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Objective Many occupations and industries use wood as a raw material and wood dust is a well-known carcinogen. This study presents trends in occupational exposure to wood dust for all workers (employees and self-employed workers) in France between 1982 and 2017 and focuses on the exposed workers in 2017. Methods Exposures to this carcinogen were assessed using the Matgéné job-exposure matrix. Trends in the prevalence and proportion of exposure over the study period were estimated by linking the matrix with population data from the 1982, 1990, 1999, 2007, and 2017 censuses and are described for selected industry groups. Results The number of exposed workers to wood dust has decreased significantly over the last 40 years, from 466,900 potentially exposed workers in 1982 to 305,000 workers in 2017. The proportion of exposed workers has also decreased over time, although not uniformly across industries. Increases in the proportion of exposed workers are observed in certain industries, such as “Sawmilling and logging” (from 61.2% to 73.6% over the period for men) and “Finishing of sale premises” (from 3.3% to 6.2% for women). Conclusion This article is the first to describe occupational exposure to wood dust in France for all workers and to follow its evolution over the last 40 years. Occupations and industries still at risk in 2017 are also described with the aim of helping to improve prevention policies.

Objectifs Mis en place en 1998, le Programme national de surveillance du mesotheliome pleural fonctionne depuis vingt ans. Il permet de dresser un bilan de l’evolution de la situation epidemiologique des mesotheliomes pleuraux entre 1998 et 2017, en France, en termes d’incidence, de survie, d’expositions des patients atteints et de leur reconnaissance medico-sociale. Methodes Dans les 21 departements couverts par le programme, une procedure standardisee de recueil actif et de confirmations diagnostiques anatomopathologique et clinique des tumeurs primitives de la plevre est mise en œuvre. Les expositions vie entiere a l’amiante et aux autres facteurs etudies, professionnelles et extra-professionnelles, sont recueillies par questionnaire aupres de chaque cas. Les recours des cas de mesotheliome aux dispositifs d’indemnisation (maladie professionnelle et Fonds d’indemnisation des victimes de l’amiante-Fiva) sont recueillis et analyses. Resultats Sur la periode 1998-2016, on observe une augmentation du nombre de cas annuel estime, passant de 800 a1100 cas avec une augmentation de la proportion de femmes de 20 a 25 %. Chez les hommes, les expositions professionnelles sont encore largement predominantes et restent stables depuis 1998 (environ 90 %), avec toutefois un deplacement de la problematique des metiers d’utilisation et de transformation de l’amiante vers les metiers d’intervention sur des materiaux contenant de l’amiante tel que le secteur du BTP. Chez les femmes, la part des expositions professionnelles a l’amiante reste faible (environ 40 %), mais 35 % des femmes ont ete exposees en dehors du travail (via le fait de resider avec des proches exposes professionnellement, le bricolage ou expos domestiques). Pour 25 % des femmes, on ne retrouve aucune de ces expositions. Le recours aux dispositifs d’indemnisation est encore insuffisant, avec 27 % des cas affilies au regime general de securite sociale (RGSS) ne faisant aucune demarche et 53 % des cas hors RGSS n’ayant pas recours au Fiva. Perspectives La mise en œuvre du dispositif national de surveillance des mesotheliomes (DNSM) integrant le PNSM et la declaration obligatoire (DO) permettra de moderniser et optimiser la surveillance de tous les mesotheliomes (plevre et autres localisations) sur le territoire national, de l’adapter aux nouveaux enjeux (dont les expositions environnementales), d’optimiser le dispositif national d’enquetes d’expositions et de renforcer l’articulation avec les travaux de recherche, tel que l’estimation de la proximite des lieux de vie des sujets a des sources naturelles ou industrielles potentiellement exposantes.

The aim of this study was to investigate the hypothesis of an increased risk of pleural mesothelioma due to co-exposure to asbestos and refractory ceramic fibres (RCF) compared to asbestos exposure alone. Males were selected from a French case-control study conducted in 1987-1993 and from the French National Mesothelioma Surveillance Program in 1998-2006. Two population controls were frequency matched to each case by year of birth. Complete job histories were collected and occupational asbestos and RCF exposures were assessed using job exposure matrices. The dose-response relationships for asbestos exposure were estimated from an unconditional logistic regression model in subjects exposed to asbestos only (group 1) and subjects exposed to both asbestos and RCF (group 2). A total of 988 cases and 1125 controls ever-exposed to asbestos were included. A dose-response relationship was observed in both groups but it was stronger in group 2. In comparison with subjects exposed at the minimum value of the cumulative index of exposure, the odds ratio was 2.6 (95% CI 1.9-3.4) for subjects exposed to 75 fibres · mL(-1) · year(-1) in group 1 increasing to 12.4 (95% CI 4.6-33.7) in group 2. Our results suggest that the pleural carcinogenic effect of occupational asbestos exposure may be modified by additional exposure to RCF.

