Search

International audience

Objective The aim of this study was to describe return to work determinants in patients with haematological malignancy.Results This medico-social pilot study included patients with haematological malignancy in the département of Calvados, aged 18 to 55 years, diagnosed between 1st January and 31st December 2010 and alive at 1st January 2015. Patients were identified via consultation of the Lower Normandy haematological malignancy Registry. They completed a specially developed self-questionnaire, in addition to validated questionnaires for anxiety-depression, quality of life and fatigue. Of the patients contacted, 50% accepted to participate. The mean age at diagnosis was 49.8 years, and the majority of patients (79.2%) was professionally active at the time of diagnosis. Only 64.9% of subjects had stopped work due to illness. The psychological impact (demonstrated anxiety) was significantly greater in men (p=0.01). The majority of subjects returned to work after treatment (80.7%) and among them, the mean duration of absence from work was 16.1 months. Only 52.6% of subjects had informed their occupational physician and 56.7% had benefited from a pre-return visit.The satisfactory response rate obtained is promising for the extension of the present project as a prospective multicentric study.

Objective: the aim of this study was to evaluate the association between interstitial lung abnormalities, asbestos exposure and age in a population of retired workers previously occupationally exposed to asbestos. Methods: previously occupationally exposed former workers to asbestos eligible for a survey conducted between 2003 and 2005 in four regions of France, underwent chest CT examinations and pulmonary function testing. Industrial hygienists evaluated asbestos exposure and calculated for each subject a cumulative exposure index (CEI) to asbestos. Smoking status information was also collected in this second round of screening. Expert radiologists performed blinded independent double reading of chest CT-scans and classified interstitial lung abnormalities into: no abnormality, minor interstitial findings, interstitial findings inconsistent with UIP, possible or definite UIP. In addition, emphysema was assessed visually (none, minor: emphysema &lt, 25%, moderate: between 25 and 50% and severe: &gt, 50% of the lung). Logistic regression models adjusted for age and smoking were used to assess the relationship between interstitial lung abnormalities and occupational asbestos exposure. Results: the study population consisted of 2157 male subjects. Interstitial lung abnormalities were present in 365 (16.7%) and emphysema in 444 (20.4%). Significant positive association was found between definite or possible UIP pattern and age (OR adjusted =1.08 (95% CI: 1.02–1.13)). No association was found between interstitial abnormalities and CEI or the level of asbestos exposure. Conclusion: presence of interstitial abnormalities at HRCT was associated to aging but not to cumulative exposure index in this cohort of former workers previously occupationally exposed to asbestos.

International audience; BackgroundThe objective of the study was to compare the prevalence of occupational exposure to asbestos and crystalline silica according to histological types of lung cancer and age at diagnosis.MethodsCaProMat study is a pooled case‐only study conducted between 1996 and 2011. The current study consisted of 6521 lung cancer cases. Occupational exposure to asbestos and crystalline silica was assessed by two Job‐Exposure Matrices. A weighted prevalence of exposure was derived and compared according to histological types and age at diagnosis.ResultsThere was no difference of weighted prevalence of exposure to asbestos and crystalline silica according to histological types of lung cancer. There was a statistically significant difference of weighted prevalence of exposure to asbestos and crystalline silica according to age at diagnosis.ConclusionsDue to the limited clinical importance of the difference, neither the histological type, nor the age at diagnosis can be used as an indicator for the occupational exposure to asbestos or crystalline silica.

Objectives The aim of this study was to assess the effect modification of the association between tobacco smoking and phenotypes of lung cancer (histological type, tumor location, and age at diagnosis) by occupational exposure to asbestos or to crystalline silica. Materials and methods The CaProMat study is a pooled case-only study including 7256 male lung cancer cases recruited between 1996 and 2011 in France and Canada. Two job-exposure matrices (JEMs) were used to assess occupational exposure to asbestos and crystalline silica. Statistical interactions between tobacco smoking and occupational exposure to asbestos or crystalline silica were assessed using unconditional logistic regression models for histological type and tumor location and linear regression models for age at diagnosis. Results Tobacco smoking was associated with squamous cell carcinoma and small cell carcinomas as well as an earlier age at diagnosis. Additional exposure to either asbestos or crystalline silica did not modify the effect of tobacco smoking for either histological type or age at diagnosis. Neither tobacco smoking nor occupational exposure to asbestos or crystalline silica influenced tumor location. Conclusions Tobacco smoking was the main factor related to histological type and age at diagnosis. Those associations were not modified by occupational exposure to asbestos or crystalline silica.

Context.—Pleural mesothelioma is a rare cancer with an often-challenging diagnosis because of its potential to be a great mimicker of many other tumors. Among them, primary lung and breast cancers are the 2 main causes of pleural metastasis. The development and application of targeted therapeutic agents have made it even more important to achieve an accurate diagnosis. In this setting, international guidelines have recommended the use of 2 positive and 2 negative immunohistochemical biomarkers.Objectives.—To define the most highly specific and sensitive minimum set of antibodies for routine practice to use for the separation of epithelioid malignant mesothelioma from lung and breast metastasis and to determine the most relevant expression cutoff.Design.—To provide information at different levels of expression of 16 mesothelial and epithelial biomarkers, we performed a systematic review of articles published between 1979 and 2017, and we compared those data to results from the Mesothelioma Telepathology Network (MESOPATH) of the standardized panel used in routine practice database since 1998.Results.—Our results indicate that the following panel of markers—calretinin (poly)/thyroid transcription factor 1 (TTF-1; clone 8G7G3/1) and calretinin (poly)/estrogen receptor-α (ER-α; clone EP1)—should be recommended; ultimately, based on the MESOPATH database, we highlight their relevance which are the most sensitive and specific panel useful to the differential diagnosis at 10% cutoff.Conclusions.—Highlighted by their relevance in the large cohort reported, we recommend 2 useful panels to the differential diagnosis at 10% cutoff.

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.

