Retrospective analysis of large-scale research screening of construction workers for the early diagnosis of mesothelioma

Our plain-English summary of Retrospective analysis of large-scale research screening of construction workers for the early diagnosis of mesothelioma, by T. Hirohashi, K. Igarashi, M. Abe, et al (Molecular and Clinical Oncology, 2014).

The study

• Authors: T. Hirohashi, K. Igarashi, M. Abe, M. Maeda, O. Hino
• Journal: Molecular and Clinical Oncology
• Published: 2014;2(1):26-30
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The early diagnosis of mesothelioma, an aggressive malignant tumor, is considered to be important for prognosis. X-ray is commonly used for the assessment of a mass in a population exhibiting a risk factor. However, there are currently no available studies indicating that such an assessment may be used to achieve early diagnosis and improve the patient's outcome. We previously reported that N-ERC/mesothelin may be a useful blood tumor marker for mesothelioma. In order to investigate whether this tumor marker is useful for early diagnosis in a mass examination, in 2007 we initiated a 5-year large-scale screening of construction workers with a risk of asbestos exposure in Japan. Blood samples were collected annually and N-ERC/mesothelin levels were determined. Based on the results of those findings, along with medical history and related data, we screened the participants to identify a high-risk population. As a result, 62 subjects were identified among ~40,000 participants as the high-risk population. Two of these 62 participants subsequently developed mesothelioma, although the remaining participants have not yet developed mesothelioma. In conclusion, N-ERC/mesothelin may be useful as a blood tumor marker in the early diagnosis of mesothelioma in a mass examination. A future prospective study to confirm the findings of this research screening is currently under planning.

In plain English

This was an interim, retrospective analysis of a 5-year blood-test screening program begun in 2007. It enrolled members of a Tokyo construction workers' union and health insurance association, chosen because their jobs put them at risk of asbestos exposure. By September 26, 2010, about 40,000 people had enrolled and 124,288 blood samples had been tested for a marker called N-ERC/mesothelin. Of these samples, 1,603 were above 8.00 ng/ml, and 714 stayed high on re-testing. A case review committee then named 62 participants as a high-risk group, who were compared with 7,850 low-risk participants. Mean levels were 9.83 to 17.28 ng/ml in the high-risk group versus about 2.20 to 4.33 ng/ml in the low-risk group, and rose faster in the high-risk group. X-rays had not suggested mesothelioma in the high-risk group, but two of the 62 developed mesothelioma. One of them, aged 72 with a 50-year history of asbestos exposure, reached 78.6 ng/ml after missing a yearly test. The authors concluded the marker may be useful for early diagnosis in large-scale screening. Asbestos exposure histories were not collected unless a participant developed 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: Interim retrospective analysis of a 5-year large-scale blood-marker screening program, comparing a high-risk group with a low-risk control group
• Who was studied: About 40,000 adult male and female members of the Tokyo General Construction Workers Union and the Tokyo Doken National Health Insurance Association in Japan, enrolled at 85 research sites. Screening began in 2007 and data were analyzed as of September 26, 2010. From these, 62 high-risk participants (mean age 56, range 35 to 76) and 7,850 low-risk participants from 17 sites were analyzed.
• Exposure: Occupational risk of asbestos exposure from construction or plumbing work. No fiber types or doses were reported, and asbestos exposure history was not collected unless a participant developed mesothelioma. The measurement studied was the blood marker N-ERC/mesothelin, tested annually.
• Main results:
  • 124,288 blood samples were collected and analyzed for N-ERC/mesothelin from about 40,000 participants.
  • 1,603 samples had abnormal values (above 8.00 ng/ml).
  • After re-analysis to exclude interference from human anti-mouse antibody, 714 samples still had high values.
  • 62 participants were finally identified as the high-risk population by the case review committee.
  • X-ray findings did not indicate suspected mesothelioma in anyone in the high-risk population at this interim assessment.
  • Mean N-ERC/mesothelin levels were about 2.20 to 4.33 ng/ml in the low-risk population and 9.83 to 17.28 ng/ml in the high-risk population. The authors described these as similar to healthy volunteers and to mesothelioma patients respectively, based on their earlier work.
  • In the high-risk population, the marker level increased by about 2.0 points per year.
  • In the low-risk population, the marker level increased by only 0.4 points per year.
  • At the fifth assessment, the difference in mean change from the first assessment between the high-risk and low-risk groups was 5.32 ng/ml (95% CI 4.47 to 6.16).
  • No significant differences in mean marker level by age or gender were identified between the two populations.
  • Two of the 62 high-risk participants developed mesothelioma.
  • Mesothelioma case 2 was a 72-year-old male participant with a 50-year history of asbestos exposure.
  • Case 2 had abnormally high values on the first three yearly tests (9.3, 8.8 and 11.1 ng/ml). The participant skipped the fourth-year test.
  • In the fifth year, case 2's level had risen to 78.6 ng/ml, and the participant was diagnosed with epithelioid-type mesothelioma.
  • Two other high-risk participants developed other cancers (lung and appendiceal cancer).
• The authors' conclusion: The authors concluded that N-ERC/mesothelin levels may be a useful marker for the early diagnosis of mesothelioma in a large-scale setting. They noted that a prospective study is planned.
• Limitations the authors state:
  • The number of data points in the high-risk population was limited.
  • Asbestos exposure history was not collected except for participants who developed mesothelioma.
  • Other cancer types were outside the study's scope, so their incidence could not be compared between the high-risk and entire populations.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Prognosis, Mesothelin, Tumor Marker, Asbestos Exposure.

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