Statement on malignant mesothelioma in the UK

Current status of screening for malignant pleural mesothelioma

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.

Detection of Malignant Mesothelioma in Asbestos-Exposed Individuals: The Potential Role of Soluble Mesothelin-Related Protein

Malignant mesothelioma (MM) is strongly associated with asbestos exposure. Measurement of soluble mesothelin-related protein (SMRP) levels in the serum may prove valuable as an adjunct to current tests for the diagnosis of MM and for monitoring MM patients for the early detection of disease recurrence. SMRP measures also may be useful in an overall screening program for MM because early results show that some individuals have elevated levels 1 to 4 years before symptom development. Although individuals with occupational and nonoccupational asbestos exposure are justifiably concerned about their risk of developing MM, consideration must be given to the complex issues surrounding screening for this disease, and a more substantial evaluation of the SMRP marker must be undertaken before deciding to promote a screening program.

Pleural effusion: a structured approach to care

The accumulation of fluid in the pleural space is a common manifestation of a wide range of disease. This review provides a structured approach to the investigation of the patient with a pleural effusion. This should allow an accurate diagnosis to be made with the minimum number of invasive and time-consuming investigations.