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Background: This article presents the mortality data compiled among a cohort of workers at risk of internal uranium exposure and discusses the extent to which this exposure might differentiate them from other nuclear workers., Methods: The cohort consisted of 2897 Areva-NC-Pierrelatte plant workers, followed from 1st January 1968 through 31st December 2006 (79,892 person-years). Mortality was compared with that of the French population, by calculating Standardized Mortality Ratios (SMR) and 95% confidence intervals (CI95%). External radiation exposure was reconstructed using external dosimetry archives. Internal uranium exposure was assessed using a plant-specific job-exposure-matrix, considering six types of uranium compounds according to their nature (natural and reprocessed uranium [RPU] and solubility [fast-F, moderate-M, and slow-S]). Exposure-effect analyses were performed for causes of death known to be related to external radiation exposure (all cancers and circulatory system diseases) and cancer of uranium target-organs (lung and hematopoietic and lymphatic tissues, HLT)., Results: A significant deficit of mortality from all causes (SMR=0.58; CI95% [0.53-0.63]), all cancers (SMR=0.72; CI95% [0.63-0.82]) and smoking related cancers was observed. Non-significant 30%-higher increase of mortality was observed for cancer of pleura (SMR=2.32; CI95 % [0.75-5.41]), rectum and HLT, notably non-Hodgkin's lymphoma (SMR=1.38; CI95 % [0.63-2.61]) and chronic lymphoid leukemia (SMR=2.36; CI95% [0.64-6.03]). No exposure-effect relationship was found with external radiation cumulative dose. A significant exposure-effect relationship was observed for slowly soluble uranium, particularly RPU, which was associated with an increase in mortality risk reaching 8 to 16% per unit of cumulative exposure score and 10 to 15% per year of exposure duration., Conclusion: The Areva-NC-Pierrelatte workers cohort presents a non-significant over-mortality from HLT cancers, notably of lymphoid origin, unrelated to external radiation exposure. The pilot study suggests an association between mortality from the HLT and lung cancers and exposure to slowly soluble RPU compounds. The results of this study should be investigated further in more powerful studies, with a dose-response analysis based on individual assessment of uranium absorbed dose to uranium-target organs., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Background: A mortality study was carried out in a cohort of veterans present on the sites of the French nuclear experiments center in the Pacific (CEP) from 1966 to 1996, and for whom external dosimeter monitoring recordings were available., Methods: The cohort included 32,550 veterans having had at least one dosimetry recording. Current vital status was collected from the National Register of Identification of Physical People and causes of death data from the national causes of death database. Total mortality and mortality by cause were compared with mortality of the French population using standardized mortality ratios (SMR). To test the effect of a dosimeter recording higher than the threshold (0.2 mSv), i.e., no null dosimetry, the mortality of veterans was compared inside the cohort, using standardized ratios and Poisson regression models., Results: The mortality analysis was performed among 26,524 men, of whom 8% had had at least one non-null dosimeter. Five thousand four hundred and ninety-two (21%) veterans died before December 31, 2008 and causes were available for nearly 97% of these deaths. Comparing the mortality between the cohort and the French population highlighted a deficit of mortality, for all causes, by cancer and for radiation-induced pathologies; these results were related to the "healthy worker effect". The data showed that all causes mortality and cancer mortality of the cohort of veterans with no null dosimeter were not different from those of other veterans, but also showed an excess of hematological malignancies in this sub-population: this excess was significant in the regression model (RR=1.82; CI 95% [1.6-2.0])., Conclusion: Among veterans with an external dosimeter monitoring recording, presence on the sites of CEP from 1966 to 1996 does not constitute a factor of increased mortality compared with the national population. However, an increased risk was observed for mortality by hematological malignancies among veterans with no null dosimetry. This result is in line with studies on veterans present during nuclear experiments abroad., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

