Extended screening program for the early detection of occupational mesothelioma (EVA-Mesothel)

Extended screening program for the early detection of occupational mesothelioma (EVA-Mesothel)

General situation in Germany

The number of occupational mesotheliomas (tumors of the serous membranes like pleura and peritoneum) is still at a high level despite the ban on asbestos in 1993 in Germany. In 2023 the German Social Accident Insurance (DGUV) reported about 650 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. For this reason, follow-up screening for insured persons with occupational asbestos exposure who belong to a high-risk group has to be improved by new and effective diagnostic methods without medical radiation exposure.

MoMar studies

The MoMar studies (MoMar, MoMarFollow) of the Institute of Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), showed – for the first time – that the combination of the biomarkers mesothelin and calretinin was able to detect mesotheliomas up to a year earlier than with established diagnostic methods. Generally, 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.

EVA-Mesothel

To achieve this, the DGUV founded the taskforce „Therapy of Mesothelioma“ in 2019. This taskforce initiated and designed the extended screening program for the early detection of mesothelioma (EVA-Mesothel). Currently, the offer is made exclusively to a selected high-risk-group, i.e., insured persons with recognized asbestosis or benign asbestos-related pleural disease. The screening comprehends an annual medical examination including blood checks for the biomarkers.

EVA-Mesothel started its pilot phase in spring 2023 for the central region of the Rhine-Ruhr metropolitan area for persons insured by one of five statutory accident insurances covering the sectors 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. Starting September 2025, EVA-Mesothel has been offered nationwide by all statutory accident insurances. Continuing medical training was certified by the Medical Association of Westphalia-Lippe and is available as a flexible e-learning platform since July 2025.

According to medical guidelines, the IPA will evaluate EVA-Mesothel scientifically within the project “EVA-Mesothel-Monitor”.

Accompanying measures to EVA-Mesothel

• 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

• Offer of consultation for patients with already diagnosed mesothelioma at the mesothelioma units, e.g., for second opinion, special diagnostics and/or treatment.

• Offer of individually best therapies for insured patients with mesothelioma, accompanied and supported by the rehabilitation management units of the statutory accident insurances

• Ongoing development and evaluation of mesothelioma biomarkers for prognosis, prediction, and monitoring of treatment

• Ongoing development of the dedicated medical fee schedule to reimburse certified mesothelioma units and doctors taking part in EVA-Mesothel

• Fostering scientific and medical exchange and networking between the mesothelioma units with special discussion panels on mesothelioma therapy and by using the dedicated mailing list „MesoTheraNet“

Procedure of EVA-Mesothel

The above-mentioned group of eligible persons will get an invitation from their respective statutory accident insurance. After giving informed consent, each person will then make an appointment for a consultation with an insurance-authorized physician. During the consultation doctor and patient will first discuss the individual advantages and possible risks of the screening. Only then has the patient to decide whether to take part in the biomarker screening and the scientific evaluation by EVA-Mesothel-Monitor. After taking the patients history and physical examination, a blood sample is taken.

The blood samples are being processed exclusively at specialized laboratories that are equipped to analyze the biomarkers.

If the result of a blood test is normal, the first round of examinations is completed and the next scheduled blood test will take place one year later.

Is one of the biomarkers elevated or are there other potential signs of a mesothelioma (e.g., pleural effusion found during the physical examination) the patient will get an offer for an individual consultation at a mesothelioma unit in order to verify the findings by additional diagnostics.

If a mesothelioma is confirmed by further diagnostics, individual treatment options will be offered – if desired, in close cooperation with the rehabilitation management of the responsible accident insurance.

In case that, despite conspicuous biomarker findings, no mesothelioma can be confirmed during further diagnostics, an additional blood draw will be recommended after three months.