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Last Modified August 18, 2022
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What Are Mesothelioma Blood Tests?

Mesothelioma blood tests are laboratory analyses that detect the presence of asbestos cancer. These tests can recognize byproducts of tumor cells called biomarkers that circulate through the blood when a person has mesothelioma.

Doctors use a blood test for asbestos exposure in combination with imaging scans such as X-rays and CT scans to improve the accuracy and speed of a mesothelioma diagnosis.

These steps and tests can collect a tissue biopsy and a pathology workup. Pathologists can closely examine cancer cells collected during surgery or biopsy.

Using sophisticated lab tests, these specialist doctors can not only differentiate mesothelioma from other tumor types but they can also determine the type of mesothelioma and its genetic makeup.

Immunohistochemical markers are one example of the complex laboratory studies your pathologist may use to provide the most accurate diagnosis. This, in turn, allows your oncologists to develop the best treatment plan for your unique cancer type.

How Do Mesothelioma Blood Tests Work?

Mesothelioma blood tests screen for biomarkers in the blood that cancer cells produce. These biomarkers typically aren’t present in a blood sample from a person without mesothelioma.

For some tumors, biomarker proteins are unique to that specific cancer. Identifying them indicates that a person may have that particular cancer, but it is not definitive proof of a diagnosis.

Asbestos blood tests use mesothelioma-specific biomarkers to identify asbestos-related disease. They rely on the presence of proteins in the blood that only a mesothelioma tumor is likely to produce.

Potential New Uses for Mesothelioma Biomarkers

Researchers are investigating mesothelioma biomarkers for possible new uses other than blood tests. For example, isolating and identifying new biomarkers as therapeutic targets may lead to new mesothelioma treatments. 

A 2022 research study identified the biomarker YAP as a potential target for new mesothelioma therapy. This biomarker is responsible for the molecular composition of mesothelioma tumor cells that control growth factors and stability. 

Mesothelin is a biomarker that mesothelioma produces. Clinical trials are working on modifying patient immune cells to recognize mesothelin as a cancer target. In another recent study, nearly 80% of patients in the trial experienced a complete response, partial response or stable disease after an average follow-up of almost three years.


The MESOMARK assay measures the quantity of SMRP (serum-measured soluble mesothelin-related peptide) in a patient’s blood sample. Abnormally high SMRP levels may indicate the presence of mesothelioma. 

A 2021 clinical research study tested the effectiveness of MESOMARK and concluded that the test was suitably sensitive for mesothelioma diagnosis and monitoring response to treatment.

Some types of mesothelioma, such as sarcomatoid tumors, do not release high levels of SMRP. For this reason, the FDA recommends that doctors combine the MESOMARK assay with other tests to ensure an accurate mesothelioma diagnosis.

Some insurance companies do not cover this particular blood test. However, if you have a history of asbestos exposure and therefore are at high risk for developing mesothelioma, ask your doctor if the MESOMARK blood test is something you should consider.

The MESOMARK Assay Procedure

The MESOMARK assay is completed in two steps. First, your doctor will collect a blood sample and send it to a laboratory for analysis. Next, laboratory technicians add antibodies to the blood sample. These antibodies bind to SMRP and fragments of this protein.

Computer software analyzes the blood sample and measures the levels of SMRP-bound antibodies. SMRP levels at or above a specific reference point may suggest the presence of mesothelioma or another malignant pleural disease.

Elevated Serum SMRP levels bar graph
Percent of patients who had elevated serum SMRP levels

The MESOMARK blood test for mesothelioma is currently only used to diagnose suspected mesothelioma cases. However, a recent study noted that mesothelin blood levels were much lower in people without mesothelioma, suggesting MESOMARK could screen people at high risk of developing mesothelioma.

N-ERC/Mesothelin Test

The N-ERC/Mesothelin test detects a specific form of mesothelin known as N-ERC/mesothelin.

The test is similar to MESOMARK, but it uses a specially designed enzyme to find a particular version of the mesothelin molecule. This increases the test’s accuracy.

The N-ERC/mesothelin test is 95% effective at detecting mesothelioma. However, it is only 76% effective at ruling mesothelioma out because a few other types of cancer can also produce mesothelin.

Even though it is more accurate than MESOMARK, the N-ERC/Mesothelin blood test cannot serve as a single test to diagnose mesothelioma.

