Recent Medical Study Discusses New Testing Method That May Help Doctors Determine The Prognosis And Diagnosis Of Pleural Mesothelioma For Individuals With Past Asbestos Exposure

In its October 11, 2012 edition the New England Journal of Medicine (NEJM) published this article, “Fibulin-3 as a Blood and Effusion Biomarker for Pleural Mesothelioma”.

From the Abstract for this 2012 medical article about pleural mesothelioma testing:

Background
New biomarkers are needed to detect pleural mesothelioma at an earlier stage and to individualize treatment strategies. We investigated whether fibulin-3 in plasma and pleural effusions could meet sensitivity and specificity criteria for a robust biomarker.

Conclusions
Plasma fibulin-3 levels can distinguish healthy persons with exposure to asbestos from patients with mesothelioma. In conjunction with effusion fibulin-3 levels, plasma fibulin-3 levels can further differentiate mesothelioma effusions from other malignant and benign effusions.

A December 2012 report about this NEJM article, “Fibulin-3 biomarker may detect early-stage pleural mesothelioma”, published on the HemOncToday web site provided this overview by James P. Stevenson, MD, Staff Physician, Department of Solid Tumor Oncology, Taussig Cancer Institute, The Cleveland Clinic:

This study is important in that it describes the first highly-sensitive and specific plasma and pleural effusion biomarker for pleural mesothelioma. Studies of other markers including soluble mesothelin-related protein (SMRP) and osteopontin did not show enough sensitivity/specificity to be considered “robust” biomarkers for mesothelioma. The authors do caution that while promising, these results need to be validated prospectively in future studies.

Does this mean we now have a screening test for mesothelioma, given the finding that fibulin-3 levels were not elevated in asbestos-exposed individuals who did not have mesothelioma? No. To have an effective screening test you must able to apply the test to a well-defined at-risk population. There are multiple, varied workplaces and occupations that were associated with asbestos use and exposure, and mesothelioma can develop in people who had both short and prolonged exposures (as well as family members who had indirect exposure through clothing, etc.). Also, the lag time between asbestos exposure and the development of mesothelioma is typically 20-50 years, raising the question of when to screen.

The December 2012 HemOncToday web site report also provides a good summary of the study described in the NEJM medical journal article about pleural mesothelioma diagnosis and prognosis.


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