The employees who have been exposed to asbestos or who are still being exposed benefit from a medical supervision which includes regulatory examinations (according to the French labor law) : chest X-ray and pulmonary function tests. Recently, craftsmen who have just retired also benefit from a supervision in some French regions : it includes a spiral CT. Any pathology linked to asbestos, should it be benign or malignant, can be considered as an occupational disease. For the social Security, even a short exposure to asbestos turns mesothelioma into an occupational disease.
History of asbestos
Asbestos was introduced massively in industrialized countries at the end of World War I and since then, was massively used. The use of asbestos wasn't controlled in France until 1977, when standards of exposure to fibres were introduced. Asbestos has been classified as carcinogen since 1976. In 1982, owing to major economical issues, asbestos industrialists created and financed an informal organism, “le comité permanent amiante” (CPA), who will conduct the health policy in this field during 12 years. The interest of stopping the use of asbestos in France has been manifestated too late in consequences the cpa was disolved by the government of Alain Juppé, known as the “asbestos scandal”.
Since 1997 asbestos has been banned in France by the “décret nº 96-1133 du 24 décembre 1996” linked to asbestos ban. The asbestos policy has always been closely linked to other industrial toxics – silica, iron, etc. It has changed since it was noticed that the dose effect link for the mesothelioma wasn't the same was usual : there isn't any safety threshold.
Concerned professions
The professions concerned by the exposure to asbestos have evolved throughout the decades. In the 1960s were concerned the professions of the production and the use of asbestos. In the 1980s-1990s the highest risk concerns profession with interventions on materials containing asbestos : toilers, boil makers, industrial coach builders, plumbers, carpenters, electricians...Currently, exposure to asbestos are various : welders, laboratory technicians, painters, decorators, jewellers, fitters, car mechanics.. Exposure levels are now lower than in the past, but the number of people exposed is significant.
The website of the “Institut national de recherche et de sécurité”[INRS; National Institut of research and security] is entirely dedicated to asbestos. All the exposed professions are listed. Indeed, all the buildings built before 1997 contain asbestos. Therefore, all workers who are in charge of the maintenance and renovation of these buildings are exposed [1] [2].
Any building worker must have access to the technical diagnosis asbestos [DTA: dossier technique amiante], in order to know whether the constructions contain any asbestos or not. But craftsmen who accomplish works for companies or in individual houses hardly ever ask for this file. Prevention in this field is far from being effective [3].
Pathologies linked to asbestos
Asbestos is toxic when inhaled and can cause respiratory diseases. Some are quite benign – such as pleural plaques– but others are very serious – such as lung cancer, mesothelioma or fibrosis (asbestosis). Other tissues can be stroke such as pericardium and peritoneum.
8 to 50 % of the exposed people have pleural plaques. Apparently, they do not represent one more risk factor for mesothelioma and lung cancer, but they are considered as a benign pathology. Screening them can have some negative psychological consequences. That is why "Société française de pneumologie de langue française" [SPLF; french-language Society of pneumology] considers that currently there is no medical argument to consider it [4].
It is surprising to notice the difference between medical and financial interests for the employee. In deed, if the employee has pleural plaques, considered as a benign pathology linked to asbestos, he can claim for an early retirement (50 years old instead of 60) [5] and he can get a compensation from “le Fonds d’indemnisation pour les victimes de l’amiante” [FIVA]; compensation for asbestos victims], i.e. about 20,000 € for pleural plaques.
When it comes to lung cancer, exposure to asbestos is a reckoned etiological factor. There is a well-documented dos effect link. But according to the « Société française de pneumologie de langue française" [SPLF; French-language Society of pneumology], there is currently no element solid enough to judge the efficiency of screening on the mortality due to lung cancer, should it be by sputum cytology or chest X-ray.
For pleura cancer (mesothelioma), there is a link between the exposure length, the dose and the pathology. “The analysis of the data obtained between 1978 and 1997 in nine French departments within the Francim network (cancer records), shows a progressive increase of the incidence of youngest cohorts. This increase, which is linear for men, is exponential for women. The risk has tripled for men between the cohorts 1913 and 1943, and for women between the cohorts 1923 and 1943. This increase of the incidence until the most recent cohort could imply a continuous increase of the incidence in the decades to come, according to the report of November 2003“Asbestos and occupational hazards : recent epidemiological studies” by the Symposium, organised by the “Institut de veille sanitaire”, the labour and health ministries. Apart from exposure to asbestos, one case of mesothelioma out of a million inhabitants is noticed. Apart from the exposure to asbestos, no risk factor is known. The latency time between exposure and pathology is between 30 and 40 years. No complementary non-invasive examinations enabling a useful screening exist. According to SPLF, it is best to use Spiral CT though only radiography and lung function tests are usually used by physicians owing to the current legislation.
