Objectifs Mis en place en 1998, le Programme national de surveillance du mésothéliome pleural fonctionne depuis vingt ans. Il permet de dresser un bilan de l’évolution de la situation épidémiologique des mésothéliomes pleuraux entre 1998 et 2017, en France, en termes d’incidence, de survie, d’expositions des patients atteints et de leur reconnaissance médico-sociale. Méthodes Dans les 21 départements couverts par le programme, une procédure standardisée de recueil actif et de confirmations diagnostiques anatomopathologique et clinique des tumeurs primitives de la plèvre est mise en œuvre. Les expositions vie entière à l’amiante et aux autres facteurs étudiés, professionnelles et extra-professionnelles, sont recueillies par questionnaire auprès de chaque cas. Les recours des cas de mésothéliome aux dispositifs d’indemnisation (maladie professionnelle et Fonds d’indemnisation des victimes de l’amiante-Fiva) sont recueillis et analysés. Résultats Sur la période 1998-2016, on observe une augmentation du nombre de cas annuel estimé, passant de 800 à1100 cas avec une augmentation de la proportion de femmes de 20 à 25 %. Chez les hommes, les expositions professionnelles sont encore largement prédominantes et restent stables depuis 1998 (environ 90 %), avec toutefois un déplacement de la problématique des métiers d’utilisation et de transformation de l’amiante vers les métiers d’intervention sur des matériaux contenant de l’amiante tel que le secteur du BTP. Chez les femmes, la part des expositions professionnelles à l’amiante reste faible (environ 40 %), mais 35 % des femmes ont été exposées en dehors du travail (via le fait de résider avec des proches exposés 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 affiliés au régime général de sécurité sociale (RGSS) ne faisant aucune démarche et 53 % des cas hors RGSS n’ayant pas recours au Fiva. Perspectives La mise en œuvre du dispositif national de surveillance des mésothéliomes (DNSM) intégrant le PNSM et la déclaration obligatoire (DO) permettra de moderniser et optimiser la surveillance de tous les mésothéliomes (plèvre et autres localisations) sur le territoire national, de l’adapter aux nouveaux enjeux (dont les expositions environnementales), d’optimiser le dispositif national d’enquêtes d’expositions et de renforcer l’articulation avec les travaux de recherche, tel que l’estimation de la proximité des lieux de vie des sujets à des sources naturelles ou industrielles potentiellement exposantes.

L’association éventuelle entre l’exposition professionnelle à l’amiante et le cancer de l’œsophage demeure actuellement controversée, comme en témoigne l’évaluation du Centre international de recherche sur le cancer (CIRC) réalisée en 2012. La question du lien éventuel entre ce cancer et l’exposition à l’amiante est cependant très importante, tant en matière de surveillance médicale des sujets exposés, qu’en matière de réparation médico-légale des patients présentant ce type de pathologie. L’objectif de notre étude est d’analyser l’incidence et la mortalité par cancer de l’œsophage dans une cohorte de sujets ayant été exposés professionnellement à l’amiante (cohorte ARDCo : « Asbestos-Related Diseases Cohort »). Un suivi sur 10 ans de 14 515 hommes inclus dans le programme ARDCo entre octobre 2003 et décembre 2005 a été réalisé. L’exposition à l’amiante a été analysée par des hygiénistes industriels à partir des données issues d’un questionnaire standardisé adressé aux sujets éligibles. Les variables utilisées pour caractériser cette exposition à l’amiante ont associé : la durée d’exposition à l’amiante, un indice d’exposition cumulée à l’amiante (IEC) et la latence (délai entre le début de l’exposition et l’apparition des premiers symptômes de la maladie). Une analyse statistique des associations entre les variables d’exposition à l’amiante et, d’une part, l’incidence du cancer de l’œsophage et, d’autre part, la mortalité par cancer de l’œsophage, a été réalisée à l’aide d’un modèle de Cox, avec ajustement sur le statut tabagique, la latence et l’IEC (exprimé en Ln (IEC + 1)). Nous avons mis en évidence une relation dose-effet significative entre l’IEC à l’amiante et le cancer de l’œsophage, à la fois en incidence et en mortalité. Cette vaste étude est en faveur d’une relation entre l’exposition à l’amiante et le cancer de l’œsophage.

