Screening for mesothelioma: more harm than good?

Our plain-English summary of Screening for mesothelioma: more harm than good?, by J.P. van Meerbeeck, G. Hillerdal (American Journal of Respiratory and Critical Care Medicine, 2008).

The study

• Authors: J.P. van Meerbeeck, G. Hillerdal
• Journal: American Journal of Respiratory and Critical Care Medicine
• Published: 2008;178(8):781-2
• Type of article: Comment, Editorial
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This editorial commented on a study by Park and colleagues, published in the same journal issue, that measured soluble mesothelin-related protein (SMRP) by ELISA in people occupationally exposed to asbestos. The authors noted that malignant pleural mesothelioma (MPM) is a rare tumor mainly associated with earlier occupational asbestos exposure. Its latency is usually 3 to 5 decades, and average survival after diagnosis is less than 1 year. They reviewed earlier work. Low-dose spiral CT screening had been hindered by the low prevalence of the disease and by frequent nonmalignant nodules. A retrospective series of people exposed to crocidolite from the Wittenoom mine in Western Australia had reported a specificity of 100% and a sensitivity of 84% for SMRP in diagnosing mesothelioma. In the Park study of 538 asbestos-exposed persons, no mesothelioma was observed, although 15 (almost 3%) had elevated SMRP levels. Investigation with PET-CT detected one lung cancer and one suspected cardiac tumor. The editorialists judged the test's specificity to be low, with many false positives, and argued that screening for mesothelioma was not worthwhile. They noted there was no proof that early discovery would cure patients or improve survival, and they called for randomized treatment studies. They concluded that SMRP probably has a role in monitoring patients with MPM, but that it should be avoided for screening pending the results of ongoing large prospective studies.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was an editorial, not a new study. The authors commented on a study by Park and colleagues, published in the same journal issue, that tested a blood test for soluble mesothelin-related protein (SMRP) in people occupationally exposed to asbestos. As the editorial described that study, it included 538 asbestos-exposed persons. None was found to have mesothelioma, although 15 (almost 3%) had raised SMRP levels. Those 15 were examined with PET-CT scans, which found one lung cancer and one suspected cardiac tumor. The authors judged the test's specificity to be low, with a large number of false positives. They argued that raised SMRP levels could mean many people being followed for years with expensive and possibly harmful investigations. They also wrote that there is no proof that finding malignant pleural mesothelioma early cures patients or improves survival. The authors concluded that screening for mesothelioma is not a worthwhile effort. They said the SMRP test should be avoided for screening until ongoing large prospective studies report on its accuracy and on how SMRP levels relate to survival and mortality.

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: Editorial (commentary) on a prospective cohort study by Park and colleagues published in the same issue; no original data
• Who was studied: The editorial studied no population of its own. The study it discussed (Park and colleagues) included 538 asbestos-exposed persons.
• Exposure: Occupational asbestos exposure, in the context of screening with a blood test (SMRP-ELISA) for mesothelioma
• Main results:
  • As reported in the editorial about the Park study: no mesothelioma was observed among the 538 asbestos-exposed persons
  • As reported in the editorial about the Park study: 15 (almost 3%) of the 538 persons had elevated SMRP levels
  • As reported in the editorial about the Park study: PET-CT investigation of those with elevated SMRP found one lung cancer and one suspected cardiac tumor
  • The authors' interpretation: the test's specificity was low, with a large number of false positives
  • The authors argued that a high SMRP level could lead to many patients being followed with expensive and possibly harmful investigations for years
  • The authors stated there is no proof that early discovery of malignant pleural mesothelioma cures the patient or improves survival
• The authors' conclusion: The authors concluded that screening for mesothelioma is not a worthwhile effort. They said the SMRP-ELISA should be avoided for screening until ongoing large prospective studies report on its diagnostic accuracy and on the relationship between SMRP levels and mortality.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Mesothelin, Soluble Mesothelin-Related Peptides (SMRP), Pleural Mesothelioma, Asbestos Exposure, Latency, Crocidolite, Wittenoom.

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