After working for so long with mesothelioma, renowned surgeon Robert Cameron doesn't get this enthusiastic often.
But that is his mood now, smelling the potential for a significant breakthrough in a field too often filled with frustration and disappointment.
The Breath Print for Mesothelioma has him — and a lot of others around the world — believing real progress is getting close.
"This is exciting. We are really excited about this right now," said Cameron, scientific advisor for the Pacific Meso Center in Los Angeles, California, and surgeon at the UCLA Medical Center. "The early returns are very impressive."
Cameron's lab is one of a few in the world, along with labs in Australia and Italy, testing a type of electric nose that can detect mesothelioma at an early stage. The test? Someone's breath.
Simple To Administer Test
The prospect of a non-invasive, easy-to-administer test that anyone can take — especially with a cancer that has been so difficult to diagnose — has the mesothelioma community taking notice.
"Everyone could be screened for the risk of mesothelioma, and not just the disease itself," Cameron said. "Very exciting."
Only a few days earlier, Cameron pointed out that there is no definitive proof that early detection of mesothelioma was leading to longer survival rates, unlike many other cancers.
But while the typical surgery/chemotherapy/radiation therapy combination hasn't proven it would work better at an earlier stage, the hope is that new therapies would be uncovered with the screenings of high-risk candidates and early detection from the electric nose.
Researchers have shown the effectiveness of breath analysis in identifying emphysema, COPD, lung cancer and organ rejection following transplantation. The mesothelioma testing is in its early stages.
Much of the previous work with the breath test has involved lung cancer. Cameron worked earlier with several other well-known colleagues, including Harvey Pass (New York University Medical Center) and Michael Phillips (New York Medical College), on research involving digital analysis of breath biomarkers to detect lung cancer.
The issue with mesothelioma is obtaining a large enough sample to prove its worth. And with mesothelioma, research funding is usually an issue. Breath testing for mesothelioma, though, now is gaining traction.
"This one makes good sense," Pass said recently, adding his sought-after stamp of approval.
Study Shows 88% Accuracy
Researchers at the University of South Wales recently completed a study involving a breath-test analysis focusing on malignant mesothelioma. In that analysis, the sample included 20 patients with mesothelioma, 18 with other asbestos-related diseases and 42 control subjects.
Authors of the study, which used a carbon polymer array electronic nose, distinguished between the three groups accurately 88 percent of the time.
Professor Deborah Yates, who headed the study at South Wales, said that she hopes eventually the breath test can be used in conjunction with other screening tests, like blood biomarkers and CT scans. She also said much more research would need to be done before it could stand on its own or used in a clinical setting.
"We do not know, on current evidence, that early detection will improve survival. But advances in surgical techniques, radiotherapy and chemotherapy are occurring, and eventually we will have effective therapy," Yates said. "The earlier we can institute this [breath test], the better. Earlier detection could help us to understand the mechanisms by which mesothelioma occurs and spreads."
She said her group is hoping to coordinate efforts with researchers in New York and beyond.
"What we need is a large, more appropriately-powered study to replicate the findings," she said. "The technique is up and running. We just need to develop it further."
Researchers in Italy and the Netherlands last fall completed a breath-test study using the same technology that included an 80 percent success rate in differentiating mesothelioma patients from patients with other asbestos-related illnesses, and healthy individuals.
No More Invasive Procedures
Researchers consistently say that the more conventional techniques to diagnose mesothelioma often can't distinguish between benign and malignant asbestos-related diseases.
It often requires an invasive procedure, which is difficult for elderly patients already struggling with an undiagnosed illness, and it discourages screening for high risk patients. Often it takes a thoracoscopy for a small tissue sample or a excisional biopsy to make a definitive diagnosis.
The development of an accurate, clinical breath test for mesothelioma would be a huge improvement.
The latest breath-test technology that could be used for mesothelioma, according to Cameron, would start with an expensive, time-consuming analysis to identify the "breath print," of patients confirmed with asbestos exposure and mesothelioma.
For screening purposes, though, it would be used as a benchmark for comparative purposes against for anyone taking a test that would take as little as 10 minutes and be done with a relatively-inexpensive machine anywhere in the world.
"This could work. What we really need at this point is to find a funding source to get this done. It takes money to do the kind of research it would need," Cameron said. "The other diseases already have told us it will work. It might take a few years, but the potential is really exciting."
