with asbestos-exposed individuals, but the insensitivity of X-ray in screening patients with mesothelioma has never supported the wide-scale adaptation of such an effort. With the advent of computerized tomography, prospective trials, many of which are chiefly prevalence detection studies, have been performed and stress the importance for proper detailing by carefully qualifying suspicious changes, as well as defining the correct cohort to screen. Most recently, serum biomarkers with the potential to discriminate asbestos-exposed, non-cancer-bearing individuals from those with mesothelioma have been investigated both at single institutions and with multi-institutional-blinded trials. These markers, including soluble mesothelin-related protein, osteopontin, and megakaryocyte potentiating factor, may, in the future, be incorporated into a screening algorithm for high-risk asbestos-exposed individuals to help monitor these cohorts in a noninvasive fashion and guide the use of computerized tomography.

In plain English

This article was a review, not a new study. The authors reviewed published research on screening asbestos-exposed people for malignant pleural mesothelioma using chest X-rays, computed tomography (CT) scans, and blood (serum) markers. In the reviewed studies, X-ray surveys of over 2400 UK naval dockyard workers detected no mesotheliomas. CT programs found few or no mesotheliomas, and in a Canadian study of 516 people, screening did not lead to early diagnosis of any mesothelioma. Among blood markers, one reviewed study found raised soluble mesothelin-related protein (SMRP) in 37 (84%) of 44 mesothelioma patients. The authors' own earlier work reported that osteopontin separated mesothelioma patients from asbestos-exposed people with an accuracy score (AUC) of 0.888. In another reviewed study, at 95% specificity against healthy controls and patients with benign asbestos-related disease, sensitivity for mesothelioma was 34% for megakaryocyte potentiating factor, 47% for osteopontin and 73% for mesothelin. The authors concluded that X-ray and CT screening had proved ineffective for finding early mesothelioma. They also concluded that no blood marker had yet been validated for clinical use, though SMRP, osteopontin and megakaryocyte potentiating factor were promising.

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: Narrative review of published screening studies (chest X-ray, CT) and serum biomarker studies for malignant mesothelioma
• Who was studied: Published studies of asbestos-exposed cohorts in several countries (UK, Finland, USA, Italy, Germany, Canada, Australia), plus biomarker studies comparing mesothelioma patients with asbestos-exposed people and other controls
• Exposure: Mainly occupational asbestos exposure (for example miners, construction, shipyard and insulation workers). The article also mentions environmental erionite exposure in Cappadocia, Turkey, as the setting of a planned future cohort.
• Main results:
  • In a reviewed UK study of over 2400 asbestos-exposed naval dockyard workers given standard chest X-rays, no cases of mesothelioma were detected
  • In a reviewed Helsinki CT screening study of asbestos-exposed workers, CT detected 6 malignancies (1%): 5 lung cancers and 1 peritoneal mesothelioma
  • In a reviewed Italian CT study of 1045 asbestos-exposed workers and former workers, CT identified 10 thoracic malignancies and no mesotheliomas
  • In a reviewed Canadian CT study of 516 asbestos-exposed individuals, screening did not lead to early diagnosis of mesothelioma in any case; all mesothelioma patients died soon after diagnosis, with maximal survival of 9 months
  • In a reviewed study by Robinson and colleagues, 37 (84%) of 44 mesothelioma patients had raised serum SMRP
  • In a reviewed 1-year SMRP screening study of 538 people with previous asbestos exposure, 15 had elevated SMRP, of whom 1 had lung cancer. No subjects were diagnosed with mesothelioma.
  • In the authors' own earlier study (serum from 69 people with asbestos-related nonmalignant disease and 76 surgically staged mesothelioma patients), osteopontin distinguished mesothelioma from asbestos-exposed individuals with an AUC of 0.888
  • In a reviewed study by Creaney, at 95% specificity relative to healthy controls and patients with benign asbestos-related disease, sensitivity for mesothelioma was 34% for megakaryocyte potentiating factor, 47% for osteopontin and 73% for mesothelin
• The authors' conclusion: The authors concluded that large-scale screening with chest X-ray and CT had proved ineffective for detecting early-stage mesothelioma in asbestos-exposed people. They also concluded that no biomarker had yet been validated in prospective trials, although SMRP, osteopontin and megakaryocyte potentiating factor were promising.
• Limitations the authors state:
  • The authors noted that most earlier biomarker studies had very few patients and had not been prospectively evaluated
  • The authors stated that none of the promising biomarkers had been rigorously validated in a blinded fashion
  • The authors noted difficulty standardizing the reading of chest X-rays and CT scans

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Malignant Mesothelioma, Latency, Mesothelioma, Chest X-Ray, Biomarker, Mesothelin, Osteopontin.

Related studies

• Biomarkers for malignant pleural mesothelioma: current status — L. Greillier, P. Baas, et al. (2008)
• Serum biomarkers in patients with mesothelioma and pleural plaques and healthy subjects exposed to naturally occurring asbestos — M. Bayram, I. Dongel, et al. (2014)
• Factors determining early adherence to a lung cancer screening protocol — U. Montes, L.M. Seijo, et al. (2007)
• Yield of Low-Dose Computerized Tomography Screening for Lung Cancer in High-Risk Workers: The Case of 7189 US Nuclear Weapons Workers — S.B. Markowitz, A. Manowitz, et al. (2018)
• Variations in lung cancer risk among smokers — P.B. Bach, M.W. Kattan, et al. (2003)
• Comparison of osteopontin, megakaryocyte potentiating factor, and mesothelin proteins as markers in the serum of patients with malignant mesothelioma — J. Creaney, D. Yeoman, et al. (2008)

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