IntroductionGuidelines concerning the follow-up of subjects occupationally exposed to lung carcinogens, published in France in 2015, recommended the setting up of a trial of low-dose chest CT lung cancer screening in subjects at high risk of lung cancer.ObjectiveTo evaluate the organisation of low-dose chest CT lung cancer screening in subjects occupationally exposed to lung carcinogens and at high risk of lung cancer.Methods and analysisThis trial will be conducted in eight French departments by six specialised reference centres (SRCs) in occupational health. In view of the exploratory nature of this trial, it is proposed to test initially the feasibility and acceptability over the first 2 years in only two SRCs then in four other SRCs to evaluate the organisation. The target population is current or former smokers with more than 30 pack-years (who have quit smoking for less than 15 years), currently or previously exposed to International Agency for Research on Cancer group 1 lung carcinogens, and between the ages of 55 and 74 years. The trial will be conducted in the following steps: (1) identification of subjects by a screening invitation letter; (2) evaluation of occupational exposure to lung carcinogens; (3) evaluation of the lung cancer risk level and verification of eligibility; (4) screening procedure: annual chest CT scans performed by specialised centres and (5) follow-up of CT scan abnormalities.Ethics and disseminationThis protocol study has been approved by the French Committee for the Protection of Persons. The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings.Trial registration numberNCT03562052; Pre-results.

As pleural plaque has been reported as a risk factor in the occurrence of lung cancer and mesothelioma, a reproducible and precise method of measurement of pleural plaque volume (PPV) is needed to further describe these relationships. The aim of the study was to assess the reproducibility of a 3-dimensional computed tomography (3D-CT) volumetric analysis of PPV in patients with occupational exposure to asbestos.A total of 28 patients were retrospectively randomly selected from the multicenter APEXS (Asbestos Post Exposure Survey) study, which was held between 2003 and 2005. All patients underwent a 3D-CT scan. Two readers specialized in chest radiology completed the 3D semiautomated quantification of lung volume using dedicated software. They also had to categorize the visual extent of pleural plaque in terms of thickness and circumference. Reproducibility of the continuous PPV variable was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. Reproducibility of categorical variables was assessed using the κ test.Intraobserver reproducibility of PPV was almost perfect (ICC=0.98 [95% interval: 0.97-0.99]), and interobserver reproducibility was very good (ICC=0.93 [0.88-0.97]). At Bland-Altman analysis, the mean differences were 0.1 (limit of agreement: -11.0 to 11.2) and 3.7 cc (-17.8 to 25.2), respectively. Visual analysis of both plaque in terms of thickness and circumference were fair to moderate, with κ values ranging from 0.30 to 0.60.3D semiautomatic quantification of PPV is feasible and reproducible using CT in patients with occupational exposure to asbestos. PPV measurement may be useful to correlate with other asbestos-related disease outcomes and prognosis.

Objectives Prostate cancer is one of the most frequent cancers among men worldwide. Its etiology is largely unknown, but an increased risk has been repeatedly observed among farmers. Our aim was to identify occupational risk factors for prostate cancer among farmers in the prospective cohort study AGRICAN. Methods Data on lifetime agricultural exposures (type of crops, livestock and tasks including pesticide use, re-entry and harvesting) were collected from the enrolment questionnaire. During the period from enrolment (2005–2007) to 31 December 2009, 1672 incident prostate cancers were identified. Hazard ratios (HR) were estimated using Cox regression analysis. Results We found an increased risk for cattle breeders using insecticides [HR 1.20, 95% confidence interval (95% CI) 1.01–1.42] with a significant dose–response relationship with number of cattle treated (P for trend 0.01). A dose–response relationship was also observed with the number of hogs (P for trend 0.06). We found an excess of prostate cancer risk among people involved in grassland activities, mainly in haymaking (HR 1.18, 95% CI 1.02–1.36). Pesticide use and harvesting among fruit growers were associated with an elevated prostate cancer risk, with a two-fold increased risk for the largest area. For potato and tobacco producers, an elevated prostate cancer risk was observed for almost all tasks, suggesting a link with pesticide exposure since all of them potentially involved pesticide exposure. Conclusions Our analysis suggests that the risk of prostate cancer is increased in several farming activities (cattle and hog breeding, grassland and fruit-growing) and for some tasks including pesticide use.

ObjectivesFarmers are considered at lower risk of lung cancer. However, specific tasks can expose them to hazardous air contaminants such as pesticides, diesel exhaust and mineral dust. This study aimed to assess the associations between various crops and related tasks and the risk of lung cancer, overall and by histological subtypes.MethodsAGRIculture and CANcer is a prospective French cohort of individuals affiliated to the agricultural health insurance scheme. Incident lung cancers (n=897) were identified by cancer registries from enrolment (2005–2007) to 2013. Data on crop and livestock exposure during lifetime were obtained from the enrolment questionnaire. We used a Cox model with attained age as timescale, adjusted for gender, smoking history and exposure to cattle and horses. Effects of duration and surface were assessed and analyses stratified on gender and smoking status were performed.ResultsWinegrowers were at higher risk of adenocarcinoma (HR=1.27 (95% CI 0.94 to 1.72)). We also found an association between pea growing and small cell lung cancer: significant effect of duration (ptrend=0.04) and the suggestion of a surface–effect relationship (ptrend=0.06); increased risk (HR=2.38 (95% CI 1.07 to 5.28)) for pesticide users; and significant effect of duration (ptrend=0.01) for harvesters. The risk of squamous cell carcinoma was increased for sunflower growing (HR=1.59 (95% CI 0.97 to 2.62), fruit-tree pruning (HR=1.44 (95% CI 0.92 to 2.27)) and pesticide use on beets (HR=1.47 (95% CI 0.92 to 2.34)). Corn and/or wheat/barley growers were at lower risk of lung cancer.ConclusionsOur results suggest associations between lung cancer and several crop-related tasks, even if we cannot rule out some chance findings due to multiple comparisons.

Introduction Beyond pesticide exposure, farmers are likely to be exposed to several air pollutants. Some of them are of particular interest, either because of their known carcinogenic properties, for lung cancer (total dust, Diesel exhaust, crystalline silica,) or other cancer sites (mycotoxins) or because of a supposed protective effect on lung cancer risk (endotoxins). However, except for endotoxins, very few studies, assessed farmers’ exposure levels by individual samplings. Our study aims at describing the levels, and assessing the determinants, of agricultural exposure to these air pollutants. Methods We assessed French farmers’ individual exposure to several air contaminants: (1) inhalable endotoxins and mycotoxins during various tasks in several breedings (cattle, horse) and 3 crops (grassland, wheat/barley, peas); (2) respirable crystalline silica during harvesting of these 3 crops; (3) respirable elementary carbon during the use of Dieselized farm equipment. Inhalable dusts, up to 20 µ, were assessed in real time. Sampling was performed during the whole activity, and endotoxin exposure was also assessed for each task separately. Field monitors followed the farmers and collected detailed information on the activity. Results The field study is on-going, we already observed around 40 individual measurements in 20 different farms. The protocol was judged acceptable by the participants. Sampling duration ranges from 80 to 240 min, depending on the type of activity. First results from real-time dust measurements suggest a higher exposure during stables cleaning and mulching (mean concentration of inhalable dusts: 0.545 mg/m3). A total of several hundreds of measurements is expected in various types of farms and working conditions (number of animals, cultivated area, type of equipment). Discussion We hope our study will improve the assessment of occupational health hazards in agriculture, and thus primary prevention, by quantifying the levels of individual exposure to several air pollutants.

