Bronchopulmonary and pleural cancers (mesothelioma) are currently the only types of cancer covered by a table of occupational diseases related to asbestos exposure. However, they are not the only types of cancer that can be caused by these fibres: since 2012, the International Agency for Research on Cancer (IARC) has considered that there is a proven causal link between asbestos exposure and ovarian and laryngeal cancers.
ANSES was formally asked by the public authorities to provide the scientific evidence needed to consider the creation of occupational disease tables for these two types of cancer.
Under-reported and under-recognised occupational diseases
According to data provided by the National Health Insurance Fund (CNAM), only 130 applications for recognition of laryngeal cancer as an occupational disease associated with asbestos exposure were examined between 2010 and 2020. During the same period, six applications for recognition of ovarian cancer were submitted. According to the analysis of the data collected for this expert appraisal, these types of cancer associated with occupational exposure to asbestos are under-reported and under-recognised.
"When we interviewed healthcare professionals for this expert appraisal, we realised that despite its recognition by the IARC ten years ago, very little was known about the link between laryngeal and ovarian cancers and asbestos exposure. As asbestos is more commonly associated with lung and pleural cancers, neither doctors nor patients make the connection with other cancers." explains Alexandra Papadopoulos, project leader in the Air-related Risk Assessment Unit and coordinator of the expert appraisal.
ANSES's recommendations on the creation of occupational disease tables
In view of the numerous high-quality scientific studies showing a link between asbestos exposure and laryngeal and ovarian cancers, ANSES has concluded that the causal link is proven, which constitutes a compelling argument in favour of creating occupational disease tables for these two cancers.
According to ANSES, the creation of an occupational disease table would facilitate the recognition of these types of cancer, and therefore patients' compensation, by automatically recognising the link with occupational exposure from the moment the applicant meets the conditions defined by the table.
"It is already currently possible to have these types of cancer recognised as occupational diseases, but this requires the victim to prove the link between the cancer and their work. Such conditions are far more restrictive than with an occupational disease table," continues Alexandra Papadopoulos.
The ANSES working group formulated its recommendations on the conditions of exposure to asbestos and the methods of diagnosing diseases, which could be used to create the occupational disease tables. It is now up to the State to decide on the creation of these tables, in the general and agricultural social security schemes, following an opinion by the occupational disease committees.
Many industry sectors concerned
Due to the massive use of asbestos in France for more than 130 years and the wide range of industrial uses, many industry sectors, occupations and works have been or are still concerned by occupational exposure to asbestos.
Before these fibres were banned in 1997, the production and use of asbestos were the main sources of occupational exposure in France. The building and public works sector, including work on and the removal of materials and products containing asbestos, is now the sector with the largest number of exposed workers. Other sectors such as waste disposal, transport and agriculture are also concerned. Many other occupational activities are carried out in asbestos-contaminated environments, for example in the administration, education and healthcare sectors.
Improving traceability of the occupational exposure of women
As few women work in the construction industry, epidemiological studies are mainly carried out on men, but this does not mean that women are not subject to asbestos-related health risks. Women's occupational exposure to asbestos is mainly related to the manufacture of non-flammable textiles. Women are also exposed indirectly to asbestos in some sectors, such as healthcare, in which they are over-represented. "The expert group believes that more data are needed to document women's exposure to asbestos and the health impacts," argues Alexandra Papadopoulos.
In general, ANSES recommends providing better information for doctors and better support for workers who have been exposed to asbestos and who suffer from laryngeal or ovarian cancer, as well as for their dependents, to help them in their claims for recognition of occupational diseases.