Background: most of pleural mesothelioma are linked to previous occupational exposure to asbestos. There are several systems for compensation of this disease in France Aim: to study factors associated with the compensation of the disease in subjects included in the National Mesothelioma Surveillance Program (PNSM), and having had at least one job in the construction industry during their working life. Methods: Occupational disease reports (OD) and data from the Asbestos Victims Compensation Fund (FIVA) were analyzed in men with confirmed diagnosis of pleural mesothelioma between 1999 and 2015. Chi2 and Fisher tests, as well as an unconditional logistic regression model were used to test the association with the following variables: age at diagnosis, likelihood of occupational exposure to asbestos, marital status, residence department, socio-professional category and the fact of having at least one job in the construction industry. Results: Of the 1409 men, 40% had at least one job in the construction industry (average duration : 17.5 years). In univariate analysis, subjects having had at least one job in the construction industry asked more frequently for compensation as OD than workers having never worked in this industry (82% versus 55%, p = 0.002). They also claimed for compensation to the FIVA more frequently. In multivariate analysis, the factors associated with claim for compensation as OD were age below 75 years, blue collar status, marital status and work in the construction. Conclusion: construction workers represent a high proportion of subjects registered in the PNSM, with a substantial proportion of construction workers (depending on the type of job held) that do not claim for any compensation in France

BACKGROUNDOur study aimed at analyzing incidence and mortality from esophageal cancer within a cohort of workers with previous occupational asbestos exposure (ARDCo Program).METHODSA 10-year follow-up study was conducted in the 14 515 male subjects included in this program between October 2003 and December 2005. Follow-up began when exposure stopped. Asbestos exposure was analyzed by industrial hygienists using data from a standardized questionnaire. The Cox model was used, with age as the time axis variable adjusted for smoking, time since first exposure (TSFE) and cumulative exposure index (CEI) of exposure to asbestos.RESULTSWe reported a significant dose-response relationship between CEI of exposure to asbestos and esophageal cancer, in both incidence (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.00-1.58), and mortality (HR 1.40, [95%CI 1.12-1.75]).CONCLUSIONSThis large-scale study suggests the existence of a relationship between asbestos exposure and cancer of the esophagus.

Contexte Dans les suites de la conference de consensus de 1999 sur le suivi medical des personnes ayant ete exposees a l’amiante, un programme experimental multiregional a ete mis en place, avec constitution de la cohorte asbestos-related diseases cohort (ARDCO). Objectif Ce travail etudie l’association entre plaques pleurales identifiees sur examen tomodensitometrique (TDM) du thorax et risque de mesotheliome ou de deces par cancer du poumon. Methodes Entre 2003 et 2005, des sujets retraites, anterieurement exposes a l’amiante et relevant du RGSS ont ete invites a participer a un programme de depistage dans les regions Aquitaine, Haute et Basse Normandie et Rhone-Alpes. Un index d’exposition cumule (IEC) a l’amiante a ete calcule pour chaque individu a partir d’un questionnaire professionnel standardise. Les examens TDM thoraciques ont ete relus par des experts radiologues, afin de determiner notamment l’existence d’anomalies pleurales liees a l’amiante (donnees disponibles chez plus de 5000 sujets). Les cas de mesotheliome incidents ont ete reperes a partir des demandes de prise en charge en ALD ou en maladie professionnelle (MP) aupres de la Securite sociale, avec sollicitation du College des anatomopathologistes specialises (MESOPATH) pour confirmer le diagnostic. Pour l’etude des CBP, une etude de mortalite a ete realisee avec obtention des causes de deces jusqu’au 31-12-2010 aupres du service CepiDc de l’Inserm. L’analyse statistique s’appuie sur une analyse de survie basee sur un modele de Cox, l’âge etant la variable principale. Resultats Chez les hommes, l’etude d’incidence (donnees ALD-MP) a retrouve une association significative entre la presence de plaques pleurales sur le TDM et le risque de developper un mesotheliome (hazard ratio [HR] ajuste sur l’IEC a l’amiante et la latence : 6,8 [IC 95 % : 2,2–21,4] pour les plaques pleurales typiques). L’etude de mortalite a identifie une association significative entre plaques pleurales et mortalite par cancer du poumon (HR ajuste sur le tabac et l’IEC a l’amiante : 2,41 [IC 95 % : 1,21–4,85]). Conclusion La presence de plaques pleurales apparait etre un facteur de risque independant pour la survenue du mesotheliome pleural et pour le risque de deces par cancer du poumon chez des sujets ayant ete exposes a l’amiante.