As said above, mesothelioma can develop on other linings such as the peritoneum and the pericardium. But it is much more seldom.
A mesothelioma epidemic
This mesothelioma epidemic is going to continue in France during again 2 or 3 decades for its incidence increases by 25 % every 3 years. "Un programme national de surveillance du mésothéliome" [PNSM] was put in place by the "pouvoirs publics". The aim of this epidemiological supervision system is to document the evolutions of the epidemic permanently. It is a concerted action between the “département santé travail de l’Institut national de veille sanitaire (Invs)” who gets help from specialists of various fields : epidemiology, anatomopathology, neumology, cancerology, occupational medicine and industrial hygiene. Among the goals of the PNSM are the improvement of the diagnosis and the improvement of (pleural) mesothelioma taken as an occupational pathology.
The prognosis of mesothelioma remains poor. A long survival is linked to a young age at the moment of the diagnosis, to an epithelioid type and to an established occupational exposure to asbestos [6].
Pulmonary fibrosis – or asbestosis – is screened by 2 to 15 % of exposed workers and the link between dose and effect is clearly proved on a epidemiological level. Smoking is an aggravating factor.
Fibrosis, especially when it is evolutive, is one more risk factor to lung cancer. No treatment is available for this fibrosis.
All pathologies listed above can receive compensation as occupational pathologies according to the charts n° 30 and 30 bis of the “régime général” [general scheme].
Another sanitary tragedy ?
In France, there has been several sanitary dramas : contaminated blood, growth hormone, asbestos... With the “arrêts amiante” of March 2004, the “Conseil d'Etat” underlined that the government is the only responsible for assessing the potential risks and the chemical risks (100,000 chemical products are on the market, 30,000 are potentially dangerous, but only 5,000 have seen their risks assessed on a global scale) [7].
Many specialists in occupational health are worrying wether nano-materials won't end up in a sanitary drama in the decades to come because we use them without knowing their impact on health and protection devices aren't adapted. Some occupational physicians decided to warn the government [8]. But will their warnings be heard ?
History of asbestos
Asbestos was introduced massively in industrialized countries at the end of World War I and since then, was massively used. The use of asbestos wasn't controlled in France until 1977, when standards of exposure to fibres were introduced. Asbestos has been classified as carcinogen since 1976. In 1982, owing to major economical issues, asbestos industrialists created and financed an informal organism, “le comité permanent amiante” (CPA), who will conduct the health policy in this field during 12 years. The interest of stopping the use of asbestos in France has been manifestated too late in consequences the cpa was disolved by the government of Alain Juppé, known as the “asbestos scandal”.
Concerned professions
The professions concerned by the exposure to asbestos have evolved throughout the decades. In the 1960s were concerned the professions of the production and the use of asbestos. In the 1980s-1990s the highest risk concerns profession with interventions on materials containing asbestos : toilers, boil makers, industrial coach builders, plumbers, carpenters, electricians...Currently, exposure to asbestos are various : welders, laboratory technicians, painters, decorators, jewellers, fitters, car mechanics.. Exposure levels are now lower than in the past, but the number of people exposed is significant.
The website of the “Institut national de recherche et de sécurité”[INRS; National Institut of research and security] is entirely dedicated to asbestos. All the exposed professions are listed. Indeed, all the buildings built before 1997 contain asbestos. Therefore, all workers who are in charge of the maintenance and renovation of these buildings are exposed [1] [2].
Any building worker must have access to the technical diagnosis asbestos [DTA: dossier technique amiante], in order to know whether the constructions contain any asbestos or not. But craftsmen who accomplish works for companies or in individual houses hardly ever ask for this file. Prevention in this field is far from being effective [3].
