Digestive cancers and occupational asbestos exposure: incidence study in a cohort of asbestos plant workers.

OBJECTIVE: The aim of our study was to estimate the incidence of digestive cancers within a cohort of asbestos-exposed workers. METHODS: Our study was based on a cohort of 2024 participants occupationally exposed to asbestos. The incidence of digestive cancers was calculated from 1 January 1978 to 31 December 2009 and compared with levels among the local general population using Standardised Incidence Ratios (SIRs). Asbestos exposure was assessed using the company's job-exposure matrix. RESULTS: 119 cases of digestive cancer were observed within our cohort, for an expected number of 77 (SIR=1.54 (1.28 to 1.85)). A significantly elevated incidence was observed for peritoneal mesothelioma, particularly in women. Significantly elevated incidences were also observed among men for: all digestive cancers, even when excluding peritoneal mesothelioma (SIR=1.50 (1.23 to 1.82)), oesophageal cancer (SIR=1.67 (1.08 to 2.47)) and liver cancer (SIR=1.85 (1.09 to 2.92)). Concerning colorectal cancer, a significant excess of risk was observed for men with exposure duration above 25 years (SIR=1.75 (1.05 to 2.73)). CONCLUSIONS: Our results are in favour of a link between long-duration asbestos exposure and colorectal cancer in men. They also suggest a relationship between asbestos exposure and cancer of the oesophagus in men. Finally, our results suggest a possible association with small intestine and liver cancers in men.

Cancer incidence within a cohort occupationally exposed to asbestos: a study of dose--response relationships.

OBJECTIVES: The aim of our study was to analyse the dose-response relationship between occupational asbestos exposure and risk of cancer. METHODS: Our study was a retrospective morbidity study based on 2024 subjects occupationally exposed to asbestos, conducted over the period 1 January 1978 to 31 December 2004. Analysis of the dose-response relationship between occupational asbestos exposure, as a time-dependant variable, and risk of cancer was performed using a Cox model. In order to account for the effect of latency, we conducted the analysis with a lag of 10 years. RESULTS: 285 cases of cancers were observed in our cohort. The relative risk of pleuro-peritoneal mesothelioma, lung cancer and colorectal cancer associated with asbestos exposure, adjusted for age as a time-dependant variable and for sex, was correlated with exposure intensity (or average exposure level, AEL). The risk of cancer, whatever the anatomical site, did not increase with the duration of exposure to asbestos. CONCLUSION: While confirming the established relationship between asbestos exposure and pleuropulmonary and peritoneal cancers, this study also suggests a causal relationship between asbestos exposure and colorectal cancer.

The French medico-legal concept of aptitude and fitness appraisal by occupational physicians: an ethical issue?

For many years, medical aptitude in occupational health, a French exception, did not raise any particular issue. However, from the 1980's onwards, this concept has been approached from a more critical point of view, authors questioning its compatibility with personal liberty. The increase in precarious working conditions have but reinforced such criticism, raising the question of the confrontation of such a concept with due respect of the right to work and the right for health protection. Special decrees, in particular the CMR decree (relating to carcinogenic, mutagenic and toxic substances for reproduction), issued in 2001, have added further force to the debate, particularly with regard to the problematic compatibility between the notice of aptitude and the respect of medical ethics and deontology. After having exposed the reasons behind the debate on aptitude in occupational health, and having identified the associated ethical issues, we will discuss the eventuality of the concept's abolition, together with possible replacement solutions.

Children employed in the performing arts, advertising and fashion industry: what legal protection do they have?

Ill-treatment can sometimes take on an unfamiliar face. Particularly, this is the case for certain types of child employment. In France, as in most European countries, there are laws for protecting children and guaranteeing their right to schooling. Over and above the frequently observed apprenticeship contracts, obtained by eligible under 16 years, there is also the dispensatory case of children employed in the performing arts, advertising and the fashion industry. In France, legislators take the child's vulnerability into account when developing legislative and regulatory mechanisms, concerning the modalities of his/her professional activity, particularly in artistic fields and in fashion modelling. Since both may employ very young children, or even infants, one essential question ought to be raised: from a legal point of view, are these children sufficiently protected, with regard to the potential physical and psychological consequences of their particular professional activities?

Comparative analysis of medicolegal compensation for occupational cancers in France and other western European countries: development proposals.

In France, contemporary medicolegal reparation system of occupational diseases--in particular occupational cancer--has been questioned, constantly, due to changes in the state's legal system. For a long time, associated legislation was considered as a genuine social breakthrough. However, it shall remain acknowledged that over the past 15 years, it has been the French legal system itself that generated a certain level of inequality among victims of occupational diseases.. This inequality came to exist following certain jurisdictional understandings of legal matters, as well as the creation of exceptional schemes for granting compensation for physical injuries. It is agreed by both, courts and compensatory funds, that full compensation must be granted for particular group of victims. Yet, this is not the case as for granting compensation over occupational diseases, where reparation is on a set lump sum basis. In light of this proved inequality in the France legal system, with regard to the medicolegal reparation for loss or damage, associated with a claimant's occupational activity, we aim at investigating the procedures as practiced in various European countries occupational cancer in order to identify optimal compensation for these disorders.

Professional photosensitive eczema of fishermen by contact with bryozoans: disabling occupational dermatosis.

Eczema associated with bryozoans is a form of occupational dermatosis caused by a living animal, involving contact eczema, occasionally associated with photosensitivity and concerning fishermen on a quasi-elective basis. This affection can prove to be extremely disabling, frequently generating disastrous social consequences, since the eviction of the responsible allergen is very often synonymous to occupational reclassification, a measure which fishermen, highly attached to their profession, have great difficulty in accepting. Based on the description of three cases of photosensitive eczema associated with contact with the bryozoan, Alcyonidium gelatinosum, identified in fishermen from the English Channel coastline, we describe the characteristics and the specificities of this occupational dermatosis, then approach the issue of its prevention, which, unfortunately, remains limited.