In the course of an investigation, judicial or not, the expert opinion encompasses several questions of a different nature, including the following one « did the patient die of a disease he/she was supposed to suffer from at time of death? » Based on a personal experience over one year in 2008, the goal of this paper is to tackle this question of imputability, which was asked in respect of 12 investigations, including ten of occupational diseases, one of nosocomial infection and one iatrogenic accident. Only two autopsies were carried out; one autopsy refusal was reported. In five out of 12 cases, the imputability of death related to an occupational disease or an iatrogenic accident was considered by the expert to be certain in one case, very probable in two cases, and possible in two cases; in seven out to 12 cases, imputability of death was unlikely, since the cause of death was unknown in two cases, or was not the suggested cause in five cases. The discussion considers several arguments that can help answer this question: evaluation of the vital prognosis of the disease, the importance of the quality of medical records, the contributions and limits of autopsy findings, deaths that result from multiple causes, and the concept of aggravating circumstances., (Copyright © 2011 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: Determinate the different prognostic factors of survival in ethmoidal sinus adenocarcinomas (ADK)., Material and Methods: 60 patients with ethmoidal sinus ADK. 59 men and one woman. Average of 62.2 years (41-82). Retrospective study between 1985 and 2005. The following data were analyzed: exposure time to wood dust, disease incidence, primary clinical symptoms and ASA score. Radiological data were recovered by tomodensitometry and magnetic resonance imaging. Histological groups were described. TNM classification according to UICC 2002 and Roux/Brasnu was established on clinical and radiological constatations. Different treatments used were analyzed. Estimate of survival rate and impact of different prognostic factors were based on Kaplan-Meier actuarial method and multivariate analysis., Results: Incidence rate was 2.86 patients a year. Exposure average time to wood dust was 25.6 years (2-44). T3/T4 stages were predominant (66.7%). the survival rate was 46.5% at 5 years. The survival rate was significantly superior respectively in T1 and T2 stages than in T3 and T4 stages, and in T4a than in T4b stages. Extension of the lesion to the sphenoid sinus was revealed as a significant bad prognostic factor. The ASA score and the exposure time to wood dust were not identified as statistically significant prognosis factors., Conclusion: Survival factors of ethmoïd sinus ADK were T stage and the extension of the tumor to the sphenoid sinus. On the results of this study, we consider that extension in sphenoïd sinus could be include in TNM classification of ethmoïd sinus adenocarcinomas.

Work plays a major role in the production of social inequalities in health in two ways. It determines the place that each one is occupying in the production and in the society, which is influencing the social inequalities as regards living conditions, income, housing, social security and access to the healthcare. In addition, the conditions and the organization of work have direct effects on worker's health according to the types of social division of work and of occupational hazards. The social differentiation of the occupational exposure to carcinogenic substances is under the influence of such a social division of work which plays also a role in the production of the inequalities in cancer. Known since decades, such inequalities are generally considered as related to the individual behaviours. The role of work in the social construction of these inequalities is little questioned, even if epidemiological data exist concerning occupational cancer. These are not visible in public area and little recognised in occupational disease. French and European regulations are taking in account the prevention of occupational cancer, but the effective practices are still poorly developed. This article attempts to show what is the state of the problem in terms of knowledge, compensation and prevention of these cancers which are related to work and for a large part invisible. This invisibility is contributing to the social growth of social inequalities in cancer.

In addition to conventional risk factors, environmental and occupational strain is an actor of the development and evolution of cardiovascular diseases. In industrialised countries, cardiovascular mortality is inversely correlated with the socio-economic level and type of occupation. In the French Ihpaf study, systemic hypertension and obesity were correlated with the socio-economic level. Among possible explanations for the importance of occupational environment, psychological stress at work, sedentary jobs, passive smoking and shift working may all play a role. Thus, beyond the conventional approach to individual risk factor management, it appears necessary to consider cardiovascular prevention through collective actions taking into account occupational environment.

From the retrospective study of 76 adenocarcinomas of the ethmoid sinuses, results were expressed in two terms: the morbidity related to surgery and the oncologic outcome. This case study extends between 1975 and 2000. It includes 71 men and 5 women, with an average of 61 years. 81% of them works in wood dust, with a mean duration of exposure of 26 years. The diagnosis of adenocarcinoma is realized in the three months after the first signs, essentially rhinologicals, next neurologicals and ophthalmologicals. The majority of tumors were classified as T3N0M0, i.e. 57.89%. The treatment of this tumors is surgical: 34.2% surgical only and 59.2% with radiotherapy. The transfacial approach (paralateronasal and degloving) and the combined surgery are respectively performed in 36 patients and 35 patients. 23.2% patients had a local recurrence, and 10% developed cervical nodes and systemic metastasis. Survival rate based on the Kaplan-Meier actuarial method is 82% at 3 years, 80% at 5 years, 72% at 10 years. The prognosis of ethmoidal cancer is strictly correlated to local control. Local recurrence is statistically more likely in patients with involvement of the dura, brain and sphenoid sinus. With the analysis of the carcinologics results, we discuss the therapeutics indications of the adenocarcinomas and a new classification. Taking in account the involvement of the dura, sphenoid and orbit. We did not find any statistical differences between T3 patients treated by combined approach (n = 13) or by transfacial approach (n = 15).