Introduction 2,6-Dinitroanilines included 15 herbicides, some of which are still used on a wide range of crops worldwide and in France, especially pendimethalin which was given special attention by the IARC. The aim of our analyses was to estimate the associations between LC and exposure to pendimethalin, benfluralin, butralin, ethalfluralin, nitralin, oryzalin, trifluralin -all once or still authorised in France-, in the French AGRIculture and CANcer (AGRICAN) cohort. Methods More than 1 80 000 people affiliated for at least 3 years to the agricultural health insurance scheme were enrolled between 2005 and 2007. A total of 563 incident LC were identified from enrollment to 2011. Data on crop exposure during lifetime (13 crops, specific tasks including pesticide use) were collected. The evaluation of potential exposure to each dinitroaniline relied on a specific crop-exposure matrix, PESTIMAT. Analyses were adjusted on smoking history, involvement in cattle and horse breeding, peas growing, exposure to farming activities during childhood. Results In the population, 16 533 people (11.2% of the cohort) were potentially exposed to one or more dinitroanillines. Pendimethalin and trifluralin were the most frequently used, but not associated to any increased risk of LC, nor was exposure to dinitroanillines in general. We observed an increased risk of adenocarcinoma for oryzalin exposure (HR=2.93[1.13–7.59], n=5 exposed cases), but with no linear effect with duration. Conclusion We did not found any increased risk of LC among pendimethalin users. Our results suggest a possible association of lung adenocarcinoma with oryzalin, currently authorised in France, especially on the vineyard.

Background: The relationships between asbestos exposure and colorectal cancer remain controversial. Objectives: We examined the association between asbestos exposure and colorectal cancer incidence. Methods: Volunteer retired workers previously exposed to asbestos were invited to participate in the French ARDCo screening program between 2003 and 2005. Additional data on risk factors for colorectal cancer were collected from the ARDCo-Nut subsample of 3,769 participants in 2011. Cases of colon and rectal cancer were ascertained each year through 2014 based on eligibility for free medical care following a cancer diagnosis. Survival regression based on the Cox model was used to estimate the relative risk of colon and rectal cancer separately, in relation to the time since first exposure (TSFE) and cumulative exposure index (CEI) to asbestos, and with adjustment for smoking in the overall cohort and for smoking, and certain risk factors for these cancers in the ARDCo-Nut subsample. Results: Mean follow-up was 10.2 years among 14,515 men, including 181 colon cancer and 62 rectal cancer cases (41 and 17, respectively, in the ARDCo-Nut subsample). In the overall cohort, after adjusting for smoking, colon cancer was significantly associated with cumulative exposure (HR = 1.14; 95% CI: 1.04, 1.26 for a 1-unit increase in ln-CEI) and ≥ 20–40 years since first exposure (HR = 4.67; 95% CI: 1.92, 11.46 vs. 0–20 years TSFE), and inversely associated with 60 years TSFE (HR = 0.26; 95% CI: 0.10, 0.70). Although rectal cancer was also associated with TSFE 20–40 years (HR = 4.57; 95% CI: 1.14, 18.27), it was not associated with ln-CEI, but these findings must be interpreted cautiously due to the small number of cases. Conclusions: Our findings provide support for an association between occupational exposure to asbestos and colon cancer incidence in men. Citation: Paris C, Thaon I, Hérin F, Clin B, Lacourt A, Luc A, Coureau G, Brochard P, Chamming’s S, Gislard A, Galan P, Hercberg S, Wild P, Pairon JC, Andujar P. 2017. Occupational asbestos exposure and incidence of colon and rectal cancers in French men: the Asbestos-Related Diseases Cohort (ARDCo-Nut). Environ Health Perspect 125:409–415; http://dx.doi.org/10.1289/EHP153

International audience; BACKGROUND:Our study aimed at analyzing incidence and mortality from esophageal cancer within a cohort of workers with previous occupational asbestos exposure (ARDCo Program).METHODS:A 10-year follow-up study was conducted in the 14 515 male subjects included in this program between October 2003 and December 2005. Follow-up began when exposure stopped. Asbestos exposure was analyzed by industrial hygienists using data from a standardized questionnaire. The Cox model was used, with age as the time axis variable adjusted for smoking, time since first exposure (TSFE) and cumulative exposure index (CEI) of exposure to asbestos.RESULTS:We reported a significant dose-response relationship between CEI of exposure to asbestos and esophageal cancer, in both incidence (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.00-1.58), and mortality (HR 1.40, [95%CI 1.12-1.75]).CONCLUSIONS:This large-scale study suggests the existence of a relationship between asbestos exposure and cancer of the esophagus.

Objectives To investigate inter-reader agreement for the detection of pleural and parenchymal abnormalities using CT in a large cross-sectional study comprising information on individual cumulative exposure to asbestos. Methods The project was approved by the hospital ethics committee, and all patients received information on the study and gave their written informed consent. In 5511 CT scans performed in a cohort of retired workers previously exposed to asbestos and volunteering to participate in a multiregional survey programme (Asbestos Related Diseases Cohort, ARDCO), double randomised standardised readings, triple in case of disagreement, were performed by seven trained expert radiologists specialised in thoracic imaging and blind to the initial interpretation. Inter-reader agreement was evaluated by calculating the κ-weighted coefficient between pairs of expert readers and results of routine practice and final diagnosis after expert reading. Results κ-Weighted coefficients between trained experts ranged from 0.28 to 0.52 (fair to good), 0.59 to 0.86 (good to excellent) and 0.11 to 0.66 (poor to good) for the diagnosis of asbestosis, pleural plaques and fibrosis of the visceral pleura, respectively. κ-Weighted coefficients between results of routine practice and final diagnosis after expert reading were 0.13 (poor), 0.53 (moderate) and 0.11 (poor) for the diagnosis of asbestosis, pleural plaques and fibrosis of the visceral pleura, respectively. Conclusions Interpretation of benign asbestos-related thoracic abnormalities requires standardisation of the reading and trained readers, particularly for participants asking for compensation, and with a view to the longitudinal survey of asbestos-exposed workers.

