[Compensation of occupational diseases during monitoring of the ARDCO cohort]. / Les reconnaissances en maladie professionnelle lors du suivi de la cohorte ARDCO.

INTRODUCTION: Questions concerning under-reporting of occupational diseases (OD) linked to asbestos exposure are regularly voiced in France. Monitoring of the French multicenter Asbestos-Related Disease Cohort (ARDCO), which ensures post-occupational medical surveillance of subjects having been exposed to asbestos, provides information on (1) the medico-legal steps taken following screening by computed tomography (CT) for benign thoracic diseases, and (2) recognition of OD as a causal factor in malignant diseases. METHODS: OD recognition - and possible compensation - was analyzed in July 2021 among 13,289 volunteers in the cohort recruited between 2003 and 2005. RESULTS: Fifteen percent of the subjects in the cohort were found to have at least one recognized asbestos-related OD (78.2% benign pleural disease, 10.3% asbestosis, 14.2% lung cancer, and 6.0% mesothelioma). Only 58% of pleural plaques reported by the radiologist who performed the CT resulted in their recognition as ODs. On a parallel track, 88.7% of the mesotheliomas identified based on French National health insurance data and 46.9% of lung cancers were recognized as ODs. CONCLUSIONS: This study confirms the feasibility of a system designed to facilitate recognition, leading to possible compensation, of asbestos-related occupational diseases. The system could be improved by better training of the medical actors involved.

[Psychological impacts of follow up for occupational asbestos exposure. Consequences after compensation for occupational disease in the SPP-A cohort]. / Impact psychologique du suivi post-professionnel amiante à long terme. Quelles conséquences après la déclaration suivie de la reconnaissance d'une maladie professionnelle chez des sujets de la cohorte SPP-A ?

INTRODUCTION: In France, long-term follow-up after occupational exposure to asbestos is recommended. This study looked at the psychological consequences in the longer term following a CT-scan, in particular the impact of having received compensation for an occupational disease. METHODS: As part of an asbestos post-exposure survey study (APExS), volunteers from Normandy were asked to complete self-assessment questionnaires about their psychological condition at different points during follow-up, including a psychological questionnaire before, then 6 months, and finally 18 to 24 months after their chest CT-scan. Information collected from 622 individuals were analyzed based on information provided as to the result of the screening and whether they had received compensation for having an occupational disease. RESULTS: The identification of an occupational disease eligible for compensation is associated with a long term increase in psychological distress. The impact of psychological state during follow-up is greater in men who reported receiving occupational disease compensation. The discovery of an asbestos-related disease during the screening is associated with a negative perception of general health and an increase in psychological distress. CONCLUSION: The receipt of compensation of an occupational disease does not seem to compensate for the negative psychological impact related to the discovery of a disease during the asbestos post-exposure follow-up.

Incidence and survival of peritoneal malignant mesothelioma between 1989 and 2015: A population-based study.

BACKGROUND: Peritoneal malignant mesothelioma is a rare disease for which few population-based studies are available. The aim of this study was to describe the evolution of the incidence and survival of peritoneal malignant mesothelioma in France between 1989 and 2015, using data derived from the French network of cancer registries. METHODS: Age world-standardized incidence rates and overall survival were calculated using data from 16 French cancer registries. Log-linear Poisson regression analysis was used to estimate the average annual percentage change in incidence rates. Overall survival was performed using age-adjusted Cox proportional hazards model. RESULTS: In French men, the incidence has increased quietly over the reporting period from 0.07 to 0.10 with a maximum of 0.16 per 100,000 persons-years in 2001-2003. For women, the increase in incidence has been lower than for men over the period 1989-2015, ranging from 0.04 to 0.11. A better prognosis was associated with a diagnosis made after 2000 (HR = 1.76; p = 0.013), the epithelioid histological type (p = 0.003), and the fact of being a woman, which has a 5-year risk of death half that of men (HR = 0.55; p = 0.001), regardless of age, diagnosis period or histology. CONCLUSION: Our results are similar to those currently available for other countries. In France, peritoneal mesothelioma remains a rare and fatal cancer with a small increase in the incidence rate since 1989 and a median survival of 1 year; it seemed to develop equally in women and men over this period of time.