The group of man-made mineral fibres includes slagwool, glasswool, rockwool, glass filaments and microfibres, as well as refractory ceramic fibres. The toxicity of mineral fibres is determined by several factors such as the diameter (< or = 3-3.5 microns) and the length of the fibres (< 100 microns), their biopersistence, which is much shorter for man-made mineral fibres than for asbestos fibres, their physicochemical structure and surface properties, and the exposure level. The chemical composition of the various types of man-made mineral fibres depends directly on the raw material used to manufacture them. While naturally occurring fibres are crystalline in structure, most man-made mineral fibres are amorphous silicates combined with various metal oxides and additives. Observations using intracavitary administration have provided evidence that some types of man-made mineral fibres are bioactive in cellular and animal experiments and may induce lung tumours and mesothelioma. It is difficult to extrapolate these results to humans since they bypass inhalation, deposition, clearance and translocation mechanisms. Inhalation studies show more realistic results but differences are observed between animal species regarding their sensibility to tumours. There is no firm evidence that exposure to various wools is associated with lung fibrosis, pleural lesions or nonspecific respiratory disease in humans. A possible exception may be mentioned for refractory ceramic fibres. A slightly elevated standard mortality ratio for lung cancer has been documented in large cohorts of workers (USA, Europe and Canada) exposed to man-made mineral fibres, especially in the early technological phase. It is not possible to determine from these data whether the risk of lung cancer is due to the man-made mineral fibres themselves, in particular due to the lack of data on smoking habits. No increased risk of mesothelioma has been demonstrated in these cohorts. Epidemiological data are insufficient at this time concerning neoplastic diseases in refractory ceramic fibres.

Background: The objective was to describe a possible cancer mortality risk in relation with the occupational exposure within an International study co-ordinated by the International Agency for Research on Cancer., Methods: An epidemiological cohort study was set up to assess the mortality in four French pulp and paper companies. The four cohorts were followed up from January 1st 1968 to December 31st 1992. The causes of death were ascertained by matching with the national file of causes of death., Results: The full cohort consisted in 5,529 men and 876 women. The total numbers of subjects deceased between 1968 and 1992 were respectively 708 and 34. Causes of death could be traced for 98%. The observed mortality was significantly lower than the expected for all causes of deaths (SMR = 0.86) as well for all deaths by cancer (SMR = 0.87). The analysis by departments showed an excess mortality by cancer of the pancreas in the wood preparation department (SMR = 3.14) as well as in the paper production department (SMR = 2.04)., Conclusions: In absence of any prior hypothesis, it is difficult to assign an occupational origin to these observed excesses. The future results of the international study will enable us to interpret these results more precisely.

A retrospective oncological study was performed in 25 woodworkers, in whom an adenocarcinoma of the ethmoid sinuses was discovered between March 1985 and December 1993. All patients were males with a mean age of 57 years, and a mean duration of wood dust exposure of 24 years. Signs of nasal obstruction, drainage, and discomfort were present in all cases. Ophthalmological findings were a poor prognosis indicator. It was possible to precisely evaluate treatment and outcome in 23 cases. The majority of tumors were classified as T3 or T4 (72%), with extension beyond the ethmoid sinuses; all were in contact with the roof of the ethmoidal sinuses. Extension was predominantly into the orbital and intracranial cavities as compared with extension posteriorly or into the maxillary sinuses. Treatment was identical in the 25 patients: a) combined surgery including a paranasal and a neurosurgical approach, b) postoperative radiotherapy. Results were expressed in terms of morbidity related to surgery and the oncologic outcome. Operative morbidity and mortality were substantially reduced with reconstruction of the roof of the ethmoidal sinuses. Meticulous excision, in addition to postoperative radiotherapy, resulted in a decreased rate of local recurrence (26%). On the other hand, metastasis were encountered more frequently (30%). Radiotherapy was insufficient when macroscopic excision was incomplete. Chemotherapy was used as palliative treatment in the event of a recurrence and/or metastases. Survival rate was 68% at 3 years, and 48% at 5 years. Most complications and recurrences arose within the first two years. Exophthalmos, intracranial extension, incompleteremoval, and extensive class T4 tumors were associated with a poor prognosis. Optimal therapy for malignant tumors of the ethmoid sinuses requires combined transfacial and neurosurgical approaches that allow precise assessment of tumor extension and adequate excision, yielding an improved oncologic outcome. Followed by radiotherapy, this association can result in a remission. Patient prognosis depends essentially on management of the initial lesion.