To elaborate and describe a large prospective agricultural cohort including males and females in France with various agricultural activities and to study causes of death. To date, few large prospective cohorts have been conducted among agricultural population. AGRIculture and CANcer cohort is a large prospective cohort of subjects in agriculture studying cancer among active and retired males and females, farm owners and workers, living in eleven areas of France with a population-based cancer registry. Enrollment was conducted from 2005 to 2007 with a postal questionnaire. In January 2008, 180,060 individuals (54 % males, 54 % farm owners, 50 % retired) were enrolled. Mortality was studied until December 2009 (605,956 person-years with standardized mortality ratio (SMR) by comparison with the general population of the areas. Over this period, 11,450 deaths 6,741 in men and 4,709 in women were observed, including 3,405 cancer-related deaths. SMRs were significantly reduced for global mortality (SMR = 0.68, 95 % CI 0.67–0.70 in males and SMR = 0.71, 95 % CI 0.69–0.73 in females) and for death by cancer (SMR = 0.67, 95 % CI 0.65, 0.70 in males and SMR = 0.76, 95 % C: 0.71, 0.80 in females). These results were mainly explained by less frequent smoking-related causes of death (lung cancer, cardiovascular diseases). Nonsignificant excesses of death were observed only for rheumatoid arthritis and arthrosis, suicides (in females), death for event of undetermined intent (in males) and breast cancer in male agricultural workers. These first results are the first ones obtained in France based on a large prospective agricultural cohort showing that farmers would be in healthier condition than the general population.

Purpose Livestock farming has been recognized as a risk factor for chronic bronchitis (CB). The role of crop farming, however, has been less studied. We sought to assess the role of a large range of farming activities on the risk of CB in the French agricultural cohort AGRICAN (AGRIculture and CANcer). Methods Data on respiratory health and farming activities were collected by questionnaire from 2005 to 2007. Associations between farming activities and self-reported doctor's diagnosis of CB were estimated by a logistic regression adjusted for confounders. Results CB was reported by 1207 farmers (8.4%). Two farming activities were associated with CB: cattle raising (odds ratio [OR] 1.24, 95% confidence interval 1.03–1.48), and potato production (OR 1.33, 95% confidence interval 1.13–1.57). Associations were more pronounced in small-scale cattle raising and in large-scale potato production, in particular among the longest exposed workers (≥20 years). Pesticide poisoning and exposure to pesticides in potato farmers were significantly associated with CB risk (OR 1.64 and OR 1.63, respectively). Conclusions This analysis suggests that other agricultural settings not previously reported, such as potato production, may be a risk factor for CB. The nature and circumstances of exposure to hazardous agents need to be further explored.

Background The association between pleural plaques and pleural mesothelioma remains controversial. The present study was designed to examine the association between pleural plaques on computed tomography (CT) scan and the risk of pleural mesothelioma in a follow-up study of asbestos-exposed workers. Methods Retired or unemployed workers previously occupationally exposed to asbestos were invited to participate in a screening program for asbestos-related diseases, including CT scan, organized between October 2003 and December 2005 in four regions in France. Randomized, independent, double reading of CT scans by a panel of seven chest radiologists focused on benign asbestos-related abnormalities. A 7-year follow-up study was conducted in the 5287 male subjects for whom chest CT scan was available. Annual determination of the number of subjects eligible for free medical care because of pleural mesothelioma was carried out. Diagnosis certification was obtained from the French mesothelioma panel of pathologists. Survival regression based on the Cox model was used to estimate the risk of pleural mesothelioma associated with pleural plaques, with age as the main time variable and time-varying exposure variables, namely duration of exposure, time since first exposure, and cumulative exposure index to asbestos. All statistical tests were two-sided. Results A total of 17 incident cases of pleural mesothelioma were diagnosed. A statistically significant association was observed between mesothelioma and pleural plaques (unadjusted hazard ratio (HR) = 8.9, 95% confidence interval [CI] = 3.0 to 26.5; adjusted HR = 6.8, 95% CI = 2.2 to 21.4 after adjustment for time since first exposure and cumulative exposure index to asbestos). Conclusion The presence of pleural plaques may be an independent risk factor for pleural mesothelioma.

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.

Introduction Even though some risk factors for breast cancer are well-established (reproductive history or lifestyle), they explain no more than 50% of cases. Occupational exposures, including farming, have been seldom studied and were based on small-scale studies. Our aim was to assess the association between farming activities and breast cancer in the AGRICAN cohort. Methods AGRICAN consisted of 181,842 participants affiliated to the French agricultural health insurance. Data on lifetime agricultural exposures (18 farming activities, up to 5 tasks) and living in a farm during first year of life were collected from the enrollment questionnaire (2005–2007). Hazard ratios were estimated using Cox regression analysis with age as time scale. Results From enrolment to 2011, 743 incident breast cancers were identified among 55,558 postmenopausal women (555 ductal and 99 lobular carcinoma) through linkage with cancer registries. We found an overall lower breast cancer risk among farmers (HR 0.81, 95% CI: 0.65–1.01) and cattle breeders, with a linear inverse relationship with duration (≥40 years HR 0.71, 95% CI: 0.52–0.95; p-trend Conclusion This work provides new results on associations between farming activities and breast cancer among postmenopausal women. It also emphasises the need to consider pesticide exposures during other tasks than application.

