Asbestos Exposure and Pleural Mesothelioma: A Review of 20 Years of Surveillance.

CP-Surveillance-Mesotheliome-270619.pdf

Published on 27 June 2019

Pleural mesothelioma is a cancer of the pleura that occurs primarily following exposure to asbestos. The National Surveillance Program for Pleural Mesothelioma (PNSM) was established in 1998, one year after the ban on the use of asbestos. Santé publique France is releasing a new report today titled “20 Years of Surveillance (1998–2017) of Mesothelioma Cases, Their Exposures, and Compensation Processes.” This study shows that asbestos exposure is and will remain a major public health issue for several decades to come, requiring continued surveillance and strengthened prevention efforts.

Pleural Mesothelioma: A Current Public Health Issue

Asbestos was widely used for its performance and insulating properties until it was banned on January 1, 1997. Its health effects can appear up to 30 to 40 years after initial exposure.

Over the past 20 years, the National Mesothelioma Surveillance Program (PNSM) has made significant contributions. It has not only improved epidemiological knowledge of pleural mesothelioma but has also highlighted the importance of maintaining prevention efforts. It provides a solid foundation for shaping public policies around the still-relevant issue of asbestos exposure

Dr. Laurence Chérié-Challine, Head of the Pathology and Occupational Health Unit at Santé publique France

The main findings of the PNSM show that cases of pleural mesothelioma continue to rise. It is currently estimated that 1,100 new cases of mesothelioma occur annually in France. The increase is more pronounced among women, with cases doubling over 20 years to reach 310 cases per year.

Furthermore, there are significant regional disparities: the incidence is particularly high in the North, Northwest, and Southeast regions.

The main sources of asbestos exposure vary by gender. We observe:

a strong predominance of occupational exposure among men, with more than 9 out of 10 affected men having been exposed,
exposure outside the workplace for 1 in 3 women.

Furthermore, it should be noted that for 1 in 4 women, no source of asbestos exposure was identified.

“A particularly affected industry: construction”

The proportion of people with pleural mesothelioma who worked in the construction industry has been steadily increasing since 1998, reaching 50% in 2016. Occupational exposure to asbestos is considered likely or very likely for 97% of them. Occupational exposure to asbestos is found in 84% of cases involving individuals who worked in the construction industry after the ban on asbestos.

The results of the PNSM indicate a shift from occupations involving the use and processing of asbestos toward occupations involving work on materials containing asbestos. This highlights the need to adapt and strengthen prevention measures, particularly in this sector.

Insufficient use of patient compensation programs

Diseases caused by occupational exposure to asbestos are listed in the schedules of occupational diseases under the health insurance system for employees and farmers. Furthermore, since 2002, anyone affected by asbestos-related health issues can obtain compensation from the Asbestos Victims Compensation Fund (FIVA). The PNSM shows that the use of these compensation schemes remains insufficient. Between 2005 and 2017, more than one in four people diagnosed with mesothelioma and enrolled in the general social security system had not taken any steps to have their condition recognized as an occupational disease, nor had they applied to the Fiva. The information provided by investigators to individuals included in the PNSM appears to have had a positive effect on the use of these compensation mechanisms during the 2008–2016 period. Indeed, the estimated recognition rate was higher in the area covered by the PNSM among men (72% vs. 60% outside the area) and among women (50% vs. 29%). This finding confirms the importance of better informing healthcare professionals and their patients about compensation options.

Optimizing surveillance through a new system, the DNSM

The DNSM will simplify and strengthen interactions with stakeholders responsible for mesothelioma surveillance in France. Its implementation will provide a responsive surveillance system to strengthen and adapt the prevention of occupational risks of asbestos exposure. It will also address the need to improve knowledge of environmental risk factors

Sébastien Denys, Director of Environmental and Occupational Health at Santé publique France

With the ongoing goal of strengthening and streamlining surveillance systems and adapting them to evolving public health challenges, Santé publique France is introducing a new initiative, the “National Mesothelioma Surveillance System.” Ultimately, this system will enable us to:

optimize the epidemiological surveillance of mesotheliomas (all sites) nationwide, adapting it to new challenges, particularly environmental exposures,
expand the use of knowledge to prevent asbestos-related risks in the workplace and among the general population,
measure changes in medical and social recognition procedures, and in particular the impact of information.