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

Methods: A total of 1,199 male cases and 2,379 control subjects were included in a French pooled case-control study. Complete job histories were collected, and occupational exposure to asbestos, mineral wool (MW), and silica were assessed by three French job exposure matrices.Unconditional logisticregressionmodelsadjustedfor age, birth date, and occupational asbestos exposure were used to estimate odds ratios (OR) and 95% confidence intervals (CIs). Measurements and Main Results: A significant association between mesothelioma and MW exposure was observed after adjustment for occupational asbestos exposure. OR for subjects exposed to less than 0.01 fibers$ml 21 $yr 21 was 1.6 (95% CI, 1.2–2.1) and increased to 2.5 (95% CI, 1.8–3.4) for subjects exposed to more than 0.32 fibers$ml 21 $yr 21 . All ORs for silica exposure were around the null. CoexposuretoeitherasbestosandMWorasbestosandsilicaseemed toincreasethe risk ofpleuralmesothelioma. ORswere 17.6 (95%CI, 11.8–26.2) and 9.8 (95% CI, 4.2–23.2) for subjects exposed to both asbestos and MW and for subjects exposed to both asbestos and silica, respectively, compared with 4.3 (95% CI, 1.9–9.8) for occupational asbestos exposure alone. Conclusions: Our results are in favor of an increased risk of pleural mesothelioma for subjects exposed to both asbestos and MW or asbestos and silica.

Aims Unintentional nanoscale particles (UNP) are generated from usual work processes and thus exist since a long time and are more prevalent than the manufactured nanoscale particles. The objective of this study was to develop a job-exposure matrix, a useful tool to estimate prevalence of occupational exposure to UNP for epidemiologic studies. . Methods Work-processes generating UNP and their associated chemical families have been identified through an extensive literature review and the knowledge of an expert’s panel in various domain such as industrial hygiene, toxicology, atmospheric physics and chemistry, epidemiology… These processes were associated to occupations extracted from the ISCO classification edition 1968. A probability and a frequency were assessed for each specific combination “occupation × work-process”. When an occupation was related to several work-processes, the final exposure assessment consisted in the highest probability of exposure and a weighted-frequency of exposure combining assessments from each related work-process. Exposure assessment for some specific occupations could differ according to industries and historical periods. Due to the few available measurement data, intensity could not be assessed at that time. Results Over 50 work-processes generating UNP have been identified and were related with seven UNP chemical families: metal, mineral, carbon, wood, polymer, polycyclic aromatic hydrocarbon (PAH) and other organic. A little less than 50% occupational ISCO codes were unexposed, and 9%, 13% and 31% were possibly, probably and certainly exposed, respectively. Most of occupations were exposed to carbonaceous, PAHs UNP and then to metallic and mineral UNP. Conclusions These results suggest that occupational exposure to UNP might be important at the workplace and might concern a wide variety of workers. In order to assess intensity of exposure, we are currently organising measurement campaigns in French and Canadian workplaces (ExproPNano program).

Introduction The EpiNano program was launched for an epidemiologic follow-up of workers handling carbon nanotubes (CNT), TiO2 and SiO2 nano-objects and their aggregates and agglomerates (NOAA) at their workplaces. Method Workers are identified using a 3-level approach: 1-identification and enrollment of companies dealing with the concerned NOAA (based on compulsory declaration of nanomaterials used and produced in France and ‘Company questionnaire’), 2-onsite visit and observation of the workstations/tasks concerned with NOAA exposure (based on standardised tool ‘Onsite technical logbook’), and 3-identification of workers involved in these workstations/tasks. Workers identified are invited to participate in the program, with data of interest collected through ‘Inclusion questionnaire’. Results The program started in January 2014. During the first 18-month operation period, 22 companies accepted to participate and were visited. Among 149 workstations dealing with NOAA and observed onsite, almost a half was classified as concerned with NOAA exposure. In public research laboratories, workstations were more often classified as concerned with NOAA exposure and were less equipped with personal and collective protection devices than in private companies visited. In total, 156 workers have been identified as potentially exposed, and 94% of them were included into EpiNano perspective cohort. This cohort is subject to a passive epidemiological surveillance, based on the national health insurance database and national causes of death registry data. Moreover, forty percent of this cohort is subject to an active surveillance based on the regular (yearly) exposure and health follow-up questionnaires. Discussion Data of EpiNano cohort will be matched with data from the national health insurance database and national causes of death registry for studying incidence and mortality with respect to the NOAA exposure by the end of 2017. Meanwhile, an effort is being made to encourage companies’ participation and increase the number of workers involved in the program.

Inter-method reliability is a measure of the ability of two different methods which evaluate the same underlying exposure to yield similar results on the same subjects. In this study we compared an observational “EpiNano-method” developed for assessing exposure to nano-objects and their agglomerates and aggregates (NOAA) in workplaces within the framework of the French epidemiological surveillance program EpiNano with a more accurate but more expensive and time-consuming “Reference-method”. Methods EpiNano-method consists in an onsite visit of facilities and an observation of workstations where NOAA are present using a standardised tool, the Onsite technical logbook. Reference-method involved an onsite visit, interviews with operators and supervisors, analysis of the available exposure measurements data, a debriefing meeting and an expert’s report to validate results through consensus. Seven workstations which synthesise and functionalize carbon nanotubes were assessed by Reference-method and by EpiNano-method implemented by three evaluators. All statistics were calculated based on pairwise comparisons of the evaluator’s respective results with the results from the Reference-method by using mainly Spearman correlation coefficients (ρ) and weighted Fleiss kappa (kF). Results The prediction of exposure to NOAA using EpiNano-method exhibited substantial agreement with that of the reference method ((kF = 0.70, sensitivity = 0.88, specificity = 0.92). The best reliability of quantitative exposure scores was found for the EpiNano-method results of Evaluator#1, when comparing with the Reference-method (ρ = 0.75). The correlation was positive but of moderate strength (ρ = 0.57) for Evaluator#2 and negative for Evaluator#3. When comparing the semi-quantitative exposure potential variable almost perfect correlation was found; all but one workstation were classified in the first category corresponding to “Negligible to low” exposure potential. Conclusion This study allowed a first validation of the EpiNano-method. However, it should be confirmed by further comparison with more robust quantitative exposure measurement data, available for a larger workstation number, with more contrasting exposure conditions and various types of NOAA.