Background Epidemiological studies have repeatedly found lower risks of lung cancer in farmers. Besides a lower prevalence of tobacco-smoking, exposure to endotoxins, which is highly present in animal farming, has been offered as an explanation. However, its role remains controversial. Little is known about the agricultural activities concerned. In the AGRICAN cohort, we assessed the relationship between animal farming and lung cancer by investigating the type of animals, tasks, timing of exposure and taking smoking history into account. Methods The AGRICAN cohort consisted of 170,834 participants affiliated to the French agricultural health insurance scheme. Linkage with cancer registries identified 487 incident lung cancers from enrolment (2005–2007) to 2011. The enrolment questionnaire provided detailed information on lifelong farming, including tasks performed with cattle, horses, pigs, poultry, sheep and/or goats with years of beginning and end, and exposure to a farm during the first year of life. Associations between lung cancer and exposure to animals were analysed using a Cox model with adjustment for smoking, using age as time scale. Results Risk in lung cancer (especially adenocarcinoma) was inversely associated with duration of occupational exposure to cattle (≥40 years: HR = 0.60, [95% CI=0.41–0.89], p–trend = 0.04) and horse (≥20 years: 0.64 [0.35–1.17], p–trend = 0.08), but not with poultry or pig farming. Lower lung cancer risk remained associated with long–term exposure to cattle, even 25 years after cessation of exposure. More pronounced decreased risks were observed among individuals who had cared for animals, undertaken milking and who had been exposed to cattle in infancy. Interpretation Our study provides strong evidence of an inverse association between cattle and horse farming, and lung cancer. Further research is warranted to identify the etiologic protective agents and biological mechanisms involved.

Introduction Certain digestive cancers, especially colorectal cancer, may be related to asbestos exposure. The aim of our study was to estimate the incidence of digestive cancers within a cohort of asbestos plant workers. Methods Our study was based on a retrospective cohort of 2,024 male and female workers occupationally exposed to asbestos, in the Calvados departement (France). Data on the cases of digestive cancers were collected thanks to the Calvados’ digestive cancer registry. For each localization, the observed number of cancers was calculated from 1st January 1978 to 31st December 2009 and compared with the expected number among the local general population, using Standardised Incidence Ratios (SIR). Asbestos exposure was assessed for each subject, using the company’s specific job exposure matrix, and according to three indicators: duration of exposure, Cumulative Exposure Index (CEI), mean atmospheric level. Results One hundred and nineteen cases of digestive cancers were observed, for an expected number of 77 (SIR = 1.54 [1.28; 1.85]). A significant excess of risk was observed for peritoneal mesothelioma, especially in women (SIR = 43.0 [13.9; 100]). Significantly elevated SIR were also observed among men for: all digestive cancers, even when excluding peritoneal mesothelioma (SIR = 1.50 [1.23; 1.82]); esophageal cancer in general (SIR = 1.67 [1.08; 2.47]) and among those with CEI above 80 fibres/ml.years (SIR = 1.90 [1.16; 2.94]); liver cancer (SIR = 1.85 [1.09; 2.92]). Concerning colorectal cancer, a significant excess of risk was observed for men with exposure duration above 25 years (SIR = 1.75 [1.05; 2.73]). Conclusions Our results are in favour of a link between long-duration asbestos exposure and colorectal cancer in men, which is consistent with most of the literature. They also suggest a relationship between asbestos exposure and cancer of the oesophagus in men. Finally, there might be an association with small intestine and liver cancers in men.

For lung cancer, there is evidence of a joint effect between smoking and asbestos. However, little is known about a possible joint effect between asbestos and other inorganic particles. The objective was to study the association between lung cancer and occupational asbestos exposure in the abscence or presence of additional exposure to inorganic particles. A 12-year follow-up study was conducted to analyse lung cancer incidence in a cohort of 13,814 retired workers previously exposed to asbestos and volunteering to participate in a multiregional survey program (Asbestos Related Diseases Cohort, ARDCO) from October 2003 and December 2005. From complete work histories, occupational exposure to asbestos, mineral wools, refractory ceramic fibers, crystalline silica and cement dust were assessed by job-exposure matrices. Association between lung cancer and occupational asbestos exposure was estimated by Cox model, adjusted for smoking, in the presence or absence of additional exposure to inorganic particles. At the end of follow-up (April 2015), 364 incident lung cancer cases were diagnosed. The association between lung cancer and asbestos exposure was statistically significant (HR=2.3 [95% CI=1.0-5.4]), but it seemed increased in the presence of additional exposure to mineral wools (HR=3.1 [95% CI=1.4-7.2]). However, at equal asbestos exposure level, the association was no longer different in the presence of additional exposure to mineral wools. Other inorganic particles did not modify the association between asbestos and lung cancer. Mineral wools may modify the association between lung cancer and asbestos. However, subjects exposed to both factors seemed also to be more exposed to asbestos.

Introduction Epidemiologic studies have found lower risks of lung cancer (LC), partly due to a lower prevalence of smoking, and with increasing evidence of potential protection in some animal farmers. However, farmers are also exposed to some hazardous air contaminants (pesticides, diesel exhaust, mineral dust). In the prospective cohort AGRICAN, we assessed associations between several crop-related activities and tasks and LC risk, including adenocarcinomas (ADC), squamous cell carcinomas (SqCC) and small cell carcinomas (SmCC). Methods AGRICAN includes French individuals affiliated to the agricultural health insurance scheme. Incident LC were identified by linkage with cancer registries from enrolment (2005–2007) to 2011. Data on crop exposure during lifetime (13 crops and from 2 to 5 specific tasks) were obtained from the enrolment questionnaire. Analyses were performed using a Cox model, with attained age as time scale, adjusted for gender, smoking history and exposure to potential protective activities – cattle and horses. Results Among the 148,046 subjects, 487 incident LC were identified. Higher risks were observed in pea growers, especially in those who harvested, (harvesting: HR = 1.43[0.99–2.06], with a significant relationship with duration of exposure (p-trend for duration = 0.06)), for all subtypes except ADC. Increased risks were also observed among (i) farmers growing vegetables (HR = 1.26[0.93–1.72]), (ii) vine-growers (ADC: HR = 1.37[0.97–1.93]), especially in those performing re-entry tasks (ADC: HR 1.40 [0.96–2.04]) and harvesting (ADC: HR = 1.37[0.95–1.95]); (iii) pesticide users on beets (SqCC: HR = 1.88[1.13–3.11]) and (iv) farmers who treated rape seeds (SqCC: HR = 2.55[1.17–5.53]). No significant relationship was observed with duration for any of these activities and tasks. Conclusions We found positive associations between LC risk and several crop-related tasks including pesticide exposure (application in fields or on seeds, re-entry tasks) or not like peas harvesting.