Le mésothéliome 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 évoquée. Le travail présenté ici étudie les facteurs associés à la prise en charge médico-sociale des mésothéliomes pleuraux inclus dans le Programme national de surveillance du mésothéliome (PNSM) qui couvre actuellement 21 départements en France. Les déclarations en maladie professionnelle (DMP) pour la période 1999–2014 et le recours au Fonds d’indemnisation des victimes de l’amiante (FIVA) pour les années 2005–2014, ont été analysés chez les sujets dont le diagnostic de mésothéliome a été confirmé par le collège des anatomopathologistes spécialistes du mésothéliome (groupe Mésopath). Les tests du Chi2, ou le test exact de Fisher ainsi qu’un modèle de régression logistique non conditionnelle ont été utilisés pour tester l’association avec différentes variables : sexe, âge au diagnostic, catégorie socio-professionnelle, situation familiale, probabilité d’exposition professionnelle à l’amiante, régime de protection sociale, département de résidence. Parmi les 2839 sujets étudiés entre 1999 et 2014 et qui relèvent du Régime général de la Sécurité sociale (RGSS), 60 % ont effectué une DMP. Les facteurs associés à la DMP chez les hommes étaient l’âge, la catégorie socio-professionnelle, la situation familiale et la probabilité d’exposition professionnelle à l’amiante. Chez les femmes, seule la probabilité d’exposition professionnelle à l’amiante était associée à la DMP. Chez les hommes comme chez les femmes, la proportion de DMP variait selon les départements. Parmi les 2746 sujets identifiés entre 2005 et 2014, 55 % avaient adressé une demande au FIVA. Cette proportion significativement plus importante chez les sujets relevant du RGSS que pour ceux relevant d’autres régimes de protection sociale, variait selon les départements. La demande auprès du FIVA était associée à l’âge, à la situation familiale, et à l’exposition professionnelle à l’amiante. Au total, sur les 2193 sujets relevant du RGSS sur la même période (2005–2014), seulement 45 % avaient conjointement effectué une DMP et adressé une demande au FIVA. Il est à noter que 27 % n’avaient effectué aucune démarche. Ces résultats confirment l’importance de renforcer l’information des acteurs médicaux prenant en charge ce type de patients, afin de les sensibiliser aux enjeux médico-sociaux liés au mésothéliome pleural.

Plusieurs travaux ont rapporté l’existence d’un lien possible entre une exposition professionnelle à l’amiante et le risque de cancer colo-rectal. Toutefois, les différentes études disponibles sont discordantes et le CIRC dans sa dernière évaluation de 2012 n’a retenu qu’un lien probable. Le but de cette étude est de rechercher l’existence d’une association éventuelle entre ce type de cancer et l’amiante au sein de l’étude de cohorte « Asbestos-Related Diseases COhort » (ARDCO). Entre 2003 et 2005, plus de 16 000 volontaires retraités ou sans emploi, ayant été exposés professionnellement à l’amiante ont été inclus dans un programme de dépistage des pathologies bénignes de l’amiante par TDM. Depuis, un suivi annuel des prises en charge pour cancer en ALD ou en MP a été effectué jusqu’en 2014 et permet d’approcher l’incidence des cancers dans cette cohorte. Les expositions à l’amiante ont été expertisées de manière indépendante par plusieurs hygiénistes industriels et ont été caractérisées selon un indice d’exposition cumulée (IEC) sur la carrière entière. En 2011, un questionnaire complémentaire a été envoyé à l’ensemble des sujets, permettant de recueillir les principaux facteurs de risque du cancer colo-rectal chez un échantillon de sujets appelé ARDCO-NUT. Les analyses statistiques reposent sur le modèle de Cox, avec prise en compte du tabagisme, de l’IEC et de la latence pour l’amiante, et des principaux facteurs de risque alimentaires (alcool, viande rouge), personnels (IMC) et familiaux (polypes) du cancer colo-rectal. Près de 14 500 hommes ont été retenus pour cette analyse, dont 3769 ont répondu au questionnaire complémentaire. Dans la cohorte globale ARDCO, une relation dose-réponse est mise en évidence entre le risque de cancer colique et l’IEC à l’amiante (hazard risk = 1,14 [1,04–1,26]) après ajustement sur le tabagisme et la latence de l’exposition à l’amiante. Après stratification sur la latence (moins de 40 ans, 40 ans et plus), une relation plus forte est mise en évidence pour une latence < 40 ans (HR = 1,57 [1,25–1,98]). Les analyses effectuées sur l’échantillon ARDCO-NUT confirment ces résultats, après prise en compte des facteurs de risque du cancer colique. Aucune relation significative n’est observée avec le cancer du rectum considéré seul. Cette étude est en faveur d’une relation dose-réponse entre l’exposition à l’amiante et le cancer du colon, après prise en compte des principaux facteurs de risque de ce cancer.