Introduction Toxicological studies have shown potential health effects related to nanoscale particles (NP). These particles could be emitted unintentionally from usual work-processes (“ultrafine particles”) or produced intentionally for commercial purpose (“manufactured NP”) at workplace. Thus, associated exposure might concerned many workers. However, in the absence of NP strategy measurement consensus, occupational exposure is poorly monitored. Aim In this context, the ExproPNano project aims at make operational existing NP exposure assessment recommendations, combine them with work activity analysis and test the developed strategy in French and Canadian industries involving both unintentional and manufactured NP. Methods The first year, in 2015, was dedicated to the implementation of the project (method, team training, equipment and industries selection) with partner institutions (INRS, INERIS, LEPI, InVS, Aquitaine CARSAT, and University of Montreal – DSEST). Campaigns in different industries (aeronautics, rubber and composite, construction, mines…) will be conducted in 2016–2017 following two main steps: (1) pre-visit: prevention system analysis, process understanding, interviews and preliminary measures; (2) NP measurement and work observation: video recording synchronised with real-time measures and air sampling for physic-chemical characterisation; (3) results analysis and presentation in companies. Expected results and conclusion Work task analysis combined with NP measurement must ensure a better understanding of the NP exposure determinants and result in recommendations of adapted prevention which may be extended to various workplaces. The tested exposure assessment method must be operational and thus easily used by all actors involved in unintentional and manufactured NP risk management. Therefore, relevant NP occupational exposure data could be produced, recording them in specific database such as Evalutil or NECID-PEROSH, it will contribute to knowledge improvement of NP exposure levels and associated health effects by public health professionals such as epidemiologists.

Asbestos is the primary cause of pleural mesothelioma (PM). The objective of this study was to elucidate the importance of different temporal patterns of occupational asbestos exposure on the risk of PM using case–control data in male subjects. Cases were selected from a French case–control study conducted in 1987–1993 and the French National Mesothelioma Surveillance Program in 1998–2006. Population controls were frequency matched to cases by year of birth. Occupational asbestos exposure was evaluated with a job–exposure matrix. The dose–response relationships were estimated using restricted cubic spline functions in logistic regression models. A total of 2,466 ever-asbestos-exposed males (1,041 cases and 1,425 controls) were used. After adjustment for intensity and total duration of occupational asbestos exposure, the risk of PM was lower for subjects first exposed after the age of 20 yrs and continued to increase until 30 yrs after cessation of exposure. The effect of total duration of exposure decreased when age at first exposure and time since last exposure increased. These results, based on a large population-based case–control study, underline the need to take into account the temporal pattern of exposure on risk assessment.

Background Occupational exposure to asbestos, widely used in various industries for decades, is the most important risk factor for pleural mesothelioma. We report here the ranking of occupations and industries in France at high risk for this cancer among men and women. Methods A population-based case–control study, conducted from 1998 to 2002, included 462 cases (80.3% men) and 897 controls. Data were collected in face-to-face interviews with a standardized questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each occupation and industry; subjects never employed in each category were the reference. Results For men, risks were high for several occupations and industries. Besides the expected high risks for non-metallic mineral product makers and manufacturing asbestos products, occupations such as plumbers (OR ¼ 5.57, 95% CI: 2.90–10.69), sheet-metal workers, welders, metal molders, coremakers, and cabinetmakers were also at high risk. Elevated risks were found in the industries of shipbuilding (OR ¼ 9.13, 95% CI: 5.20– 16.06) and construction, but also in the manufacturing of metal products, chemicals, and railroad and aircraft equipment. The results for women showed increased but not significant risks in several occupational activities. Conclusions This report provides new insight into the epidemiology of mesothelioma, confirming risks for occupational activities reported earlier and pointing out risks in activities never previously reported. It offers guidance to authorities for the compensation of asbestos victims and for prevention in at-risk activities still involving asbestoscontaining products. Am. J. Ind. Med. 53:1207–1219, 2010. 2010 Wiley-Liss, Inc.

There are numerous industry sectors and processes where worker exposures to nanoscale particles (NP), either unintentionally emitted or manufactured, have the potential to be significant if organisational and control measures and personal protective equipment are not properly defined, usable or used. However, too little exposure data are available today for meta-analysis for risk assessment or epidemiology. One reason for this observation is probably the lack of a harmonized and consistent approach to assess worker exposure. In this work, we propose a multi-tiered approach that integrates aerosol measurement and work task analysis. This multi-disciplinary approach aims to enhance exposure assessment and understand more precisely determinants of exposure. Illustrated in the Figure 1, this approach combines (i) information gathering; (ii) real time aerosol measurements and aerosol sampling (e.g. for electron microscopy analysis); (iii) contextual and observational information; (iiii) video exposure monitoring; (iiiii) interviews with stakeholders and construction of suitable safety measures. In the context of the development of the method, the proposed approach will now be tested in a variety of work environments, including research laboratories (involving manufactured NP) and facilities in aeronautic (additive manufacturing, machining, surface treatment and maintenance) and rubber sectors (mixture of fillers).