Introduction Farming and pesticide use have been repeatedly and consistently associated with prostate cancer risk but analysis on the role of specific active ingredients remain scarce and results inconclusive. We assessed associations between occupational exposure to specific organochlorines and prostate cancer in the agricultural cohort AGRICAN. Methods The AGRICAN cohort consisted of 181,842 participants, affiliated for at least 3 years to the French agricultural health insurance. Data on pesticide use on 6 crops, including years of beginning and ending, were collected from the enrolment questionnaire. Exposure to organochlorine insecticides and duration of exposure between 1950 and 2010 was assessed with the help of a crop-exposure matrix (PESTIMAT). Associations with prostate cancer were estimated using a Cox regression analysis with attained age as time scale. Results From enrolment (2005–2007) to 2009, 1 672 incident prostate cancer cases among 98,974 male participants were identified through linkage with cancer registries. A nearly significant increase in prostate cancer risk was observed when considering organochlorines as a group (HR 1.15, 95% CI: 0.99–1.32; 463 cases) with no linear relationship with duration of exposure. A significant association was observed for eight individual organochlorine pesticides (out of 18) and a significant relationship with duration of exposure was observed for 6 of them (aldrin, chlordane, dieldrin, DDD, toxaphene and HCH). When adjusting for exposure to the 5 other organochlorines, a greater prostate cancer risk remained among men with the highest duration of exposure to HCH and DDD. Conclusions Our study provides new results concerning the association between pesticide exposure and prostate cancer, especially for two organochlorines: DDD (a DDT metabolite) and HCH (a mix of isomers including γ-HCH also called lindane).

Introduction: Even though some risk factors for breast cancer are well-established (reproductive history or lifestyle), they explain no more than 50% of cases. Occupational exposures, including far...

Introduction: Farming and pesticide use have been repeatedly and consistently associated with prostate cancer risk but analysis on the role of specific active ingredients remain scarce and results ...

Literature on agricultural activities and bladder cancer risk is scarce. However, farmers can be subjected to carcinogenic exposure (e.g. arsenic, previously used as a pesticide in France). This study aimed at assessing the role of a large range of agricultural activities and tasks on bladder cancer risk. The study population was the AGRIculture and CANcer cohort, a large prospective cohort of individuals affiliated to the agricultural health insurance scheme (MSA) in France. Incident bladder cancers were identified by cancer registries from enrolment (2005–2007) to 2009. Data on agricultural exposure during professional lifetime (5 animals, 13 crops, specific tasks) were obtained from the enrolment questionnaire. Associations between bladder cancer and agricultural exposure were analysed using a Cox model, adjusted for gender and smoking history. Among the 148,051 farm owners and workers included in this analysis, 179 incident bladder cancers were identified. We observed an elevated risk among field-grown vegetable workers [HR 1.89, 95% CI (1.20–2.99)], with an exposure–response relationship with duration of work [≥30 years: HR 2.54, 95% CI (1.11–5.83), p-trend = 0.02], and higher risk among women [HR 3.82, 95% CI (1.58–9.25), p-interaction = 0.05]. Non-significantly increased risks were also observed in greenhouse farmers (HR = 1.95), pea sowing (HR = 1.84), rape sowing (HR = 1.64); several tasks involving pesticide use, especially seed treatment (HR = 1.24); and in activities and tasks potentially exposing to arsenic compounds via pesticide use (HR = 1.49) or re-entry tasks (HR = 1.63). Our analyses raise the question of a possible link between agricultural activity, especially field-grown vegetables, and greenhouse cultivation and bladder cancer.

Objectives The aim of our study was to analyse the dose–response relationship between occupational asbestos exposure and risk of cancer. Methods Our study was a retrospective morbidity study based on 2024 subjects occupationally exposed to asbestos, conducted over the period 1 January 1978 to 31 December 2004. Analysis of the dose–response relationship between occupational asbestos exposure, as a time-dependant variable, and risk of cancer was performed using a Cox model. In order to account for the effect of latency, we conducted the analysis with a lag of 10 years. Results 285 cases of cancers were observed in our cohort. The relative risk of pleuro-peritoneal mesothelioma, lung cancer and colorectal cancer associated with asbestos exposure, adjusted for age as a time-dependant variable and for sex, was correlated with exposure intensity (or average exposure level, AEL). The risk of cancer, whatever the anatomical site, did not increase with the duration of exposure to asbestos. Conclusion While confirming the established relationship between asbestos exposure and pleuropulmonary and peritoneal cancers, this study also suggests a causal relationship between asbestos exposure and colorectal cancer.

High dosage buprenorphine (Subutex(®)) has been prescribed as a replacement therapy for major opioid dependencies in France since 1996. However, several studies have underlined its lethal risk, especially when administered intravenously, or when combined with benzodiazepines, alcohol or other central nervous system depressants. We report three fatal buprenorphine-related poisonings after snorting, among outside protocol individuals, observed at the Forensic Medicine Unit of Caen University Hospital. Medico-legal autopsies and complementary examinations were performed. The results are presented and discussed. Lethal poisoning after snorting buprenorphine was considered the most probable cause of death. These observations illustrate the risk of fatal poisoning by buprenorphine per-nasal route, which has rarely been reported in the literature although snorting is particularly prized by individuals outside the substitution therapy. We also observed the combination of buprenorphine and alcohol. By evaluating the pharmacological characteristics of this substance, as well as the data previously published in the literature, we have attempted to explain the pathophysiological mechanisms of this particular mode of poisoning that can easily be fatal.

The term ‘euthanasia’ is not clearly defined. Euthanasia is evoked in many aspects of terminal care: interruption of curative treatment at the end of life, palliative care or the act of deliberately provoking death through compassion. A law on ‘patients’ rights and the end of life', promulgated in France on 22 April 2005, led to changes in the French Code of Public Health. In this work, we have first outlined the key provisions of this law and the changes it has brought, then we have compared current legislation on the subject throughout Europe, where a rapid overview of current practice in terminal patient care revealed four different types of legislation: the first authorizes euthanasia (in the sense of provoking death, if this choice is medically justified), the second legalizes ‘assisted suicide’, the third, which is sometimes referred to as ‘passive euthanasia’, consists of the non-administration of life-sustaining treatment and, finally, the fourth prohibits euthanasia in any form whatsoever. In the last section, we have attempted to clarify the as yet indistinct notion of ‘euthanasia’ in order to determine whether the conception of terminal care in the Law of 22 April 2005 was consistent with that put forward by the philosopher Francis Bacon, who claimed that, ‘The physician's role is to relieve pain, not only when such relief can lead to healing, but also when it can proffer a calm and trouble-free death, thus putting an end to the suffering and the agony of death’ (modern adaptation of the original quote).

