Detection of Malignant Mesothelioma in Asbestos-Exposed Individuals: The Potential Role of Soluble Mesothelin-Related Protein
Section snippets
Screening for mesothelioma
There is little doubt that MM is an important disease, both for the individual and the community. In addition to health benefits, any effective therapy for MM would deliver huge economic advantages because MM is predicted to cost the European and US economies approximately $80 billion [12] and $200 billion [13], respectively, over the next 35 to 40 years. The significance of this disease extends beyond its actual incidence. If effective early intervention or preventive measures could be
Imaging
Several programs have been put in place to screen asbestos-exposed individuals for lung disease. These programs generally involve annual pulmonary function tests and chest radiographs. Neither modality has proved effective at detecting malignancy early, however, although other asbestos-related diseases have been detected [19]. Distinguishing benign from malignant disease is one of the difficulties in detecting early-stage cancers. Obesity, an increasing problem in the developed world, can be
Cancer screening
Screening programs for the early detection of several non-MM cancers, including cervical, breast, colorectal, and prostate, have been established. Papanicolaou screening (Pap smear) has been widely adopted in many developed countries for screening for cervical cancer. Pap smears are relatively inexpensive, easy to perform, are promoted by the health profession, enable treatment to be provided early in the natural history of the disease, and reduce the likelihood of developing invasive disease.
Mesothelin and soluble mesothelin-related protein
Mesothelin is a differentiation molecule of mesothelium. It is a glycophosphatidylinositol-linked cell surface glycoprotein of approximately 40 kDa that was originally described as the antigenic target of a monoclonal antibody (K1) [39]. The biologic role of mesothelin has not been elucidated, although a role in cell adhesion has been suggested [39] and is supported by findings that mesothelin binds CA125/MUC16 [40], another surface glycoprotein expressed on some cancer types, including MM and
Lessons from CA125 and the early detection of ovarian cancer
CA125 has many properties that suggest it will be a good marker for the early detection of ovarian cancer, and much can be learned from the extensive work done to evaluate this finding. Approximately 85% of patients with clinically advanced ovarian cancer have elevated serum CA125. Evidence exists that in some patients, deviations in the level of CA125 can be detected 18 months or more before the appearance of symptoms [30]. In individual women, CA125 levels are temporally stable, which enables
Uses of multiple serum markers for malignant mesothelioma
From research into CA125 as a biomarker in ovarian cancer it is clear that CA125 measurements alone will be ineffective as a screening strategy and that the value of screening can be improved by using a combination of independent biomarkers in a longitudinal program with a defined target screening population, followed by a second-line highly sensitive imaging screen. Even then, the screening program must be accepted by the population and the health profession, and a reduction in disease
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This work was supported by the National Health and Medical Research Council and the Insurance Commission of Western Australia.