[The French mesothelioma network from 1998 to 2013]. / Mésothéliome: les dispositifs en place en France « le réseau mésothéliome ¼ 1998-2013.

Mesothelioma is a rare disease less than 0.3% of cancers in France, very aggressive and resistant to the majority of conventional therapies. Asbestos exposure is nearly the only recognized cause of mesothelioma in men observed in 80% of case. In 1990, the projections based on mortality predicted a raise of incidence in mesothelioma for the next three decades. Nowadays, the diagnosis of this cancer is based on pathology, but the histological presentation frequently heterogeneous, is responsible for numerous pitfalls and major problems of early detection toward effective therapy. Facing such a diagnostic, epidemiological and medico-legal context, a national and international multidisciplinary network has been progressively set up in order to answer to epidemiological survey, translational or academic research questions. Moreover, in response to the action of the French Cancer Program (action 23.1) a network of pathologists was organized for expert pathological second opinion using a standardized procedure of certification for mesothelioma diagnosis. We describe the network organization and show the results during this last 15years period of time from 1998-2013. These results show the major impact on patient's management, and confirm the interest of this second opinion to provide accuracy of epidemiological data, quality of medico-legal acknowledgement and accuracy of clinical diagnostic for the benefit of patients. We also show the impact of these collaborative efforts for creating a high quality clinicobiological, epidemiological and therapeutic data collection for improvement of the knowledge of this dramatic disease.

[Compensation of malignant mesothelioma as an occupational disease in Lower Normandy, from 1995 to 2002]. / L'indemnisation du mésothéliome malin professionnel en Basse-Normandie entre 1995 et 2002.

BACKGROUND: Despite the close relation between occupational exposure to asbestos and malignant mesothelioma, the compensation of this disease is still far from being the rule. The objective of this study is to assess the compensation process of all the cases of occupational mesothelioma recorded by the regional mesothelioma registry between September 1995 and August 2002, and to make suggestions for improvement of the compensation of future cases. METHODS: Lifetime exposure to asbestos was assessed for each of the 141 mesothelioma cases observed in Lower Normandy during this time period, and 105 cases could be related to a possible, probable, or very probable occupational exposure to this mineral. Data about notification and compensation of these occupational diseases were gathered with the help of all health insurance organisms concerned. RESULTS: Except for five cases in which insurance conditions did not allow any compensation, compensation of occupational mesothelioma occurred in 85% of the cases. This high rate was probably the result of the existence of an early asbestos industry in this region, and of the particular awareness of the Norman population about asbestos-related diseases, as well as of the epidemiological follow-up of mesothelioma in Lower Normandy. When notified for compensation, all cases but one were actually compensated, and the lag-time between notification and compensation proved to decrease since 1995, with an average delay reaching 91,1 days in 2002. Patients who did not report their disease were older than those who did, and the lack of knowledge of medical practitioners about compensation procedures seems to be an important matter in this issue. CONCLUSION: In order to improve the rate of compensation of occupational malignant mesothelioma cases, information about the usual occupational origin of the disease should be delivered systematically to the general practitioner of each patient. This could be done by pathologists, when they diagnose malignant mesothelioma, and/or by medical examiners when sickness benefits are sought, or even by the epidemiological center of death causes (INSERM, CépiDc), for the beneficiaries of patients who died from malignant mesothelioma.

The French National Mesothelioma Surveillance Program.

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 standardised procedure of pathological and clinical diagnosis ascertainment is used. Lifetime exposure to asbestos and to other factors (man made mineral fibres, ionising radiation, SV40 virus) is reconstructed, and a case-control study was also conducted. The proportion of mesothelioma compensated as an occupational disease was assessed. RESULTS: Depending on the hypothesis, 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, and 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 to 89.6). The initial pathologist's diagnosis was confirmed in 67% of cases, ruled out in 13%, and left 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 epidemiological 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.