Introduction: Age at death estimation is of major importance for the forensic scientist. Currently, various methods have used macroscopic osseous criteria for articular surfaces. Particularly in the pelvis, articular surfaces are used to classify bone evolution and age. The objective was to assess coxal bone computed tomography (CT) scan procedure to initially estimate adult male age at death and model this age using quantitative measurements. Materials and methods: The material used included 33 coxal bones obtained from adult males of known age. Samples were obtained from 27 males during forensic autopsies and the 6 remaining samples were collected by the Normandy Whole Body Donation Center. Criteria of all bone samples were measured by CT scan. The criteria were inspired by previous osseous anthropological methods for age estimation using coxal symphyseal, auricular and acetabular surfaces. Inter- and intra-reproducibility of each criterion was calculated. Then, correlation to age at death of the reproducible variables was calculated. Results: Correlation factors were used. These link CT scan criteria data to age at death. Reproducible criteria included in the analysis as reproducible and correlated to age were: auricular surface apex activity, symphyseal ventral rampart and acetabular fossa porosity. Conclusion: The results suggest that research using CT scan criteria data could be a useful forensic tool to determine age at death.

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.

Objective The aim of our study was to estimate the incidence of digestive cancers within a cohort of asbestos-exposed workers. Methods Our study was based on a cohort of 2024 participants occupationally exposed to asbestos. The incidence of digestive cancers was calculated from 1 January 1978 to 31 December 2009 and compared with levels among the local general population using Standardised Incidence Ratios (SIRs). Asbestos exposure was assessed using the company’s job-exposure matrix. Results 119 cases of digestive cancer were observed within our cohort, for an expected number of 77 (SIR=1.54 (1.28 to 1.85)). A significantly elevated incidence was observed for peritoneal mesothelioma, particularly in women. Significantly elevated incidences were also observed among men for: all digestive cancers, even when excluding peritoneal mesothelioma (SIR=1.50 (1.23 to 1.82)), oesophageal cancer (SIR=1.67 (1.08 to 2.47)) and liver cancer (SIR=1.85 (1.09 to 2.92)). Concerning colorectal cancer, a significant excess of risk was observed for men with exposure duration above 25 years (SIR=1.75 (1.05 to 2.73)). Conclusions Our results are in favour of a link between long-duration asbestos exposure and colorectal cancer in men. They also suggest a relationship between asbestos exposure and cancer of the oesophagus in men. Finally, our results suggest a possible association with small intestine and liver cancers in men.

Although asbestos is a well-known lung carcinogen, the pleural plaque-lung cancer link remains controversial.This study was designed to examine this link in asbestos-exposed workers.A 6-year follow-up was conducted to study lung cancer mortality in the 5,402 male subjects participating in an asbestos-related disease screening program conducted from October 2003 to December 2005 in four French regions. Chest computed tomography (CT) scan was performed in all subjects with randomized, independent, double reading of CT scans focusing on benign asbestos-related abnormalities. Cox model survival regression analysis was used to model lung cancer mortality according to the presence of pleural plaques, with age as the main time variable, adjusting for smoking and asbestos cumulative exposure index. All statistical tests were two-sided.Thirty-six deaths from lung cancer were recorded. Lung cancer mortality was significantly associated with pleural plaques in the follow-up study in terms of both the unadjusted hazard ratio of 2.91 (95% confidence interval = 1.49-5.70) and the adjusted hazard ratio of 2.41 (95% confidence interval = 1.21-4.85) after adjustment for smoking and asbestos cumulative exposure index.Pleural plaques may be an independent risk factor for lung cancer death in asbestos-exposed workers and could be used as an additional criterion in the definition of high-risk populations eligible for CT screening.

We report a fatal head injury caused by a tear-gas cartridge and point out the underestimated potential injury of this type of weapon. Gas pressure wounds and the death mechanisms are also described. A review of the literature and forensic considerations of head injury without projectile are presented.

International audience; Given the interest in defining biomarkers of asbestos exposure and to provide insights into asbestos-related and cell-specific mechanisms of neoplasia, the identification of gene alterations in asbestos-related cancers can help to a better understanding of exposure risk. To understand the aetiology of asbestos-induced malignancies and to increase our knowledge of mesothelial carcinogenesis, we compared genetic alterations in relevant cancer genes between lung cancer, induced by asbestos and tobacco smoke, and malignant pleural mesothelioma (MPM), a cancer related to asbestos, but not to tobacco smoke. TP53, KRAS, EGFR and NF2 gene alteration analyses were performed in 100 non-small cell lung cancer (NSCLC) patients, 50 asbestos-exposed and 50 unexposed patients, matched for age, gender, histology and smoking habits. Detailed assessment of asbestos exposure was based on both specific questionnaires and asbestos body quantification in lung tissue. Genetic analyses were also performed in 34 MPM patients. TP53, EGFR and KRAS mutations were found in NSCLC with no link with asbestos exposure. NF2 was only altered in MPM. Significant enhancement of TP53 G:C to T:A transversions was found in NSCLC from asbestos-exposed patients when compared with unexposed patients (P = 0.037). Interestingly, TP53 polymorphisms in intron 7 (rs12947788 and rs12951053) were more frequently identified in asbestos-exposed NSCLC (P = 0.046) and MPM patients than in unexposed patients (P < 0.001 and P = 0.012, respectively). These results emphasise distinct genetic alterations between asbestos-related thoracic tumours, but identify common potential susceptibility factors, i.e. single nucleotide polymorphisms in intron 7 of TP53. While genetic changes in NSCLC are dominated by the effects of tobacco smoke, the increase of transversions in TP53 gene is consistent with a synergistic effect of asbestos. These results may help to define cell-dependent mechanisms of action of asbestos and identify susceptibility factors to asbestos.