For lung cancer, there is evidence of a joint effect between smoking and asbestos. However, little is known about a possible joint effect between asbestos and other inorganic particles. The objective was to study the association between lung cancer and occupational asbestos exposure in the abscence or presence of additional exposure to inorganic particles. A 12-year follow-up study was conducted to analyse lung cancer incidence in a cohort of 13,814 retired workers previously exposed to asbestos and volunteering to participate in a multiregional survey program (Asbestos Related Diseases Cohort, ARDCO) from October 2003 and December 2005. From complete work histories, occupational exposure to asbestos, mineral wools, refractory ceramic fibers, crystalline silica and cement dust were assessed by job-exposure matrices. Association between lung cancer and occupational asbestos exposure was estimated by Cox model, adjusted for smoking, in the presence or absence of additional exposure to inorganic particles. At the end of follow-up (April 2015), 364 incident lung cancer cases were diagnosed. The association between lung cancer and asbestos exposure was statistically significant (HR=2.3 [95% CI=1.0-5.4]), but it seemed increased in the presence of additional exposure to mineral wools (HR=3.1 [95% CI=1.4-7.2]). However, at equal asbestos exposure level, the association was no longer different in the presence of additional exposure to mineral wools. Other inorganic particles did not modify the association between asbestos and lung cancer. Mineral wools may modify the association between lung cancer and asbestos. However, subjects exposed to both factors seemed also to be more exposed to asbestos.

BACKGROUND:The relationships between asbestos exposure and colorectal cancer remain controversial. OBJECTIVES:We examined the association between asbestos exposure and colorectal cancer incidence. METHODS:Volunteer retired workers previously exposed to asbestos were invited to participate in the French ARDCo screening program between 2003 and 2005. Additional data on risk factors for colorectal cancer were collected from the ARDCo-Nut subsample of 3,769 participants in 2011. Cases of colon and rectal cancer were ascertained each year through 2014 based on eligibility for free medical care following a cancer diagnosis. Survival regression based on the Cox model was used to estimate the relative risk of colon and rectal cancer separately, in relation to the time since first exposure (TSFE) and cumulative exposure index (CEI) to asbestos, and with adjustment for smoking in the overall cohort and for smoking, and certain risk factors for these cancers in the ARDCo-Nut subsample. RESULTS:Mean follow-up was 10.2 years among 14,515 men, including 181 colon cancer and 62 rectal cancer cases (41 and 17, respectively, in the ARDCo-Nut subsample). In the overall cohort, after adjusting for smoking, colon cancer was significantly associated with cumulative exposure (HR = 1.14; 95% CI: 1.04, 1.26 for a 1-unit increase in ln-CEI) and ≥ 20-40 years since first exposure (HR = 4.67; 95% CI: 1.92, 11.46 vs. 0-20 years TSFE), and inversely associated with 60 years TSFE (HR = 0.26; 95% CI: 0.10, 0.70). Although rectal cancer was also associated with TSFE 20-40 years (HR = 4.57; 95% CI: 1.14, 18.27), it was not associated with ln-CEI, but these findings must be interpreted cautiously due to the small number of cases. CONCLUSIONS:Our findings provide support for an association between occupational exposure to asbestos and colon cancer incidence in men. Citation: Paris C, Thaon I, Hérin F, Clin B, Lacourt A, Luc A, Coureau G, Brochard P, Chamming's S, Gislard A, Galan P, Hercberg S, Wild P, Pairon JC, Andujar P. 2017. Occupational asbestos exposure and incidence of colon and rectal cancers in French men: the Asbestos-Related Diseases Cohort (ARDCo-Nut). Environ Health Perspect 125:409-415; http://dx.doi.org/10.1289/EHP153.

RATIONALE:Although asbestos is a well-known lung carcinogen, the pleural plaque-lung cancer link remains controversial.OBJECTIVES:This study was designed to examine this link in asbestos-exposed workers.METHODS:A 6-year follow-up was conducted to study lung cancer mortality in the 5,402 male subjects participating in an asbestos-related disease screening program conducted from October 2003 to December 2005 in four French regions. Chest computed tomography (CT) scan was performed in all subjects with randomized, independent, double reading of CT scans focusing on benign asbestos-related abnormalities. Cox model survival regression analysis was used to model lung cancer mortality according to the presence of pleural plaques, with age as the main time variable, adjusting for smoking and asbestos cumulative exposure index. All statistical tests were two-sided.MEASUREMENTS AND MAIN RESULTS:Thirty-six deaths from lung cancer were recorded. Lung cancer mortality was significantly associated with pleural plaques in the follow-up study in terms of both the unadjusted hazard ratio of 2.91 (95% confidence interval = 1.49-5.70) and the adjusted hazard ratio of 2.41 (95% confidence interval = 1.21-4.85) after adjustment for smoking and asbestos cumulative exposure index.CONCLUSIONS:Pleural plaques may be an independent risk factor for lung cancer death in asbestos-exposed workers and could be used as an additional criterion in the definition of high-risk populations eligible for CT screening.

