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The authors present the results of an investigation conducted, under the aegis of the PETRI association, on 701 patients living in the Paris region who, over a 1-year period, had asked the medical advisers of the Social Security Sickness Benefits department to dispense them from paying their portion of the cost of treatment on the ground that they had cancer of the bladder*. The purposes of the investigation were to obtain accurate data concerning the role played by tobacco and alcohol abuse in bladder cancer and to look for possible occupational exposures. The smoking and drinking habits of 636 patients could be analyzed: 89 percent of the men were, or had been, smokers with an average consumption of 33 packs per annum, and with a frequent overconsumption of alcoholic drinks. The professional cursus of 665 patients (31 percent active, 64 percent retired) could be established. The study confirmed that tobacco smoking and alcohol abuse, as well as certain occupational factors, play a role in the development of bladder cancer. Some professional sectors, such as the plastic industry or the hide and leather work, were better represented among these patients than would have been expected from their distribution in the active population. Surveillance of the population exposed by industrial doctors, and follow-up of people who have retired from some sectors of activity are as essential as anti-smoking campaigns.

A total of 197 definite cases of mesothelioma (mainly of the pleura) have been reported by pathologists to the French Mesothelioma Register for the period 1965--78. A moderate linear increase in the annual incidence of mesothelioma cases since 1965 was noted. In men and women over the ages of 47 and 41 years, respectively, the annual death rate was higher in those with mesothelioma than in those of the general population. The proportions of mesothelioma patients who had experienced occupational, para-occupational, and unknown asbestos exposures were 77%, 3%, and 20% respectively. The number of cases reported to the register is obviously an underestimate of the true number of mesothelima cases in France, because such cases are not reported to the register systematically. Mesothelioma registers cannot provide information about dose-response relationships; however, with good management of the register, such relationships could be obtained, since a good assessment of dose can be accomplished by biologic monitoring.

A mesothelioma register was initiated in France in 1975 to record pathologists, cases diagnosed since 1965. These cases have been accepted as definite mesothelioma after histological reexamination by the mesothelioma panel. Histories of asbestos exposure have been recorded using a standardized questionnaire. Among 699 cases reported, 296 were confirmed and 79 excluded by the panel. Twenty per cent of cases were females. Tumour was located in the pleura in 96% of cases. Age at death was lower for the mesothelioma group than for the general population. A linear increase of annual incidence since 1965 has been observed. Mapping of cases showed irregular distribution with areas without any case. Distribution of cases according to asbestos exposure was the following: definite occupational history 50%, definite non-occupational 3%, possible occupational 31%, undiscovered 16%. Distribution of cases according to the latency period showed a two peaks-curve, median being 36 years. The obvious under-reporting of cases and the absence of control group greatly affected the validity of some results.

Three groups of people working in buildings with insufficient protection against sources of asbestos (ceilings, lagging, cupboards, etc.) have been compared by clinical and radiological examinations. The first group, G1 (n = 160), comprised people working in direct contact with sources of asbestos; the second one, G2 (n = 277), comprised people who had worked for at least 10 years in buildings with little protection; and the third one, G3 (n = 157), may be considered a control group, since the only period of exposure was while the buildings were being constructed. The prevalence of lung abnormalities (clinical, functional and radiological) was higher in G1 than in G3; G2 was closer to G1 for some signs, but closer to G3 for most. These differences are no explained by obvious possible confounding factors (such as age, sex or tobacco consumption). They were analysed taking the number of years of presence in the buildings into account.

Two different methods have been tested for assessing retrospectively occupational exposure to asbestos dust in 80 cases with suspected asbestos-related thoracic diseases: 1) Occupational history was recorded by an interviewer using a standardized questionnaire. The patients were divided into three groups: those obviously exposed (E), those obviously not exposed (NE) and those with an inconclusive questionnaire (IQ). 2) Ferruginous bodies were isolated from lung washing fluid and counted under the light microscope. In the questionnaire groups, the proportions positive for ferruginous bodies in lung washing fluid were as follows: E, 29/33; NE, 1/7; IQ, 17/40. In cases positive for ferruginous bodies in lung washing fluid, the median numbers of bodies per ml of fluid were: E, 11.7 (range, 0.05-31,250); NE, 0.06; IQ, 1.1 (range, 0.06-350) Since the data provided by the two methods were in good agreement (P less than 0.001) for the E and NE questionnaire groups, the presence of ferruginous bodies in lung washing fluid is considered to be a good indicator of past exposure. In the IQ group, the monitoring of ferruginous bodies in lung washing fluid demonstrated exposure to asbestos in 43% of cases.