International audience; OBJECTIVES: The hypothesis that asbestos exposure may have more specific associations with particular histological types of lung cancer remains controversial. The aim of this study was to analyze the relationships between asbestos exposure and pulmonary carcinoid tumors. METHODS: A retrospective case-control study was conducted in 28 cases undergoing surgery for pulmonary carcinoid tumors and aged >40 years and in 56 controls with lung cancer of a different histological type, matched for gender and age, from 1994 to 1999, recruited in two hospitals in the region of Paris. Asbestos exposure was assessed via expertise of a standardized occupational questionnaire and mineralogical analysis of lung tissue, with quantification of asbestos bodies (AB). RESULTS: Definite asbestos exposure was identified in 25% of cases and 14% of controls (ns). Cumulative asbestos exposure was significantly higher in cases than in controls (P < 0.05), and results of the quantification of AB tended to be higher in cases than in controls (24 and 9% had >1000 AB per gram dry lung tissue, respectively, P = 0.09). Mean cumulative smoking was lower in cases than in controls (P < 0.05). CONCLUSIONS: This study argues in favor of a relationship between asbestos exposure and certain pulmonary carcinoid tumors.

Background The aim of this study was to determine the rates of compensation awarded to patients presenting with pleural mesothelioma and factors linked to such compensation in France. Methods The study population consisted of 2,407 patients presenting with pleural mesothelioma, recorded by the National Mesothelioma Surveillance Programme between January 1, 1999 and December 31, 2009. Analysis of claims for recognition as “occupational disease” (OD) and claims for compensation by the Compensation Fund for Asbestos Victims (FIVA) were analyzed. Results Approximately 30% of subjects presenting with pleural mesothelioma, affiliated to the General National Health Insurance fund, neither sought recognition as an OD nor claimed for FIVA compensation. Gender, age at diagnosis, type of health insurance, and socio-professional category influence the likelihood of patients presenting with mesothelioma seeking compensation for this disease. Conclusions Results show an under-compensation of pleural mesothelioma as OD and by the FIVA in France. Am. J. Ind. Med. 56:146–154, 2013. © 2011 Wiley Periodicals, Inc.

Background It is uncertain whether isolated pleural plaques cause functional impairment. Objective To analyse the relationship between isolated pleural plaques confirmed by CT scanning and lung function in subjects with occupational exposure to asbestos. Methods The study population consisted of 2743 subjects presenting with no parenchymal interstitial abnormalities on the high-resolution CT (HRCT) scan. Asbestos exposure was evaluated by calculation of an individual cumulative exposure index (CEI). Each subject underwent pulmonary function tests (PFTs) and HRCT scanning. Variables were adjusted for age, smoking status, body mass index, CEI to asbestos and the centres in which the pulmonary function tests were conducted. Results All functional parameters studied were within normal limits for subjects presenting with isolated pleural plaques and for those presenting with no pleuropulmonary abnormalities. However, isolated parietal and/or diaphragmatic pleural plaques were associated with a significant decrease in total lung capacity (TLC) (98.1% predicted in subjects with pleural plaques vs 101.2% in subjects free of plaques, p=0.0494), forced vital capacity (FVC) (96.6% vs 100.4%, p 1 ) (97.9% vs 101.9%, p=0.0032). In contrast, no significant relationship was observed between pleural plaques and FEV 1 /FVC ratio, forced expiratory flow at 25–75% FVC and residual volume. A significant correlation was found between the extent of pleural plaques and the reduction in FVC and TLC, whereas plaque thickness was not related to functional impairment. Conclusions The results show a relationship between isolated parietal and/or diaphragmatic pleural plaques and a trend towards a restrictive pattern, although the observed decrease in FVC and TLC is unlikely to be of real clinical relevance for the majority of subjects in this series.

Summary 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 × 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.

International audience; 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.

> The aim of occupational health practice is to protect and promote workers’ health, to sustain and improve their working capacity and ability, to contribute to the establishment and maintenance of a safe and healthy working environment for all, as well as to promote the adaptation of work to the capabilities of workers, taking into account their state of health.1 This first principle of the International Code of Ethics for Occupational Health Professionals, adopted by the International Commission for Occupational Health in March 2002, positions the occupational physician as a “protector” of personnel health. This role, in accordance with several codes of ethics applicable in a number of different countries,2–7 has already been defined as such since 1950 by the ILO and WHO, updated by the ILO/WHO Joint Committee on Occupational Health in 1995: > Occupational health should aim at: the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations; the prevention amongst workers of departures from health caused by their working conditions.8 However, one is forced to accept that this task is not …

Ferrets are becoming more and more popular pets in American homes. Nevertheless, they can cause potentially dangerous injuries, particularly in small children. Based on the case of an infant injured by a ferret, the characteristics of the wounds are described and compared with those of other animals. The potential legal implications are also discussed.

Objectives Farmers have lower lung cancer rates than the general population, due to low smoking rates. Exposure to endotoxins may also play a role. These exposures do not however preclude the role of lung carcinogen exposures in farming activities. We assessed the associations between farming activities and lung cancer from a case-control analysis nested in the French agricultural cohort AGRICAN (n = 180,060). Methods Incident lung cancer deaths from enrolment (2005–2007) to 31/12/2009 (n = 399) were individually matched with 4 controls by year of birth and sex by incidence density sampling method. Associations between self-reported lifetime farming activities and lung cancer were estimated using conditional logistic regression, controlling for cigarettes pack years. Results Lifetime exposure to animals was significantly related to a decreased lung cancer risk (OR = 0.59, 95% CI:0.41–0.84) with a similar association among non-smokers (OR = 0.57, 95%CI: 0.29–1.12). Non-significant decreased risks were observed for some animals: cattle, sheep/goat and horse (OR = 0.63–0.74, p = 0.10–0.15). Animal care on sheep/goat was the only task significantly inversely related to lung cancer (OR = 0.48, 95%CI: 0.25–0.94). A non-significant increased risk was associated with lifetime exposure to vineyards (OR = 1.29, 95%CI: 0.90–1.86, p = 0.17), association strengthened among non-smokers (OR = 1.84, 95%CI:0.99–3.44). An increased risk was observed for cellar work in vineyards (OR = 1.59, 95%CI:0.96–2.63, p = 0.07), strengthened and significant in non-smokers (OR = 4.06, 95%CI: 1.59–10.37). Conclusion These findings support the role of a decreased lung cancer risk associated with animal-related exposures and suggest the role of hazardous exposures in vineyard, particularly for cellar work. The role of other potential hazardous exposures (including arsenic pesticides that have been used in France in vineyard until 2001 and in some fruit growing and potato production until mid 1970s) will be further investigated in this study using a crop-exposure matrix. Further efforts are needed to identify etiologic protective agents and hazardous exposures for lung cancer in farming.