[Compensation for occupational diseases after tomodensitometry screening for benign pleuro-pulmonary disease in a multiregional post-occupational medical surveillance program of asbestos-exposed retired workers]. / Déclaration et reconnaissance en maladie professionnelle après dépistage tomodensitométrique de maladies pleuropulmonaires bénignes dans le programme multirégional de surveillance postprofessionnelle de personnes exposées à l'amiante.

BACKGROUND: Underreporting of occupational diseases related to asbestos exposure remains a matter of concern in France. The aim of this study was to evaluate the number of claims for compensation for asbestos-related non-malignant pulmonary or pleural occupational disease in subjects having undergone a chest CT-scan in a multiregional screening programme. METHODS: Among the 5444 voluntary retired asbestos-exposed subjects recruited in four regions between 2003 and 2005 who had undergone a chest CT-scan, the number of claims for compensation for an asbestos-related pulmonary or pleural benign disease was analysed in 2006 and 2010. RESULTS: Following CT-scan screening, 17.2% of participants were acknowledged as presenting with an asbestos-related non-malignant occupational disease, essentially pleural plaques, by the French National Health Insurance fund. Underreporting decreased as duration of follow-up after CT-scan increased. Nevertheless, 4 years after CT-scan, underreporting was still as high as 36% for subjects identified as presenting with pleural plaques. Mean duration between the date of CT-scan and the date of recognition as occupational disease was 7.4 months, shorter in cases where screening was coordinated by specialized centres. CONCLUSION: A plan of action for an easier claiming process for compensation of asbestos-related diseases is desired. This could probably be obtained through improved sensitization of physicians engaged in the follow-up of asbestos-exposed subjects, and by standardization of the interpretation and reporting of asbestos-related abnormalities observed on chest CT-scans.

[What tools should be used for follow-up post occupational exposure? What should be the frequency?]. / Quels outils doivent être utilisés pour le suivi post-professionnel ? Quel est le rythme de ce suivi ?

As long as the value of screening for cancers related to asbestos is not proven in the population at risk, the medical benefits of follow-up post-professional exposure remain uncertain and the only justification is to answer the questions of anxious retired workers concerning the consequences of their past-exposure and to provide compensation for any abnormalities that are demonstrated. In this country, to answer the questions posed in the title of this contribution in the case of pathologies related to asbestos, it is necessary, after verifying the fact and the level of exposure, to identify the pleural or pulmonary fibrosis and, above all, the pleural plaques, which constitute the essential lesions currently screened for. Thoracic CT scanning without contrast is the examination of choice to achieve this objective. There are, however, two significant problems. On one hand there is a high incidence of pulmonary micronodules, the necessary surveillance of which requires subsequent scans, leading to increased irradiation and anxiety. On the other hand the diagnostic uncertainty concerning discrete lesions is a source of confusion for the persons followed-up. There are, at present, neither scientific criteria to determine the optimum frequency of examination nor any arguments for replacing the pragmatic proposals of the consensus conference of 1999. It is important, therefore, to provide a medical assessment appropriate to the symptoms and anxiety expressed by a person previously exposed to asbestos. Overall it is necessary to question the benefit to the exposed person, in terms of quality of life, of a regular search for lesions that would usually be asymptomatic if not identified. Would it not be more judicious and more equitable to compensate persons whose past-exposure is sufficient to increase significantly their risk of cancer independently of the presence of benign abnormalities.

Pulmonary nodules detected by thoracic computed tomography scan after exposure to asbestos: diagnostic significance.

OBJECTIVE: To analyse the relationship between pulmonary nodules detected by radiologists using computed tomography and cumulative exposure to asbestos or asbestos-related pleuro-pulmonary diseases in 5662 asbestos-exposed subjects, and the relationship between pulmonary nodules and thoracic cancer, to determine whether a specific surveillance strategy based on cumulative asbestos exposure should be adopted. DESIGN: Standardised incidence and mortality ratios (SIR) for lung cancer and pleural mesothelioma were calculated in patients with and without mention of pulmonary nodules and compared using comparative morbidity figures. RESULTS: A significant excess incidence of primary lung cancer and pleural mesothelioma was observed among subjects presenting with pulmonary nodule(s) (SIR respectively 1.95, 95%CI 1.22-2.95, and 11.88, 95%CI 3.20-30.41). However, there was no significant relationship between pulmonary nodules mentioned by radiologists and cumulative asbestos exposure or between pulmonary nodules and the presence of asbestos-related benign diseases. CONCLUSIONS: This study confirms the expected excess prevalence of lung cancer in subjects presenting with pulmonary nodules according to the radiologist's report, and shows the absence of relationship between the presence of nodules and level of cumulative asbestos exposure. Our study therefore offers no argument in favour of specific surveillance modalities based on estimated cumulative asbestos exposure.