Le risque sanitaire associe aux nano-objets, leurs agregats et leurs agglomerats (NOAA) est encore peu connu. Afin de surveiller les effets sanitaires possibles des expositions aux NOAA en France, l’InVS a ete charge de mettre en place un dispositif de surveillance epidemiologique. Le dispositif EpiNano prevoit la creation d’un enregistrement des travailleurs mettant en œuvre des NOAA et leur suivi prospectif generaliste. L’identification des travailleurs eligibles repose sur le reperage des postes de travail mettant en œuvre des NOAA lors de visites en entreprise et une caracterisation semi-quantitative de l’exposition. Pour faciliter le reperage et l’acces aux entreprises, des accords de partenariats ont ete signes avec la DGT, l’Inspection medicale du travail, l’INRS et l’ANSES, chargee de la gestion des declarations obligatoires des nanomateriaux en France. Plusieurs services de sante au travail interentreprises ont ete contactes en vue de collaboration. De plus, un partenariat scientifique Quintet ExpoNano a permis de developper et valider une methode standardisee de caracterisation de l’exposition aux NOAA. Le dispositif a ete lance en janvier 2014. A ce jour, 156 entreprises ont ete contactees en vue de leur adhesion a EpiNano. La majorite des entreprises n’ayant pas encore donne de reponse, le taux de refus preliminaire est de 11 %. Vingt-deux entreprises ayant adhere au dispositif ont ete visitees par l’equipe EpiNano. Sur 149 postes de travail mettant en œuvre des NOAA, observes par l’equipe, la moitie environ a ete classee potentiellement exposant. Ce travail a permis d’identifier 158 personnes eligibles dans EpiNano dont un tiers a deja integre le dispositif en completant le questionnaire d’inclusion. Le medecin du travail etait associe au projet dans 11 entreprises, en participant a la reunion de presentation de projet et/ou a la visite. Dans quatre entreprises, le medecin a porte le projet en tant que personne-ressource. Certains medecins ont decline leur participation par manque de temps et/ou le caractere non-prioritaire des NOAA par rapport a d’autres risques professionnels. En France, plusieurs enquetes sur ce sujet ont connu un manque d’adhesion pouvant etre attribue au caractere sensible des NOAA, a la meconnaissance de leurs dangers potentiels et a l’incertitude, voire a une meconnaissance concernant leur presence et utilisation au sein des etablissements. La collaboration des medecins du travail est precieuse pour promouvoir l’adhesion des entreprises au dispositif EpiNano. Une action de sensibilisation et un soutien des pouvoirs publics devraient encourager l’implication des medecins du travail et l’adhesion de leurs entreprises a EpiNano.

Contexte et objectifs Le mesotheliome pleural malin est un cancer rare dont le lien avec l’amiante est bien connu et l’origine professionnelle de la maladie le plus souvent evoquee. Le travail presente ici etudie les facteurs associes a la prise en charge medico-sociale des mesotheliomes pleuraux inclus dans le Programme national de surveillance du mesotheliome (PNSM) qui couvre actuellement 21 departements en France. Methodes Les declarations en maladie professionnelle (DMP) pour la periode 1999–2014 et le recours au Fonds d’indemnisation des victimes de l’amiante (FIVA) pour les annees 2005–2014, ont ete analyses chez les sujets dont le diagnostic de mesotheliome a ete confirme par le college des anatomopathologistes specialistes du mesotheliome (groupe Mesopath). Les tests du Chi 2 , ou le test exact de Fisher ainsi qu’un modele de regression logistique non conditionnelle ont ete utilises pour tester l’association avec differentes variables : sexe, âge au diagnostic, categorie socio-professionnelle, situation familiale, probabilite d’exposition professionnelle a l’amiante, regime de protection sociale, departement de residence. Resultats Parmi les 2839 sujets etudies entre 1999 et 2014 et qui relevent du Regime general de la Securite sociale (RGSS), 60 % ont effectue une DMP. Les facteurs associes a la DMP chez les hommes etaient l’âge, la categorie socio-professionnelle, la situation familiale et la probabilite d’exposition professionnelle a l’amiante. Chez les femmes, seule la probabilite d’exposition professionnelle a l’amiante etait associee a la DMP. Chez les hommes comme chez les femmes, la proportion de DMP variait selon les departements. Parmi les 2746 sujets identifies entre 2005 et 2014, 55 % avaient adresse une demande au FIVA. Cette proportion significativement plus importante chez les sujets relevant du RGSS que pour ceux relevant d’autres regimes de protection sociale, variait selon les departements. La demande aupres du FIVA etait associee a l’âge, a la situation familiale, et a l’exposition professionnelle a l’amiante. Au total, sur les 2193 sujets relevant du RGSS sur la meme periode (2005–2014), seulement 45 % avaient conjointement effectue une DMP et adresse une demande au FIVA. Il est a noter que 27 % n’avaient effectue aucune demarche. Conclusion Ces resultats confirment l’importance de renforcer l’information des acteurs medicaux prenant en charge ce type de patients, afin de les sensibiliser aux enjeux medico-sociaux lies au mesotheliome pleural.