Background: it has been recently shown that pleural plaques might be an independent risk factor for pleural mesothelioma in a cohort of asbestos-exposed subjects, but the link between pleural plaques and lung cancer risk remains controversial. Methods: retired or unemployed workers previously occupationally exposed to asbestos were invited to participate in a screening program for asbestos-related diseases in four regions of France between 2003 and 2005. All subjects had individual determination of cumulative exposure index (CEI) to asbestos, based on expertise of occupational history by industrial hygienists. Randomized independent double reading of CT scans by a panel of chest radiologists allowed determination of benign asbestos-related abnormalities in 5367 subjects, blind with respect to the level of exposure to asbestos. A follow-up study was conducted in this cohort with annual determination of the number of subjects eligible for free medical care for incident lung cancer (LC) until april 2012. Odds ratio (OR) was calculated to estimate the risk of incident LC associated with pleural plaques in men, with adjustment on age, CEI to asbestos and tobacco smoking. Results: preliminary data are based on 91 incident LC cases registered between initiation of follow-up and april 2012 (mean follow-up: 7.7 years; 41356 person-years). Adjusted OR for incident LC risk associated with the presence of pleural plaques on CT-scan is 1.25 [95% confidence interval (CI): 0.76-2.07]. Conclusion: after 7.7 years of follow-up, the presence of pleural plaques is associated with a non-significantly increased risk of lung cancer in this cohort.

BACKGROUND:In the course of setting up the National Mesothelioma Surveillance Program (PNSM), established in France in 1998, the question arose as to the most suitable method of assessing occupational exposure. The aim of this study was to define the most suitable rating method for assessing occupational asbestos exposure in order to assess medico-social care.METHOD:The study included 100 subjects-50 cases of mesothelioma and 50 controls-randomly selected and representing 457 jobs held. Job asbestos exposure was assessed by a six-expert panel using two methods: "by job" rating, where all the jobs in were assessed regardless of the subjects; and "by subject" rating, where all the jobs of a subject were assessed at the same time. Consensus was obtained and subjects' exposure was calculated for each rating. Then, two internal experts assessed job asbestos exposure with the "by subject" rating. Kappa coefficients were used to measure agreement between the ratings.RESULTS:Agreement between "by job" and "by subject" ratings was very good for subject probability of exposure (kappa = 0.84) and cumulative exposure index (kappa = 0.80). Agreement between the six-expert panel and the two internal experts was good for subject exposure (kappa for probability = 0.71; kappa for cumulative exposure index= 0.68).CONCLUSION:This study shows that the two rating systems have good or very good agreement. These results validate the routine use in the PNSM of the "by subject" rating, with the advantage of being convenient and quick to provide feedback on occupational asbestos exposure to mesothelioma cases for compensation.

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.

Background: Relationships between parietal pleural plaques and lung function impairment still remain controversial. Aims: This study analyses the relationships between isolated pleural plaques and lung function, among subjects occupationally exposed to asbestos. Methods: The study population consisted of 2,743 subjects included in a large-scale pilot screening program for asbestos-related diseases in four regions of France between 2003 and 2005. All had been occupationally exposed to asbestos, and were free of interstitial disease on high resolution chest computed tomography (HRCT). The asbestos exposure was assessed with calculation of an individual cumulative exposure index (CEI) taking into account all job periods for each subject. Each included subject benefited from pulmonary function tests (PFT) and HRCT was interpreted by a panel of expert radiologists in thoracic imaging. In both univariate and multivariate analysis, variables were adjusted on tobacco status, body mass index (BMI), CEI to asbestos and the center where PFT were made. Results: Isolated pleural plaques were associated with a significant decrease of TLC (p=0.049), FVC (p=0.001) and FEV1 (p=0.003). On the other hand, no significant relationship was observed between pleural plaques and FEV1/FVC ratio, FEF25-75% and RV. A significant correlation was found between the extent of pleural plaques and the reduction of FVC (p trend=0.0089) and TLC (p trend=0.0046). By contrast, thickness of pleural plaques was not related to any functional impairment. Conclusions: Our results are in favor of a relationship between isolated parietal and/or dipahragmatic pleural plaques and a trend to restrictive pattern.

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(p)) 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(p) 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(p) 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(p) 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(p) 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.

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 = 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 = 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 asbestos-containing products.