Genetic testing for mesothelioma is key for early detection, treatment and survival. Research suggests genetic risk factors, such as a mutated BAP1 gene, increase the likelihood an individual will develop mesothelioma as a result of asbestos exposure.
Research shows certain genes can raise your risk of mesothelioma after asbestos exposure. The risk also depends on how much asbestos you breathe in and for how long. These genes might explain why some people are more likely to develop diseases from asbestos.
Mesothelioma can develop in people even after very little exposure to asbestos. One of the main genetic risk factors is a gene called BAP1. This gene helps protect cells from becoming cancerous, but when it has a mutation, it raises the chance of mesothelioma.
Studies show about 12% of people with mesothelioma have changes in the BAP1 gene or other genes. Understanding your risk factor for mesothelioma can help you and your doctor make informed choices about health monitoring and safety.
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The BAP1 gene plays an important role in protecting cells from becoming cancerous. Dr. Michele Carbone, director of thoracic oncology at the University of Hawaii Cancer Center, and his team are credited with discovering the link between BAP1 mutations and mesothelioma. They found families with BAP1 mutations had high incidences of mesothelioma.
A 2025 study in Diagnostics explained that mutations in BAP1 increase the risk of pleural mesothelioma, a cancer affecting the lining of the lungs. This gene helps repair DNA and control cell growth. When BAP1 doesn’t work properly, cancer can develop more easily.
Researchers also found that people with BAP1 mutations might develop mesothelioma even after minimal asbestos exposure. The mutated gene causes changes in the tumor environment that help cancer cells evade the immune system. This discovery highlights the importance of genetics in mesothelioma risk and opens the door to new treatments that target these pathways to improve patient outcomes.
After several years of studying a unique mesothelioma epidemic in Cappadocia, Turkey, we noted that in certain families, up to 50% of family members developed mesothelioma. We demonstrated that susceptibility to mesothelioma was transmitted genetically from one generation to the next.
Is Mesothelioma Hereditary?
Mesothelioma isn’t hereditary. Asbestos exposure is the primary cause of mesothelioma. However, some people inherit genes that raise their risk after asbestos exposure. For instance, those with a mutated BAP1 gene face a higher risk if exposed to asbestos. The BAP1 gene controls calcium in cells. If it’s damaged or mutated, calcium levels fall. This raises cancer risk from substances like asbestos. For those with a BAP1 mutation, asbestos exposure raises mesothelioma risk.
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Some researchers believe modifying genetic mutations could help prevent and treat mesothelioma. In another study, Dr. Carbone collaborated on reports that repairing BAP 1-affected calcium channels helped chemotherapy work better.
Dr. Carbone explains, “You cannot fix something unless you know what is broken. We discovered the main biological mechanism that makes some people more susceptible. Fixing these channels could prevent cancer in people with inherited mutations and help treat tumors with these mutations.”
Previous trials testing immunotherapy drug Lynparza (olaparib), a protein inhibitor related to BAP1, and a drug called TAK-500 haven’t shown benefits for mesothelioma. However, researchers are still exploring new genetics-focused treatments.
Gene therapy uses portions of healthy DNA (1) to replace damaged genes in the body. Inactive viruses (2) carry the healthy gene segments to damaged cells and make copies (3) that target cancer.
How Genetics Impact Prognosis
Genetics affect a person’s outlook or mesothelioma prognosis because changes in their DNA influence how they respond to treatment and how long they live. Genetic testing reveals key DNA alterations that help predict how someone might respond to chemo, for example, and how long they may live.
Some gene mutations, especially in the BAP1 gene and other DNA repair genes, are linked to longer survival. People with these mutations often respond better to platinum-based chemo and can live years longer than those without mutations. These insights help mesothelioma doctors decide if more aggressive or targeted treatments could improve outcomes.
While genetics increases the risk of developing mesothelioma, they also provides important clues about disease progression. Understanding a person’s genetic profile helps doctors personalize treatment plans and give clearer information about prognosis.
Impact of DNA Suppressor Gene Mutation on Mesothelioma Patient Survival
With Mutation
Without Mutation
7.9-year median survival
2.4-year median survival
Source:
Proceedings of the National Academy of Sciences, 2019
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Other genetic biomarkers or signs of mesothelioma include changes in genes like CDKN2A, which stops working in some tumors and shows the cancer may grow faster. Changes in the NF2 gene also help the cancer spread. Doctors study genetic changes like DNA methylation, where chemical tags turn genes on or off. These signs help doctors understand the cancer and choose the best treatment.
Key Genetic Biomarkers in Mesothelioma
CDKN2A: Stops working in some tumors and signals faster-growing cancer
LATS2: Mutations link to more aggressive mesothelioma types
NF2: Helps the cancer spread and changes the tumor environment
PBRM1: Mutated mostly in mesothelioma, affecting the lining of the belly
SETD2: Affects gene control and tumor growth
SF3B1: Mutation raises mesothelioma risk after asbestos exposure
TP53: Controls cell growth and death and affects treatment response and prognosis
TERT: Changes in this gene impact how cells age and grow, and it’s common in some mesothelioma types
Doctors also study genetic changes like DNA methylation and microRNA patterns. These changes can turn genes on or off and may show early signs of mesothelioma. Protein markers like mesothelin and fibulin-3 may also help diagnose and predict disease but need more research.
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Dr. Velotta is a leading thoracic surgeon and pleural mesothelioma specialist at Kaiser Permanente Oakland Medical Center and a Clinical Assistant Surgical Professor at the University of California, San Francisco School of Medicine. With more than 15 years of experience, he leads research efforts in minimally invasive lung cancer surgery, pain management post-thoracic surgery and multimodal mesothelioma treatment. He is recognized for advancing image-guided surgical techniques and improving regional access to specialized mesothelioma care.
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