Anil Vachani, MD, Director of Clinical Research for Penn Interventional Pulmonary Services, outlines the challenges inherent in the early detection of mesothelioma, a disease that may be asymptomatic for decades before the first symptoms appear. Dr. Vachani reviews the current diagnostic armamentarium, including the blood tests (serum mesothelin, plasma osteopontin, fibulin3 and HMGB1) and screening tools (serum mesothelin), concluding with a discussion of mesothelioma studies in the Philadelphia region.