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The Monographs produced by the International Agency for Research on Cancer (IARC) apply rigorous procedures for the scientific review and evaluation of carcinogenic hazards by independent experts. The Preamble to the IARC Monographs, which outlines these procedures, was updated in 2019, following recommendations of a 2018 expert advisory group. This article presents the key features of the updated Preamble, a major milestone that will enable IARC to take advantage of recent scientific and procedural advances made during the 12 years since the last Preamble amendments. The updated Preamble formalizes important developments already being pioneered in the Monographs program. These developments were taken forward in a clarified and strengthened process for identifying, reviewing, evaluating, and integrating evidence to identify causes of human cancer. The advancements adopted include the strengthening of systematic review methodologies; greater emphasis on mechanistic evidence, based on key characteristics of carcinogens; greater consideration of quality and informativeness in the critical evaluation of epidemiological studies, including their exposure assessment methods; improved harmonization of evaluation criteria for the different evidence streams; and a single-step process of integrating evidence on cancer in humans, cancer in experimental animals, and mechanisms for reaching overall evaluations. In all, the updated Preamble underpins a stronger and more transparent method for the identification of carcinogenic hazards, the essential first step in cancer prevention.

Introduction Even though the number of recognised cases by the national health insurance system is improving in France (number of yearly recognised cases>300 since 2014), it is far from reflecting the reality of psychosocial risk at work. Data issued from health monitoring networks help to bring out these occupational health issues and to set priorities for prevention. Our aim was to describe the main characteristics of work-related mental diseases (WRMD) from data provided by the French national occupational disease surveillance and prevention network (RNV3P). Methods The RNV3P is constituted by 31 occupational disease centres in French university hospitals and 10 occupational health services. Cases were collected from the RNV3P database between 2001 and 2015. The classifications used were ICD-10 for diseases, ISCO-88 for occupations and NAF93 (edited by the French National Institute for Statistics) for occupational sectors. For exposure, we used a specific thesaurus adapted for psychosocial risk factors. Cases included are mental disorders for which the causal link between work and disease was estimated at least possible. Results Between 2001 and 2015, 28 697 cases of WRMD (32% men, 68% women) were collected. The disorders most frequently diagnosed were anxiety disorders (38,4%), depressive episode or recurrent depressive disorders (33.3%), reaction to severe stress and adjustment disorder (17.2%). The main occupational risk factors were factors related to management and work organisation, experienced bullying, violence, conflict and relational difficulties in work, and low decisional latitude. Consulting women worked mainly in health and social sector (20.2%), services (17.3%), trade (14.8%) and administration (10.8%); consulting men mainly in industries (19.7%), services (16.0%), trade (14.6%), and administration (8.7%). Significant temporal trends will be presented. Discussion The RNV3P provides important data to assist in the recognition of work-related mental illnesses and to carry out preventive actions in the sectors and enterprises most concerned.

National audience; Les risques sanitaires actuels liés aux expositions environnementales sont caractérisés par leur complexité et de nombreuses incertitudes qu’il est nécessaire de prendre en compte dans l’évaluation scientifique et plus globalement dans la gestion des risques. Le cadre des décisions qui découlent de l’expertise est donc fréquemment celui de la précaution. Cela nécessite pour les experts scientifiques, au-delà de l’évaluation des risques, de fournir tous les éléments utiles sur les différentes dimensions du risque qui serviront à apprécier un niveau d’acceptabilité. Ces éléments seront précisés sur la base d’exemples thématiques d’expertise de l’Anses illustrant les valeurs développées dans sa méthode d’expertise : Indépendance, impartialité et excellence scientifique à travers un processus standardisé d’expertise collective, transparence et ouverture à la société symbolisée par une charte d’engagement et des espaces de dialogue multiples avec les parties prenantes. L’interaction et la communication avec les parties prenantes sur les risques environnementaux et sur leur perception doit être intégrée de façon appropriée tout au long du processus d’expertise, non seulement pour mieux comprendre et répondre aux préoccupations sociétales, mais aussi pour éclairer les choix décisionnels qui découleront de l’évaluation.