Different lung function tests have been studied in a group of 39 spray workers, with exposure of a few months to 20 years, in order to determine early impairments in ventilatory or gaseous exchange parameters. Lung function was assessed by conventional spirometric tests, plethysmographic measurement of lung volume, determination of arterial oxygen tension at rest and on exercise and measurement of single-breath diffusion of carbon monoxide. Asbestos exposure was assessed using a standardized questionnaire administered by an interviewer to determine length of exposure, and light microscopic examination to ascertain the number of ferruginous bodies in one sputum sample or in lung washing fluid. The results of the functional tests are expressed with respect either to duration of working exposure or to the number of ferruginous bodies. Restrictive ventilatory impairment with decrease in diffusion of carbon monoxide and increase in the oxygen alveolar-arterial difference on exercise was observed both in the group with 1-50 ferruginous bodies and in workers exposed for more than five years. The decrease in lung volume was approximately 10% when the length of asbestos exposure varied from 0-5 to 10-15 years, and 15% between those with no ferruginous bodies and those with more than 50. No obstructive profile was observed, even in heavy smokers. All function tests were altered equally. Plethysmography therefore appears to be a suitable technique for the follow-up of asbestos workers.

A matched survey of 55 full-time workers probably exposed to asbestos in an electricity-generating power station (exposed group) and of 53 unexposed workers in an automobile plant has been conducted. The asbestos risk in the power station was confirmed by the presence of airborne fibers in the range 0.1--6000 X 10(-9) g/m3 in the air sampled during the survey period and by the presence of FB in the sputa of 32.7% of the workers. The following parameters were significantly related to asbestos exposure in the study group: FB in the sputa, localized rectitude of the diaphragm, pleural thickening, pleural calcification, and the chest pain. Moreover, for all persons studied, gastrointestinal symptoms and recent hoarsening of the voice were significantly related to the number of FB in the sputa.

The object of the ILO/UC International Classification of Pneumoconioses and the general instructions for its use in asbestos respiratory diseases have been set forth. The ILO 1979 classification has been used in four groups of asbestos exposed subjects : two groups were hospitalized and two groups were at work. All the subjects have been investigated by a hospitalized and two groups were at work. All the subjects have been investigated by a standardized questionnaire on occupational history, PA and lateral chest X-rays and, for most them, by ferruginous bodies counting either in sputum or in bronchoalveolar lavage. The most frequent radiological signs were parenchymal fibrosis, pleural thickening, pleural calcification and diaphragmatic straightness. The fibrosis and the diaphragmatic straightness were related to the length of the exposure. Up to 20-29 years since the onset of exposure, the frequency of radiological signs was : diaphragmatic straightness more frequent than fibrosis which was more frequent than pleural thickening, which was more frequent than calcification. But the frequency of only two signs, pleural straightness and fibrosis, appeared significant after 10 years of exposure. The value of these four radiological signs as biological indicators of asbestos exposure is discussed.

Typically, the functional abnormalities in individuals exposed to asbestos dust take the form of a pulmonary fibrosis. Recently, several authors have stressed the early existence of small airways obstruction. In the present study, by measurement of closing volume, we have confirmed an obstructive factor in a certain number of exposed subjects, even if they were non-smokers, i.e. had no other apparent reason for small airways disease.

Thirty-six histologically confirmed cases of pleural and peritoneal mesothelioma have been observed in a chest unit over a period of 53 months. The past asbestos exposure was assessed by a standardized questionnaire in all cases and the asbestos lung burden was determined by means of mineralogical analysis of lung-related biological specimens (sputum, bronchoalveolar lavage fluid, lung tissues) in 28 cases. The results of these two methods were found in good agreement. Past asbestos exposure has been definitely implicated in 17 cases and definitely eliminated in 10 cases. The results were inconclusive in other cases. The group with definite past asbestos exposure was different from the nonasbestos-exposed group by clinical, biological, pathological, and prognosis features that were analyzed. In cases without past asbestos exposure there were no other possible causative agents. Younger age and similar incidence in men and women suggest an environmental or natural disease.

The relationship was studied between the presence in X-rays of one or several regions of straightness on the diaphragm, which interrupt or replace its normal curve, and the intensity, length and latency of asbestos exposure. Subjects were four groups in whom intensity of exposure, assessed by questionnaire and by ferruginous body counts, increased progressively. Diaphragmatic straightness increased with increasing intensity but not with length or latency of asbestos exposure.