A mortality study was carried out in two factories producing stainless steel in order to assess lung cancer risk among workers employed in coke oven, blast and open hearth furnaces, foundry, electric furnace, hot and cold rolling mills and pickling areas. Occupational exposures of interest were chromium compounds, nickel compounds, polycyclic aromatic hydrocarbons (PAH), silica and asbestos. All male workers having at least one year of employment between 01.01.1960 and 31.12.1990 were followed up for mortality. The vital status was assessed from birth place registries. Complete job histories since date of first employment were abstracted from the company files. The smoking habits of 50% of the cohort members were known from medical records. The observed number of deaths (obs) were compared with the expected ones based on regional rates with adjustment for age, sex and calendar time (Standardized Mortality Ratio, SMR). The cohorts included 6324 (factory 1) and 5270 (factory 2) workers. The overall mortality did not differ markedly from that expected in both factories: SMR = 0.95 (obs = 1540, p = 0.05) in factory 1 and SMR = 1.06 (obs = 916, non-significant) in factory 2. SMRs for lung cancer did not differ from unity, respectively 0.99 (obs = 105) and 1.00 (obs = 54), in whole cohorts. Non-significant lung cancer excesses were observed among workers of some workshops where exposures of interest might have occurred: coke oven (SMR = 2.04), blast furnace (SMR = 1.36), open hearth furnace (SMR = 1.75), hot rolling mills (SMR = 1.29). These processes, however, are no longer involved in the study factories. Furthermore, no lung cancer excess was observed among workers employed in current workshops: electric furnaces and cold rolling mills.

The evaluation of cancer risk after exposure to radon is mainly based on the results of uranium miners follow-up. A cohort study on the French uranium miners has demonstrated an excess of lung cancer and of larynx cancer mortality. A linear dose-response relationship has been described between the excess relative risk of lung cancer and the cumulative exposure to radon (poisson regression). This study has contributed to a joint analysis of 11 cohorts of miners, the aim being a more precise evaluation of the different factors able to influence the dose-response relationship between radon and lung cancer mortality. These factors are: age at first exposure, attained age, time since exposure, the pattern of exposure over time and tobacco consumption. The extrapolation of the risk for the general public from the risk estimated after occupational exposure, has to be considered by taking in account several remarks: uranium miners are exposed, beside radon, to two other radiological components, gamma rays and long lived uranium dust, and to other substances specific of the mines, which are absent in the domestic environment but may with radon have an effect on the lung cancer risk. It was impossible to estimate directly, from these uranium miners data, the risk linked to radon for non-smokers and for female population. A case control-study is currently be carrying out in the French hospitals, in order to estimate the risk of lung cancer linked to the last 30 years of radon exposure in the dwellings.

In a population of about 4,400 senegalese workers followed 8 years, we analyse their level mortality (4.2%) and we compare it to the France's one. Then, we study the causes of the 164 decreases and we note that the hepatic diseases prevail.

A mortality study was carried out, throughout the period 1970-1984, in a cohort of 963 men who had worked for at least one year in a coal tar distillery. The observed number of deaths, 109, did not significantly differ from the expected number. Using the death rates of the local population as a reference, no excess was observed for lung cancer and for cancers of the larynx, while there was an excess for cancers of the oesophagus but non significant and for cancers of the buccal cavity and pharynx (SMR = 2.17 - p less than 0.05). A nested case-control study was carried out. From within the cohort, 5 deaths from lung cancer and 10 deaths from cancers of the buccal cavity and pharynx were defined as "cases". For each case, all the available dead controls with the same sex, year of birth, tobacco and alcohol consumption were selected from within the cohort. The odds ratios for lung cancer did not reveal any occupational risk. With regard to buccal cavity and pharyngeal cancers, the odds ratios were neither significant for a duration of exposure greater than or equal to 1 year nor for a duration greater than or equal to 5 years along with a latent period greater than or equal to 10 years. Nevertheless there is a significant OR for exposure less than or equal to 10 years (OR = 7.56) but it is near one for exposures greater than 10 years.

In an epidemiologic investigation of mortality among workers in a Swiss rubber-goods factory the cancer mortality in the period 1955-1975 has been studied in all male workers active on 1 January 1955 in (a) a rubber-goods factory and (b) a munitions factory, the latter as reference population. The two groups numbered some 1000 each. Both factories were located in the same Central Swiss village where no other industry was present. Mortality in each industry is compared with that in the Swiss population in general (SMR) and the mortalities of the two industries are compared with each other. The results tend to confirm that rubber workers are exposed to a higher risk of cancer mortality. Three particular types of cancer are briefly discussed: cancer of the stomach, of the lower urinary tract, and glioblastoma.