BackgroundMental disorders in the workplace are a major public health problem. Knowledge of the impact of the psychosocial work environment on mental and behavioral disorders can assist occupational physicians in the identification and description of occupational risk situations, and help to define priority actions. However, no classification for occupational exposure factors is currently available. We aimed to build a thesaurus of “Organizational, Relational, Ethical and other Contributing Factors” (FOREC) linked with the onset of mental and behavioral disorders.MethodsThe French Agency for Food, Environmental and Occupational Health and Safety (ANSES) initiated and supervised a multidisciplinary working group consisting of the representatives of the main French occupational and public health actors. All decisions were accepted on a consensus basis. This collaborative work led to the classification of occupational exposure factors for mental and behavioral disorders in the workplace. To test this thesaurus in clinical practice, a French multicenter study was implemented. Patients were workers referred to the Occupational Disease Centers for mental health issues at work. Factors contributing to mental and behavioral disorders among workers were identified and coded retrospectively from the worker’s point of view using the FOREC thesaurus.ResultsWe recruited 323 workers, aged 44.9±9.2 years, of which 31.3% were men. The most commonly encountered disorders were generalized anxiety disorders (106 workers, 32.8%) and moderate depressive episodes (86 workers, 26.7%). We identified 1357 factors, i.e. an average of 4.2 factors per worker. Among them, 575 (42.4%) were relational and 515 (37.9%) were organizational. All factors identified during consultations were described in the thesaurus.ConclusionsWe built the first thesaurus of “Organizational, Relational, Ethical and other Contributing Factors” (FOREC) that may help to generate profiles of mental and behavioral disorders at work. Encoding and describing these exposure factors, as well as using a worldwide standardized and shared terminology, will help to identify specific workplace prevention programs.

Summary Background Occupational contact urticaria (OCU) is an occupational contact dermatitis that can cause serious health consequences and disability at work. Objectives To describe OCU and its temporal trends by the main causal agents and activity sectors in a nationwide scheme in France. Methods Using data from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P), we described OCU reported during the period 2001–10 and analysed the temporal trends of OCU and OCU attributed to the most frequent agents over the study period. Trends analyses were supported by reporting odds ratios using a logistic regression model with reference to 2001, or with time as a continuous variable. Results During the study period, 251 cases of OCU were reported in RNV3P, half of which were due to natural rubber latex, in particular in the health and social work activity sector (HSW). The number of these cases declined significantly over the study period (19% per year), and particularly after 2006. Conversely, the other causes of OCU did not decrease. Conclusions Using surveillance data from a French national network, this study has found that there was a significant decline in OCU due to natural rubber latex, particularly in the HSW, when powdered latex gloves were banned from French hospitals. Our results show the effectiveness of this preventive measure, and suggest that this practice should be extended to other sectors.

International audience

The French Agency for Environmental and Occupational Health Safety (AFSSET) is in charge of assessing health risks related to both general and occupational environments and provide the French government with expertise to develop and implement legislation and regulations. A quality system based on the French standard NF X 50-110 « general requirements of competence for an expertise activity » has been implemented, on a voluntary basis. The quality requirements are: competency, independency, traceability, transparency and compliance with both the customer’s requirements and the legal and regulatory requirements. In this context, an expertise dealing with air quality in underground parking garages has been requested by the French ministries of Environment and Health. The work conducted has pointed out four main pollutants (carbon monoxide, nitrogen dioxide, particles and benzene) as being potentially worrying regarding the risks that they can represent for health in this kind of micro-environments. On this basis, different recommendations have been formulated and air quality criteria to be respected in underground parking garages have been proposed. Three possible options were presented, leaving public authorities to decide which criterion to enforce against a risk they consider as acceptable.; L'Agence française de sécurité sanitaire de l'environnement et du travail (Afsset) a mis en place une organisation de l'expertise collective pour répondre aux saisines qui lui sont adressées. Ces demandes correspondent à des questionnements sur des problématiques de santé environnementale et/ou de santé au travail, sur lesquelles il est attendu un avis de l'agence de manière à éclairer la décision publique. Engagée dans une démarche qualité volontaire, l'Afsset conduit ses expertises dans le respect de la norme NF X 50-110 (qualité en expertise), avec pour objectif l'application de cinq principes fondamentaux : compétence, indépendance, traçabilité, transparence et conformité de la réponse aux dispositions législatives et réglementaires, ainsi qu'à la question posée. C'est dans ce cadre que s'est déroulée l'expertise collective relative aux parcs de stationnement couverts, visant à fournir aux ministères chargés de l'Environnement et de la Santé une expertise pré-réglementaire des critères de qualité de l'air applicables à ces enceintes, afin de prévenir les risques sanitaires pour les usagers et travailleurs. Pointant quatre polluants (monoxyde de carbone, dioxyde d'azote, particules et benzène) plus particulièrement problématiques vis-à-vis des risques pour la santé parmi ceux pouvant se retrouver dans l'air de ces enceintes, ces travaux ont conduit à différentes recommandations, dont la proposition de critères de qualité de l'air à respecter dans les parkings couverts. Trois options possibles sont présentées, laissant ainsi la possibilité aux pouvoirs publics de se prononcer sur le critère à faire respecter au regard d'un niveau de risque qu'ils considèreraient comme acceptable.