Occupational asbestos exposure and digestive cancers - a cohort study.

BACKGROUND: Although the role of asbestos in the genesis of mesothelioma and primary bronchopulmonary cancers has been established, results from studies focusing on the relationship between occupational exposure to asbestos and digestive cancer remain contradictory. AIM: To determine whether occupational asbestos exposure increases the incidence of digestive cancers. METHODS: Our study was a retrospective morbidity study based on 2024 subjects occupationally exposed to asbestos. The incidence of digestive cancer was calculated from 1st January 1978 to 31st December 2004 and compared with levels among the local general population using Standardized Incidence Ratios. Asbestos exposure was assessed using the company's job exposure matrix. RESULTS: Eighty-five cases of digestive cancer were observed within our cohort, for an expected number of 66.90 (SIR = 1.27 [1.01; 1.57]). A significantly elevated incidence, particularly notable among women, was observed for peritoneal mesothelioma, independently of exposure levels. A significantly elevated incidence was also noted among men for cancer of small intestine and oesophagus, for cumulative exposure indexes for asbestos above 80 fibres/mL x years. A significantly elevated incidence of cancer of the small intestine was also observed among men having been exposed to asbestos for periods in excess of 25 years and for mean exposure levels in excess of 4 fibres/mL. CONCLUSIONS: This study suggests the existence of a relationship between exposure to asbestos and cancer of the small intestine and of the oesophagus in men.

Performance of chest radiograph and CT scan for lung cancer screening in asbestos-exposed workers.

OBJECTIVES: The aim was to compare, in a cohort of asbestos-exposed workers, the sensitivity and the specificity of low-radiation helical chest CT scan with chest radiograph for the biennial screening of bronchopulmonary cancer, according to the size of detected nodules. MATERIAL AND METHODS: The screening procedure consisted of biennial chest radiograph and monodetector chest CT scan, given to 972 individuals who had been highly exposed to asbestos. A total of 2555 screening procedures were performed. The study focuses on the 1230 screening procedures for which a 2-year follow-up period was available. RESULTS: Twenty-four cases of bronchopulmonary cancer were diagnosed. CT scan detected 20 cancers, 12 of which had not been detected by chest radiograph. Sensitivity of chest radiograph and CT scan were, respectively, 33% and 83%, lesions measuring over 2 mm in diameter being considered as suspect. The specificity of chest radiograph and CT scan were, respectively, 95% and 78%. Calculation of the differential false positive/true positive (FP/TP) ratio and the receiver operating characteristic curve, performed for both chest radiograph and CT scan, facilitated the determination of the best possible compromise between specificity and sensitivity, according to the diameter threshold applied for considering a nodule as suspect. CONCLUSIONS: Although this study confirms the superior sensitivity of chest CT scan compared with conventional chest radiograph, the associated loss in specificity leads to a recommended diameter of 5 mm as the threshold for considering non-calcified lesions as "suspect", for the surveillance of asbestos-exposed individuals.

[Benign asbestos-related pleuropulmonary diseases]. / Affections pleuropulmonaires bénignes liées à l'amiante.

Among the non malignant diseases related to asbestos exposure, pleural plaques are the most frequent. Pleural effusion and diffuse pleural thickening, as well as asbestosis, are uncommon nowadays in asbestos-exposed screened populations. Despite the absence of any useful treatment, accurate diagnoses of these diseases are needed for two reasons: on the one hand in order to save patients from anxiety related to diagnostic and prognostic discrepancies, and on the other hand in order to ensure a proper attribution of the high social and financial compensations which are provided in France for asbestos affected patients. CT scan of the thorax is the most sensitive and specific tool for a precise diagnosis of these lesions, but it often displays minute abnormalities which may give rise to major diagnostic discordances, owing to the absence of any tomodensitometric reference in populations proved to be free from any asbestos exposure. There is a need to seek for a suitable standardization of imaging technique and interpretation, for a consensus in the characterization of CTscan abnormalities that warrant compensation, and for a careful medico-psychologic assistance for patients affected by asbestos-related benign diseases.