Serum osteopontin levels--is it time to screen asbestos-exposed workers for pleural mesothelioma?

Our plain-English summary of Serum osteopontin levels--is it time to screen asbestos-exposed workers for pleural mesothelioma?, by M.R. Cullen (The New England Journal of Medicine, 2005).

The study

• Author: M.R. Cullen
• Journal: The New England Journal of Medicine
• Published: 2005;353(15):1617-8
• Type of article: Comment, Editorial
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

In this editorial, the author commented on a study by Pass et al., published in the same issue, of serum osteopontin levels as a marker of pleural mesothelioma in asbestos-exposed people. He noted that 2500 to 3000 mesothelioma cases occurred annually in the United States, that mean survival after diagnosis remained 6 to 10 months, and that there was no well-validated blood test. He described the osteopontin test as appearing reliable and straightforward. Its sensitivity and specificity allowed mesothelioma to be identified among workers with similar asbestos exposure, many with asbestosis or benign pleural lesions, and its results were better than or rivalled other available tests. He argued that its diagnostic value still had to be assessed in other asbestos-related conditions, such as diffuse pleural thickening, lung cancer with pleural involvement and rounded atelectasis. On screening, he cited unpublished data on 4060 heavily exposed men in the Beta-Carotene and Retinol Efficacy Trial. Over 12 to 19 years, their cumulative mesothelioma risk was 0.9 percent (38 cases), compared with 6.9 percent for lung cancer (282 cases). At such risk levels, he wrote, the test's predictive value would be very low. It was also unknown whether early detection changed outcome. He concluded that surveillance should focus on lung cancer and other more treatable asbestos-related cancers, while the findings offered a faint glimmer of hope. The author reported being medical director of Alcoa.

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 is an editorial, not an original study. The author commented on a study by Pass et al., in the same journal issue, of serum osteopontin blood levels in asbestos-exposed workers. The author wrote that the test appeared reliable and, depending on the cutoff chosen, could identify pleural mesothelioma among workers with similar exposure, many with asbestosis or benign pleural lesions. Its results rivaled other available tests. The author cautioned that it still had to be checked in other asbestos-related conditions, such as diffuse pleural thickening, lung cancer involving the pleura and rounded atelectasis. Citing unpublished data on 4060 heavily exposed men in a trial cohort, the author reported a cumulative risk of 0.9 percent (38 cases) over 12 to 19 years, against 6.9 percent for incident lung cancers (282 cases). At risks near 1 percent, the author argued, the test's predictive value would be very low, causing needless testing and worry. It was also unknown whether earlier detection would change outcomes. The author concluded that screening needed more study and that surveillance should stay focused on lung cancer and more treatable cancers. The author disclosed being medical director of Alcoa.

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 commenting on another study (Pass et al.) published in the same journal issue; not original research
• Who was studied: No study population of its own. The editorial discusses the Pass et al. study of serum osteopontin in asbestos-exposed workers with and without pleural mesothelioma, many of whom had asbestosis, benign pleural lesions, or both
• Exposure: Occupational asbestos exposure in general. The editorial notes that amphibole asbestos (crocidolite, amosite) carries a higher mesothelioma risk, dose for dose, than chrysotile, though chrysotile is no less potent for lung cancer
• Main results:
  • In the author's reading of Pass et al., the serum osteopontin test's results were better than or rivaled those of any other available test for mesothelioma
  • The author stated that the test's practical diagnostic value must await measurement of osteopontin in other asbestos-related disorders: diffuse pleural thickening with or without benign effusion, advanced lung carcinoma with pleural involvement, and rounded atelectasis
  • Citing unpublished data (Goodman G), the author reported results for 4060 heavily exposed men in the Beta-Carotene and Retinol Efficacy Trial over 12 to 19 years of follow-up. The cumulative risk was 0.9 percent (38 cases as of December 31, 2004), presented in the context of mesothelioma. This compared with a 6.9 percent rate of incident lung cancers (282 cases)
  • The author argued that even at a 1 percent risk, the predictive value of the osteopontin level would be very low. In the author's view, this would lead to needless testing and worry in far more people than could benefit
  • The author noted that one series reported survival of up to 34 months with limited thoracic disease, compared with 10 months for more extensive disease. The author argued the difference could be explained by lead time from earlier diagnosis, so it is unknown whether early detection changes outcome
• The authors' conclusion: The author concluded that any recommendation to screen asbestos-exposed workers with serum osteopontin requires further study. Given current knowledge, active surveillance should remain focused on lung cancer and other more treatable asbestos-associated cancers such as colorectal cancer. The author added that the Pass et al. findings offer a faint glimmer of hope for future patients

Topics

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

Medical terms in this study, explained in our Lexicon: Osteopontin, Pleural Mesothelioma, Mesothelioma, Asbestos Exposure, Diffuse Pleural Thickening, Lung Cancer, Rounded Atelectasis.

Related studies

• Asbestos exposure, pleural mesothelioma, and serum osteopontin levels — H.I. Pass, D. Lott, et al. (2005)
• Asbestos exposure and serum osteopontin — A.W. O'Regan, D. Serlin, et al. (2006)
• Plasma osteopontin levels in patients with head and neck cancer and cervix cancer are critically dependent on the choice of ELISA system — D. Vordermark, H.M. Said, et al. (2006)
• Changes of mesothelin and osteopontin levels over time in formerly asbestos-exposed power industry workers — M.K. Felten, K. Khatab, et al. (2014)
• Soluble mesothelin-related peptides in the diagnosis of malignant pleural mesothelioma — A. Scherpereel, B. Grigoriu, et al. (2006)
• Plasma versus serum levels of osteopontin and mesothelin in patients with malignant mesothelioma--which is best? — J. Creaney, D. Yeoman, et al. (2011)

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