Materiel et methodes Le Programme national de surveillance du mesotheliome (PNSM) a ete mis en place en 1998 par Sante publique France. Parmi ses objectifs figure une meilleure connaissance des expositions professionnelles et extra-professionnelles a l’amiante et aux autres facteurs etudies. Dans les 21 departements couverts par le programme, une procedure standardisee de recueil actif et de confirmation anatomopathologique et clinique des tumeurs primitives de la plevre est mise en œuvre. Les expositions vie entiere a l’amiante, professionnelles et extra-professionnelles, sont evaluees par expertise d’un questionnaire renseignant, entre autres, l’ensemble du calendrier professionnel. Les caracteristiques des expositions des cas ont ete etudiees (types d’exposition, âge a la premiere exposition, duree de l’exposition…). Par ailleurs, les caracteristiques des cas de mesotheliome ayant exerce au moins un emploi dans le secteur du BTP (NAF 45) ont ete comparees a celles des cas n’ayant jamais travaille dans ce secteur. La declaration obligatoire (DO) des mesotheliomes a ete mise en place en 2012 a la demande du ministere charge de la sante. Elle vise a renforcer la surveillance des mesotheliomes (toutes localisations anatomiques, ensemble du territoire national) et a ameliorer la connaissance des expositions, notamment environnementales a l’amiante. Pour cela, la DO est completee depuis 2014 par des enquetes d’exposition dans neuf regions pilotes, aupres des cas de mesotheliomes hors plevre et des cas de mesotheliomes de la plevre chez les hommes de moins de 50 ans et chez les femmes. Resultats Parmi les 2078 cas enquetes et expertises sur la periode 1998–2016 dans le cadre du PNSM, une exposition professionnelle a l’amiante a ete retrouvee chez 92,7 % des hommes et 37,4 % des femmes. Parmi les cas non exposes professionnellement, 3,3 % des hommes et 34,4 % des femmes ont ete exposes extra-professionnellement. Pour 28 % des femmes, aucune exposition a l’amiante n’est retrouvee (4 % chez des hommes). Chez les hommes, les professions ayant expose a l’amiante les plus frequentes sont : mecaniciens qualifies d’entretien d’equipements industriels (10 %), chaudronniers, toliers industriels qualifies (9 %), ouvriers non qualifies du second œuvre du bâtiment (8 %), tuyauteurs industriels qualifies (7 %), plombiers et chauffagistes qualifies (6 %), macons qualifies (6 %)… De meme, les secteurs d’activite sont : construction de navires civils (11 %), construction de bâtiments divers (11 %), travaux d’installation electrique (7 %), chaudronnerie-tuyauterie (7 %)… Parmi l’ensemble des cas enquetes, 836 (40,2 %) ont exerce au moins un emploi dans le secteur du BTP. Une exposition professionnelle a l’amiante est retrouvee pour 99,3 % d’entre eux dont 91,6 % lors d’un emploi dans le secteur du BTP. Parmi les cas en activite apres 1996, la proportion de cas professionnellement exposes a l’amiante apres cette date est beaucoup plus elevee dans le secteur du BTP que dans les autres secteurs (84 % vs 46 %). Concernant la DO des mesotheliomes, le nombre de cas de mesotheliomes diagnostiques entre 2012 et 2016 et declares au niveau national jusqu’au 31 mars 2017 est de 3 372. Notifies par un pathologiste (76 %) et/ou un clinicien (47 %), ces cas sont principalement localises a la plevre (90 %) ou au peritoine (8 %). Le taux d’exhaustivite de la DO est de l’ordre de 50 %, avec des variations regionales importantes. Dans les regions pilotes, 67 cas ont ete enquetes entre janvier 2014 et avril 2015 sur 127 cas appartenant aux populations ciblees. Pour 16 des 67 cas enquetes (24 %), une exposition professionnelle averee a l’amiante a ete identifiee. Conclusion Ces resultats montrent l’interet de poursuivre la surveillance des expositions professionnelles a l’amiante des cas de mesotheliomes afin d’orienter les actions de sante publique, et notamment les actions de prevention. En effet, on assiste a une evolution des expositions professionnelles a l’amiante des metiers d’utilisation et de transformation de l’amiante vers les metiers d’intervention sur des materiaux contenant de l’amiante (desamiantage, BTP…).

