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The number of occupational mesotheliomas is still at a high level despite the ban on asbestos in 1993 in Germany. In 2021 the German Social Accident Insurance (DGUV) reported about 700 new cases of recognized occupational mesotheliomas. Usually, these tumors are discovered at advanced stages when the cancer has spread and treatment options are very limited.
The MoMar studies (MoMar, MoMarFollow) showed that the combination of the biomarkers mesothelin and calretinin could detect mesotheliomas up to a year earlier than with established diagnostic methods. Usually, an earlier detection results in an earlier stage of the cancer. The detection of cancer at less advanced stages offers more treatment options and could help to treat earlier, potentially resulting in better outcomes. Based on these results a new, effective screening program without radiation burden will be offered to insured persons with occupational exposure to asbestos. Initially, the offer will only be made to a selected high-risk-group, i.e., persons with recognized asbestosis, pleural plaques and/or other benign asbestos-related diseases of the pleura.
To achieve this, the DGUV founded the taskforce „Therapy of Mesothelioma“ in 2019. This taskforce initiated and designed the program „EVA-Mesothel“. The screening comprehends an annual medical examination including blood checks for the biomarkers.
EVA-Mesothel started as a pilot phase in spring 2023 for the central region of the Rhine-Ruhr metropolitan area for persons insured by five statutory accident insurances being in charge in the field of mining and chemical industries (BG RCI), wood and metal processing (BGHM), building and construction industries (BG BAU), energy, textile industries, electronics and publishing (BG ETEM), and trade and logistics (BGHW). These institutions are providing work-related prevention, health care and rehabilitation services, and workers' compensation. The program is monitored scientifically by the Institute for Prevention and Occupational Medicine of the DGUV (IPA).
The new program EVA-Mesothel is linked to further measures that were initiated by the taskforce:
Offer of special consultation and further diagnostics for patients with elevated biomarkers. The consultations will take place at certified centers with extended knowledge in diagnosing and treating mesotheliomas. The centers are called „mesothelioma units“ and have been certified by the German Cancer Society (DKG): https://oncomap.de/centers?selectedOrgan=Mesotheliom
Procedure of the pilot phase of EVA-Mesothel:
I. The above-mentioned group of eligible persons will get an invitation from their respective statutory accident insurance (BG RCI, BGHM, BG BAU, BG ETEM, or BGHW) and then make an appointment for a doctor’s consultation.
II. During the consultation doctor and patient will first discuss the individual advantages and possible risks of the screening.
III. Only afterwards the patient has to make the decision whether to take part in the biomarker screening and/or the scientific monitoring.
IV. After anamnesis and physical examination, a blood sample is taken. During the pilot phase the blood sample is being analyzed at a special laboratory in the city of Duesseldorf.
V. If the result of the blood test is not elevated, the first round of examinations is completed and the next blood sample will be drawn after one year.
VI. Is one of the biomarkers elevated or are there other potential signs of a mesothelioma (e.g., pleural effusion found during the physical examination) EVA-Mesothel will be concluded for this individual patient. The patient will get an appointment at a mesothelioma unit for a special consultation in order to verify the findings. In the pilot phase this will be the Ruhrlandklinik Essen.
VII. If the additional diagnostics performed during the special consultation results in a verification of the mesothelioma diagnosis, the patient will be offered treatment at highest standards according to current guidelines and, if desired, in close cooperation with the rehabilitation management of the responsible statutory accident insurance.
If the two-year pilot phase can be completed successfully, EVA-Mesothel will be extended to all other statutory accident insurances and all federal states of Germany. In the meantime, EVA-Mesothel is going to be fine-tuned using the experiences made during the pilot phase.