Pathologies linked to asbestos
Asbestos is toxic when inhaled and can cause respiratory diseases. Some are quite benign – such as pleural plaques– but others are very serious – such as lung cancer, mesothelioma or fibrosis (asbestosis). Other tissues can be stroke such as pericardium and peritoneum.
8 to 50 % of the exposed people have pleural plaques. Apparently, they do not represent one more risk factor for mesothelioma and lung cancer, but they are considered as a benign pathology. Screening them can have some negative psychological consequences. That is why "Société française de pneumologie de langue française" [SPLF; french-language Society of pneumology] considers that currently there is no medical argument to consider it [4].
It is surprising to notice the difference between medical and financial interests for the employee. In deed, if the employee has pleural plaques, considered as a benign pathology linked to asbestos, he can claim for an early retirement (50 years old instead of 60) [5] and he can get a compensation from “le Fonds d’indemnisation pour les victimes de l’amiante” [FIVA]; compensation for asbestos victims], i.e. about 20,000 € for pleural plaques.
When it comes to lung cancer, exposure to asbestos is a reckoned etiological factor. There is a well-documented dos effect link. But according to the « Société française de pneumologie de langue française" [SPLF; French-language Society of pneumology], there is currently no element solid enough to judge the efficiency of screening on the mortality due to lung cancer, should it be by sputum cytology or chest X-ray.
As said above, mesothelioma can develop on other linings such as the peritoneum and the pericardium. But it is much more seldom.
A mesothelioma epidemic
This mesothelioma epidemic is going to continue in France during again 2 or 3 decades for its incidence increases by 25 % every 3 years. "Un programme national de surveillance du mésothéliome" [PNSM] was put in place by the "pouvoirs publics". The aim of this epidemiological supervision system is to document the evolutions of the epidemic permanently. It is a concerted action between the “département santé travail de l’Institut national de veille sanitaire (Invs)” who gets help from specialists of various fields : epidemiology, anatomopathology, neumology, cancerology, occupational medicine and industrial hygiene. Among the goals of the PNSM are the improvement of the diagnosis and the improvement of (pleural) mesothelioma taken as an occupational pathology.
The prognosis of mesothelioma remains poor. A long survival is linked to a young age at the moment of the diagnosis, to an epithelioid type and to an established occupational exposure to asbestos [6].
Pulmonary fibrosis – or asbestosis – is screened by 2 to 15 % of exposed workers and the link between dose and effect is clearly proved on a epidemiological level. Smoking is an aggravating factor.
Fibrosis, especially when it is evolutive, is one more risk factor to lung cancer. No treatment is available for this fibrosis.
All pathologies listed above can receive compensation as occupational pathologies according to the charts n° 30 and 30 bis of the “régime général” [general scheme].
Another sanitary tragedy ?
In France, there has been several sanitary dramas : contaminated blood, growth hormone, asbestos... With the “arrêts amiante” of March 2004, the “Conseil d'Etat” underlined that the government is the only responsible for assessing the potential risks and the chemical risks (100,000 chemical products are on the market, 30,000 are potentially dangerous, but only 5,000 have seen their risks assessed on a global scale) [7].
Many specialists in occupational health are worrying wether nano-materials won't end up in a sanitary drama in the decades to come because we use them without knowing their impact on health and protection devices aren't adapted. Some occupational physicians decided to warn the government [8]. But will their warnings be heard ?
References
- On the website of the "Institut national de recherche et de sécurité" (in french)
Exposure to asbestos in buildings built before 1997. - On the website of "Ministère du logement"
(in french). - On Atousante.com (in french)
"Dossier technique amiante". - On the website of the french-language Society of pneumology (in french)
"Recommandations de la Société de pneumologie de langue française pour le dépistage des pathologies liées à l’amiante en 2006". - On the website of "Ministère du travail" (in french)
"Cessation anticipée d’activité des travailleurs de l’amiante". - Mencoboni M et coll. , Comparison between short and long survivors consecutively diagnosed in a large hospital and included in the regional population-based mesothelioma registry ; 19th International Anti Cancer Treatment- ICACT (Paris) : 5-8 february
- On Atousante.com (in french)
"Nano particules". - "Dépistage des pathologies professionnelles liées à l’amiante et responsabilité médicale : les doutes d'un médecin du travail" (in french)
on the french medical law website Droit-medical.com. - Photos : © STILLFX, © humatix
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