Objectives To estimate the proportion of pleural mesothelioma cases that can be attributed to asbestos exposure in France including non-occupational exposure. Methods A population-based case-control study including 437 incident cases and 874 controls was conducted from 1998 to 2002. Occupational and non-occupational asbestos exposure was assessed retrospectively by two expert hygienists. ORs of pleural mesothelioma for asbestos-exposed subjects compared to non-exposed subjects, and population-attributable risk (ARp) of asbestos exposure were estimated using a conditional logistic regression. Results A clear dose-response relationship was observed between occupational asbestos exposure and pleural mesothelioma (OR=4.0 (99% CI 1.9 to 8.3) for men exposed at less than 0.1 f/mL-year vs 67.0 (99% CI 25.6 to 175.1) for men exposed at more than 10 f/mL-year). The occupational asbestos ARp was 83.1% (99% CI 74.5% to 91.7%) for men and 41.7% (99% CI 25.3% to 58.0%) for women. A higher risk of pleural mesothelioma was observed in subjects non-occupationally exposed to asbestos compared to those never exposed. The non-occupational asbestos ARp for these subjects was 20.0% (99% CI −33.5% to 73.5%) in men and 38.7% (99% CI 8.4% to 69.0%) in women. When considering all kinds of asbestos exposure, ARp was 87.3% (99% CI 78.9% to 95.7%) for men and 64.8% (99% CI 45.4% to 84.3%) for women. Conclusions Our study suggests that the overall ARp in women is largely driven by non-occupational asbestos exposure arguing for the strong impact of such exposure in pleural mesothelioma occurrence. Considering the difficulty in assessing domestic or environmental asbestos exposure, this could explain the observed difference in ARp between men and women.

Objectives To assess the risk of lung cancer associated with exposure to mineral wools (MWs), while taking into account smoking, asbestos, and crystalline silica exposures. Methods The analyses were restricted to men (1350 cases and 1912 controls). Lifelong occupational history was collected. MWs and asbestos exposures were assessed, using task-exposure matrices and silica exposure, a job-exposure matrix. Results We observed consistent not-significant increased risks of lung cancer of the same order of magnitude among workers exposed to high levels of MWs (odds ratio, 1.4; 95% confidence interval: 0.9 to 2.2; for highest quartile of the Cumulative Exposure Index). Conclusions These results do not allow to draw firm conclusion about a carcinogenic effect of MWs on the lung, but they cannot exclude it. Given the high number of potentially exposed workers, it will be necessary to replicate them in a future further removed from the asbestos ban.

Le programme Matgene a pour objectif la realisation de matrices emplois-expositions (MEE) specifiques de la population des travailleurs en France. Le croisement des MEE developpees pour des nuisances cancerogenes avec des donnees de la population francaise permet de decrire cette exposition professionnelle selon le genre et selon les secteurs d’activite, en considerant l’emploi en cours ou l’ensemble de la carriere professionnelle. Les MEE concernant des nuisances classees 1 ou 2A par le Circ ont ete croisees avec les donnees du recensement de la population, d’une part, et avec un echantillon d’histoires professionnelles, d’autre part. Pour chaque cancerogene, sont estimees, pour les hommes et pour les femmes, la prevalence d’exposition en France en 1999 et en 2007, ainsi que la prevalence vie professionnelle entiere calculee en 2007. Ces resultats sont declines par secteur d’activite, afin d’identifier les secteurs d’activite les plus a risque selon le genre. Les cancerogenes etudies sont les solvants trichloroethylene, perchloroethylene, chlorure de methylene, benzene, les poussieres de cuir, de silice cristalline libre et les fibres d’amiante. Les prevalences d’exposition en 1999 et 2007 a ces cancerogenes sont globalement faibles et sont plus elevees chez les hommes (entre 0,07 et 7,4 %) que chez les femmes (entre 0,02 et 0,38 %), sauf pour l’exposition aux poussieres de cuir et au perchloroethylene qui est plus frequente chez les femmes. Si l’on considere l’exposition intervenue sur l’ensemble de la vie professionnelle, les prevalences sont beaucoup plus elevees (exemple : 5,6 % d’hommes exposes a la silice en 2007 vs 15,3 % exposes en integrant leurs emplois anterieurs) mais restent en general plus faibles chez les femmes (0,75 % des femmes exposees a la silice en considerant tous leurs emplois). Les secteurs d’activite les plus exposants different selon le genre ; ainsi, les hommes exposes au trichloroethylene travaillent majoritairement dans le commerce et la reparation automobile (31 % des exposes), alors que la majorite des femmes exposees travaillent dans l’industrie du caoutchouc et des plastiques (29 % des exposees). Ces resultats mettent en evidence l’heterogeneite des expositions professionnelles selon le genre, du fait des specificites d’emploi occupes par les hommes et par les femmes. Ils montrent que le genre est un element a prendre en compte pour cibler et prioriser les actions de prevention. Enfin, ils soulignent l’interet de consigner les historiques professionnels des hommes et des femmes pour faciliter la prise en compte des expositions passees, indispensable pour la reconnaissance des cancers professionnels ou pour l’estimation de fraction de risque attribuable.

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.

Objectives Matgene is a program to develop job-exposure matrices (JEMs) adapted to the general population in France for the period since 1950. The aim is to create retrospective exposure assessment tools for estimating the prevalence of occupational exposure to various agents that can then be correlated to health-related parameters. Methods JEMs were drawn up by a team of six industrial hygienists who based their assessments on available occupational measurement, economic and statistical data, and several thousand job descriptions from epidemiological studies performed in France since 1984. Each JEM is specific to one agent, assessing exposure for a set of homogeneous combinations (occupation × activity × period) according to two occupational classifications (ISCO 1968 and PCS 1994) and one economic activities classification (NAF 2000). The cells of the JEM carry an estimate of the probability and level of exposure. Level is estimated by the duration and intensity of exposure-linked tasks or by description of the tasks when exposure measurement data are lacking for the agent in question. The JEMs were applied to a representative sample of the French population in 2007, and prevalence for each exposure was estimated in various population groups. All documents and data are available on a dedicated website. Results By the end of 2010, 18 JEMs have been developed and eight are under development, concerning a variety of chemical agents: organic and mineral dust, mineral fibers, and solvents. By implementation in the French population, exposure prevalences were calculated at different dates and for complete careers, and attributable risk fractions were estimated for certain pathologies. Some of these results were validated by comparison with those of other programs. Discussion Initial Matgene JEMs results are in agreement with the French and international literature, thus validating the methodology. Exposure estimates precision, however, vary between agents and according to the amount of exposure measurement data available. These JEMs are important epidemiological tools, and improving their quality will require investment in occupational health data harvesting, especially in the case of low-level exposures.