Fibulin-3 Test

Fibulin-3 is a protein mesothelioma cells produce. It can be detected in pleural fluid and blood. Mesothelioma specialist Dr. Harvey Pass helped develop and validate the fibulin-3 test for mesothelioma diagnosis.

He co-authored a study demonstrating that fibulin-3 is 96.7% effective at detecting mesothelioma and 95.5% effective for ruling it out in people without the disease.

Other studies have found the test less effective for detecting mesothelioma, depending on when and how it is used. For example, it was not as accurate when used on blood samples previously collected from mesothelioma patients.

A meta-analysis found significantly higher fibulin-3 blood levels in people with mesothelioma compared with all non-mesothelioma control groups, making it a potentially effective blood test biomarker in people at increased risk of developing mesothelioma.

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Emerging Biomarker-Based Blood Tests

Advanced mesothelioma blood tests sense levels of other biomarkers such as osteopontin and megakaryocyte potentiation factor (MPF). Researchers have demonstrated that mesothelioma patients have higher concentrations of these biomarkers than healthy individuals or patients with other cancers.

Osteopontin and MPF blood tests alone are not dependable or accurate enough to diagnose mesothelioma. Still, they can monitor the disease once a diagnosis is confirmed with X-rays, CT scans and tissue biopsies.

When asbestos fibers enter the body, they cause damage to healthy cells and transform them into cancer. Doctors can monitor the byproducts of asbestos-related cancer cells to track the progression of asbestos-related diseases.

Human Osteopontin ELISA Kit from R–D Systems

Osteopontin levels are elevated in mesothelioma patients, even when compared to patients with non-cancerous asbestosis symptoms or pleural thickening because of asbestos. This makes osteopontin reliable for screening healthy asbestos-exposed individuals from those who have developed mesothelioma.

Other diseases can elevate osteopontin levels, including lung, colon and breast cancers and tuberculosis. Osteopontin cannot differentiate between malignant mesothelioma and these conditions, but it can help screen asbestos-exposed populations and predict the prognosis for mesothelioma patients.

Human Megakaryocyte Potentiation Factor (MPF) ELISA Kit

Mesothelioma blood tests are available for megakaryocyte potentiation factor (MPF). Doctors do not fully understand the biological function of MPF, but they know it is released into the bloodstream of mesothelioma patients in extremely high quantities.

MPF levels may decrease after effective mesothelioma surgical debulking, indicating that MPF blood testing can help monitor a patient’s response to surgery.


8OHdG is a biomarker indicating cell damage because of oxidation and may be present in the blood during the early stages of cancer. Researchers have linked elevated 8OHdG levels with asbestosis and occupational asbestos exposure, although many other cancers and heavy metal exposure can also increase 8OHdG levels. 

However, higher 8OHdG levels correlate with more severe asbestosis. One study found that the combination of 8OHdG and the biomarkers VEGFbeta and SMRPs effectively identifies people with varying degrees of asbestos exposure.

Estrogen Receptor-β

A 2022 research study tested 46 patients for estrogen receptor-β and identified the biomarker in 30.4% of cases. They found a significant increase in the expression of ERβ in the epithelioid subtype versus non-epithelioid subtypes. 

ER-β could also be a potential target for future mesothelioma therapy. An earlier study had found that higher levels of activated ER-β in pleural mesothelioma cells improved response to cisplatin chemotherapy.

Epidermal Growth Factor Receptor (EGFR)

Authors of a 2022 research report in Targeted Oncology noted that EGFR expression is high in 50% to 95% of pleural mesothelioma cases. Like ER-β, asbestos exposure activates EGFR, which may play a role in the development of mesothelioma. 

Unfortunately, EGFR inhibitors, including erlotinib and gefitinib, have not shown effectiveness as an emerging mesothelioma treatment. Also, various cancers produce EGFR, so it cannot be used to diagnose mesothelioma. However, EGFR blood tests may help monitor treatment response.


A 2021 study published in the Journal of Clinical Medicine detailed the possible use of a calretinin blood test for asbestos disease to improve mesothelioma diagnosis. The combination of calretinin and SMRP biomarkers had the highest predictive value.

Researchers developed a test to detect calretinin in blood samples and found it performed similarly to mesothelin. Calretinin appears most likely to improve the diagnosis of epithelioid and biphasic disease, but not sarcomatoid cell mesothelioma.

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