The French National Mesothelioma Surveillance Program

Marcel Goldberg ^1*, Ellen Imbernon ¹, Patrick Rolland ², Annabelle Gilg Soit Ilg ¹, Marianne Savés ³, Anne de Quillac ⁴, Catherine Frenay ⁵, Soizick Chamming's ⁶, Patrick Arveux ⁷, Christian Boutin ⁵, Guy Launoy ⁸, Jean Claude Pairon ⁶, Philippe Astoul ⁵, Françoise Galateau-Sallé ⁴ and Patrick Brochard ³

¹ InVS, France
² LSTE-InVS Bordeaux, France
³ LSTE-ISPED Bordeaux, France
⁴ CHU Caen, France
⁵ AP-HM Marseille, France
⁶ IIMTPIF-Paris, France
⁷ Francim-Besançon, France
⁸ Francim-Caen, France

^* To whom correspondence should be addressed. E-mail: marcel.goldberg{at}st-maurice.inserm.fr.

Accepted 3 February 2006

Abstract

Objectives: The French National Mesothelioma Surveillance Program (NMSP) was established in 1998 by the national Institute for health surveillance (InVS). Its objectives are to estimate the trends in mesothelioma incidence and the proportion attributable to occupational asbestos exposure, to help improve its pathology diagnosis, to assess its compensation as an occupational disease and to contribute to research.

Methods: The NMSP records incident pleural tumours in 21 French districts that cover a population of approximately 16 million people (a quarter of the French population). A standardized procedure of pathologic and clinical diagnosis ascertainment is used. Lifetime exposure to asbestos and to other factors (man made mineral fibres, ionizing radiations, SV40 virus) is reconstructed, and a case-control study was also conducted. We assessed the proportion of mesothelioma compensated as an occupational disease.

Results: Depending on the hypotheses, the estimated number of incident cases in 1998 ranged from 660 to 761 (women: 127 to 146; men: 533 to 615). Among men, the industries with the highest risks of mesothelioma are construction and ship repair, asbestos industry, manufacture of metal construction materials; the occupations at highest risk are plumbers, pipe- fitters and sheet-metal workers. The attributable risk fraction for occupational asbestos exposure in men was 83.2% (95% CI: 76.8-89.6). The initial pathologist's diagnosis was confirmed in 67% of cases, ruled it out in 13%, and left it uncertain in the others; for half of the latter, the clinical findings supported a mesothelioma diagnosis. In all, 62% applied for designation of an occupational disease, and 91% of these were receiving workers' compensation.

Conclusions: The NMSP is a large scale epidemiologic surveillance system with several original aspects, providing important information to improve the knowledge of malignant pleural mesothelioma, such as monitoring the evolution of its incidence, of high risk occupations and economic sectors, and improving pathology techniques. .

Keywords: France, epidemiological surveillance, occupational disease compensation, pleural mesothelioma

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