International audience; Pleural mesothelioma is a primary tumor of the pleura that is mainly due to asbestos exposure. To study the relationship between mesothelioma and occupational asbestos exposure in France, two case-control studies (A and B) were conducted. A substantial difference in the attributable risk in the population (AR) was observed among men: 44.5% (95% CI: [32.6-56.4]) in study A and 83.2% (95% CI: [76.8-89.6]) in study B. As different exposure assessment expert methods were used, the main objective of this work was to re-estimate the AR men in two case-control studies according to a common standardized exposure assessment by using a Job Exposure Matrix (JEM) and to assess the role of subjects' selection. The initial observed AR difference was maintained: 36.3% (95% CI: [24.3-50.3]) in study A and 69.7% (95% CI: [51.7-83.2]) in study B. Further investigations highlighted the potential selection bias introduced in both studies, especially among controls. The AR could be underestimated in study A and overestimated in study B. After weighting subjects according to distribution of socio-economic status in the general population for controls and according to distribution of socio-economic status of cases registered by the French National Mesothelioma Surveillance Program, re-estimated AR values were 52.4% in study A and 70.2% in study B. These results provide additional information to describe the relationship between pleural mesothelioma and occupational asbestos exposure, but also confirm the importance of subjects' recruitment in case control studies, particularly control selection.

The etiology of brain tumors remains largely unknown. Among potential risk factors, exposure to electromagnetic fields is suspected. We analyzed the relationship between residential and occupational exposure to electromagnetic field and brain tumors in adults. A case–control study was carried out in southwestern France between May 1999 and April 2001. A total of 221 central nervous system tumors (105 gliomas, 67 meningiomas, 33 neurinomas and 16 others) and 442 individually age- and sex-matched controls selected from general population were included. Electromagnetic field exposure [extremely low frequency (ELF) and radiofrequency separately was assessed in occupational settings through expert judgement based on complete job calendar, and at home by assessing the distance to power lines with the help of a geographical information system. Confounders such as education, use of home pesticide, residency in a rural area and occupational exposure to chemicals were taken into account. Separate analyses were performed for gliomas, meningiomas and acoustic neurinomas. A nonsignificant increase in risk was found for occupational exposure to electromagnetic fields [odds ratio (OR = 1.52, 0.92–2.51)]. This increase became significant for meningiomas, especially when considering ELF separately [OR = 3.02; 95 percent confidence interval (95% CI) =1.10–8.25]. The risk of meningioma was also higher in subjects living in the vicinity of power lines (

International audience; The French national epidemiological surveillance program EpiNano aims at surveying mid- and long-term health effects possibly related with occupational exposure to either carbon nanotubes or titanium dioxide nanoparticles (TiO2). EpiNano is limited to workers potentially exposed to these nanomaterials including their aggregates and agglomerates. In order to identify those workers during the in-field industrial hygiene visits, a standardized non-instrumental method is necessary especially for epidemiologists and occupational physicians unfamiliar with nanoparticle and nanomaterial exposure metrology. A working group, Quintet ExpoNano, including national experts in nanomaterial metrology and occupational hygiene reviewed available methods, resources and their practice in order to develop a standardized tool for conducting company industrial hygiene visits and collecting necessary information. This tool, entitled "Onsite technical logbook", includes 3 parts: company, workplace, and workstation allowing a detailed description of each task, process and exposure surrounding conditions. This logbook is intended to be completed during the company industrial hygiene visit. Each visit is conducted jointly by an industrial hygienist and an epidemiologist of the program and lasts one or two days depending on the company size. When all collected information is computerized using friendly-using software, it is possible to classify workstations with respect to their potential direct and/or indirect exposure. Workers appointed to workstations classified as concerned with exposure are considered as eligible for EpiNano program and invited to participate. Since January 2014, the Onsite technical logbook has been used in ten company visits. The companies visited were mostly involved in research and development. A total of 53 workstations with potential exposure to nanomaterials were pre-selected and observed: 5 with TiO2, 16 with single-walled carbon nanotubes, 27 multiwalled carbon nanotubes. Among the tasks observed there were: nanomaterial characterisation analysis (8), weighing (7), synthesis (6), functionalization (5), and transfer (5). The manipulated quantities were usually very small. After analysis of the data gathered in logbooks, 30 workstations have been classified as concerned with exposure to carbon nanotubes or TiO2. Additional tool validity as well as inter-and intra-evaluator reproducibility studies are ongoing. The first results are promising.

