Current Status of Screening for Malignant Pleural Mesothelioma

  • Harvey I. Pass
    Address reprint requests to Harvey I. Pass, MD, Division of Thoracic Surgery and Thoracic Oncology, Department of Cardiothoracic Surgery, NYU Langone Medical Center, 530 First Avenue, Suite 9V, New York, NY 10016
    Division of Thoracic Surgery and Thoracic Oncology, Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York
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  • Michele Carbone
    Department of Pathology, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
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      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.


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