Posted: November 11, 2012

Mesothelioma has been difficult at times to diagnose.  Harvey Pass from NYU has just reported in The New England Journal  of Medicine on behalf of his team of co-workers at several institutions that they have perfected a blood test to diagnose Mesothelioma, a protein called fibulin-3.  That disease is caused almost exclusively by prior exposure to asbestos and typically takes decades to develop.   An abstract of that article can be found here.  You need a subscription to the Journal for the entire article.  Dr. Stark comments, “As someone who has cared for these patients throughout my career I have seen terrible human suffering from a disease in which cures are rare.  The pain from it is unbearable and the suffering protracted.  A blood test given to people with prior asbestos exposure offers the promise of being able to diagnose the disease at a much earlier stage, when treatment could be more successful.”  Hampton Roads Virginia where Dr. Stark practiced, is a hotbed of Mesothelioma because of its several large shipyards.  A former shipyard worker, a pipe-fitter now retired commented, “We all knew in the 70’s that asbestos could be harmful but we were too macho to wear respirators as requested by our employers.  It wasn’t until the 80’s that their use was required in the workplace, and for many of us, that was too late.”

As reported by Dr. Pass, fibulin-3 levels accurately separated people (mostly men) with prior asbestos exposure who had Mesothelioma from those who didn’t.  The analysis they did was retrospective.  No attempt has been made yet to incorporate this screening test into the routine care of shipyard workers and others with prior exposure; studies will need to be done first to show that adding this test to routine care results in an enhanced cure rate, and because of the relative rarity of this disease, such a study will take time.  As yet, a regular doctor can’t just order this test.  It needs to become commercially available, and insurance companies need to agree to pay for it.

Update in 2020: the data have held up.  Fibulin-3 has been shown in recent studies to differentiate people with asbestos and no cancer versus patients with mesothelioma.  Recent studies do not indicate why this test is not in more widespread use, but perhaps the answer is that mesothelioma as a disease is disappearing since most of the men exposed in industry have died.