Objectives To use job-exposure matrices (JEM), as a tool to describe trends of occupational exposure to carcinogenic chemicals present in the French workplace. Method MATGENE JEMs assess for each job and a given period in France, several exposure indices such as probability, intensity and frequency of exposure. Linking these matrices with job information data coming from French population allow to estimate the prevalence of workers exposed to several chemicals for a given year. To study the evolution of exposure to carcinogens, prevalence of exposure in France for the years 1999 and 2007 were estimated from the population census of 1999 and from a representative sample of the population in 2007. Results French available JEMs assess the exposure of workers since the 1950s for various occupational carcinogens: crystalline silica, benzene, trichlorethylene, perchlorethylene, leather dust, asbestos and refractory ceramic fibres (RCF). A significant decrease in the prevalence of exposure between 1999 and 2007 was observed among men for silica with 7.4% and 5.6% respectively, asbestos with 6.3% and 1.1% and RCF with 0.5% and 0.3%. For women, a significant decrease was also noticed for exposure to asbestos and leather dust. For solvents, the prevalence of exposure remained stable in both men and women. Conclusions The proportion of workers exposed to carcinogens, particularly to asbestos, has decreased in France since 1999. However a substantial number of workers are still exposed. As complete occupational histories are available in the 2007 population sample, the JEMs will also be used to estimate lifetime exposure prevalence and the associated disease burden.

A twelve year natural history of hepatitis C virus infection in hemodialyzed patients. A prospective non-A, non-B follow-up program, implemented in a hepatitis B surface antigen-free dialysis unit, enabled us to report on the natural history of hepatitis C virus (HCV) infection in hemodialyzed patients between 1980 and 1992. For this program, every patient was prospectively monitored every two weeks for alanine amino transferase (ALT) activity, and every month for gammaglutamyl transpeptidase (GGT) activity and systematic collection of frozen sera. Sequences of stored sera from 217 patients were repeatedly tested for anti-HCV antibodies using second generation assays. Eighty-six of the 217 patients (39.6%), including 61 of the 67 patients with non-A, non-B hepatitis (91%), had HCV infection repeatedly evidenced by positive ELISA in all, and confirmed by RIBA in 84 of 86 (97.5%). In addition, 19 out of 23 patients (82.6%) were positive for HCV RNA by the polymerase chain reaction (PCR). Of the 86 anti-HCV positive patients, 41 had previously acquired HCV infection, and 45 seroconverted during chronic dialysis. Of these, all but one patient developed hepatitis with raised ALT activity which lasted for at least six months in all. Only 29 of 45 patients (64.5%) had a history of blood transfusion. Seventy-eight of the 86 patients (91%) who were followed up for one to 11.5 years (median 5) retained anti-HCV for several years. Nineteen liver biopsies performed in 16 patients showed chronic active hepatitis in 8 (50%) and hepatocellular carcinoma without cirrhosis in one patient. In most cases, the outcome of HCV infection was chronic, since 54 patients (69.2%) exhibited persistently elevated GGT and anti-HCV positivity combined with either abnormal or fluctuating ALT (30.8%) or normal ALT (38.4%), and 16 patients (20.5%) had persistently elevated anti-HCV titers. Resolutive hepatitis C was uncommon since only eight patients (10.3%) gradually lost their HCV markers. The incidence and cumulative risk of seroconversion only decreased after 1988 to 1990, when routine testing of the blood supply for surrogate markers and anti-HCV antibody was started in France. The incidence of post-transfusion hepatitis became nil in 1990 before that of nosocomial infection (1991). HCV prevalence also decreased, from 43.6 to 29.2%. In conclusion, HCV was responsible for 91% of non-A, non-B hepatitis cases. Hepatitis was identified as the primary HCV infection in all but one case. GGT activity emerged as a reliable marker of long-term HCV infection. The severity of the disease seems to correlate with the persistence of ALT and/or GGT changes, combined with that of anti-HCV and HCV RNA positivity. Transmission of HCV was both transfusional and nosocomial. HCV prophylaxis should now focus on the eradication of nosocomial infection.

Objectives This work aims at assessing the risk of lung cancer associated with mineral wools (MW) currently used as a substitute for asbestos. They are suspected of increasing the risk of lung cancer because of their structure close to asbestos. Methods ICARE is a large multicentre population-based case-control study conducted between 2001 and 2006 in 10 French departments with a general cancer registry. ICARE includes 2926 incident lung cancer cases and 3555 controls with 78% of men. The subjects9 exposure to MW was first determined using a Job-Exposure Matrix (JEM) specific for MW. Then, individual exposure was assessed with an algorithm using specific questions on exposing tasks. We used unconditional logistic regression adjusted for age, department, number of job periods, lifelong cigarette smoking and exposure to asbestos (also assessed by a JEM and an algorithm). Results Analyses were conducted among men (2301 cases, 2780 controls) and concerned 27191 jobs. In the first analyses, we find significant associations between the risk of lung cancer and exposure to MW assessed with the JEM. They became non non-significant and close to 1 when adjusting for exposure to asbestos. In contrast, a significant dose-response relation was found between exposure to asbestos and the risk of lung cancer, even when adjusted for exposure to MW. Conclusions These results need to be completed with the exposure assessment from the algorithm. This algorithm would help us disentangle MW and asbestos exposure, which are closely related because of similar exposing jobs. Both results will be presented.