French National Mesothelioma Surveillance Program PNSM
Executive Summary
The French National Mesothelioma Surveillance Program (PNSM) was established in 1998 by France's National Institute for Health Surveillance (InVS) to track pleural mesothelioma: how often it occurs, how much of it is attributable to work with asbestos, how well it is diagnosed, and how often it is compensated as an occupational disease.[1] InVS became Santé publique France in 2016.[2]
In September 2026, Santé publique France published a report on 26 years of the program. It included 7,277 cases of pleural mesothelioma between 1998 and 2023.[3] The program does not cover all of France. Until 2022 it covered about 18 million inhabitants, 28% of the population of metropolitan France, and the national figures are estimated from that sample.[4][5]
The report finds that incidence is still rising despite France's 1997 ban on asbestos use, and faster in women than in men.[3] A separate Santé publique France report, also published in September 2026, describes a national map of 3,538 sites that may have exposed people to asbestos.[6]
At a Glance
| Question | Answer |
|---|---|
| What does the PNSM count? | Pleural mesothelioma cases diagnosed in the departments it covers[4] |
| How many cases did it include? | 7,277 cases from 1998 to 2023[3] |
| How much of France does it cover? | About 18 million inhabitants, 28% of metropolitan France, until 2022; 14 departments and the Lille area in 2024[4] |
| How many new patients a year in France? | About 1,100 a year on average[3] |
| Is incidence rising? | Yes. After adjusting for population ageing, by 2% in men and 16% in women between 1998-2001 and 2018-2021[3] |
| How is exposure assessed? | Industrial hygienists review each patient's questionnaire on lifetime work and non-work history[7] |
| Is there a map of asbestos sites? | Yes. A separate database lists 3,538 sites in four classes (2024 version), as locations rather than measured exposure[6][8] |
| What replaces it? | A new national surveillance system built on mandatory notification of mesothelioma[9] |
Key Facts
Each figure below has its own denominator. They should not be combined or compared with one another.
| Figure | What it counts |
|---|---|
| 7,277 | Pleural mesothelioma cases included in the PNSM, 1998 to 2023[3] |
| 28% | Share of the population of metropolitan France living in the area the PNSM covered until 2022 (about 18 million people)[4] |
| 4,569 | Patients under the general Social Security scheme (régime général) in the compensation analysis[10] |
| 56% | Of those 4,569 patients, the share who filed an occupational disease claim before December 31, 2024[10] |
| 3,538 | Sites in the 2024 version of the national database of sites potentially exposing people to asbestos[6] |
What Is the PNSM?
The program was set up to estimate trends in mesothelioma incidence and the proportion attributable to occupational asbestos exposure, to help improve pathology diagnosis, to assess compensation as an occupational disease, and to contribute to research.[1] At its start it recorded pleural tumours in 21 French districts covering about 16 million people, a quarter of the French population.[1]
A patient is included if diagnosed in the study period, living in one of the covered departments or the area near Lille at the time of diagnosis, and not excluded by the program's expert pathological and clinical review of the diagnosis.[4] Coverage changed over time. Until 2022 the program covered 19 departments in metropolitan France and the area near Lille; in 2024 it covered 14 departments and the area near Lille.[4]
How Cases and Incidence Are Counted
The 7,277 included cases are a count of patients in the covered area. They are not a count for all of France.[3][4] National incidence is estimated: the ratio of incidence to mortality observed in the PNSM departments, by age group and sex, is applied to national death data for France, with national hospital data (PMSI) used for 2006 to 2023.[5]
On that basis the report gives about 1,100 new patients a year on average.[3] The number of patients rose sharply between 1998-2001 and 2018-2021 in both men and women. After removing the effect of an ageing population, incidence still rose, by 2% in men and 16% in women.[3]
The patient mix also changed. The ratio of male to female cases fell from 4.1 to 3.4, the age at diagnosis rose, and the share of patients under 60 fell from 16% to 4%.[3] The share of certified diagnoses improved, from 74% in 1998-2002 to 92% in 2018-2023.[3]
How Exposure Is Assessed
Each patient's exposure is assessed by industrial hygienists who review a detailed questionnaire. A patient counts as occupationally exposed if at least one job in their career carried a non-zero probability of exposure. A patient counts as exposed to asbestos outside work if at least one non-work circumstance, such as do-it-yourself work, para-occupational exposure, or domestic and environmental exposure, carried a non-zero probability of exposure. Non-work exposure is reported only for patients with no occupational exposure.[7]
In men, asbestos exposure is found in the work history in more than 90% of cases in the most recent years.[3] In women, occupational asbestos exposure is found in about one case in three, and asbestos exposure outside work is the majority circumstance. The report cautions that results for women are hard to analyse because there are few women in the PNSM.[3]
The time from first exposure to diagnosis has lengthened, to more than 50 years for patients in the most recent inclusion period.[3]
Who Files for Compensation, and Who Does Not
The report follows two compensation routes: an occupational disease claim through Social Security, and a claim to the Asbestos Victims Compensation Fund (FIVA).[3] From 2005 to 2023, more than half of PNSM patients filed a claim with FIVA.[3]
The report's detailed analysis covers 4,569 patients under the general Social Security scheme. Of these, 56% had filed an occupational disease claim before December 31, 2024. Social Security accepted the claims of 90% of these patients. Refusals affected 10% of patients and were mostly (92%) administrative. Where the diagnosis was confirmed and asbestos exposure was found to be at least possible, 74% of patients filed and 92% of those claims were accepted.[10]
Among general-scheme patients, one quarter took no step toward compensation at all.[3] Patients under 65, patients living as a couple and patients with occupational asbestos exposure filed more often, and claim rates varied widely by region.[3]
The National Map of Sites Potentially Exposing People to Asbestos (SPEA)
Santé publique France's second September 2026 report describes a georeferenced database of sites potentially exposing people to asbestos. It is titled for metropolitan France in 2023.[6] After adding records, removing duplicates and removing natural sites, the updated database held 3,538 sites in 2024, in four classes: mines and quarries; ports; shipbuilding and ship repair; and other asbestos industries.[6]
The database records where a site was, not how much asbestos anyone breathed. 1,542 sites could be located only at the level of their town (commune). The report says these cannot support precise distance calculations to a patient's address, but can feed a proxy indicator such as the density of sites in a commune or department.[8]
The report lists its own limits. Some duplicates probably remain. Operating dates are incomplete and sometimes inconsistent, which biases the density indicator. Exposure from demolition, removal and encapsulation work, and from road traffic, is not included. The emission potential of each site could not be characterised.[11] The database is available to scientific teams on request, as a spreadsheet with a data dictionary and a GIS layer.[11]
What the Data Can and Cannot Show
The PNSM is population surveillance. It describes how many people were diagnosed, how their exposure histories were assessed, and how many sought compensation.[3] Its figures describe groups of patients, not the outlook for any one person. Exposure histories are reconstructed from questionnaires.[7]
The compensation figures count claims filed and accepted, and the groups that filed more often.[3][10]
A site on the SPEA map marks a place, not a dose. The report treats site density as a proxy indicator of possible environmental exposure.[8]
What Comes Next
Santé publique France is building a new national mesothelioma surveillance system covering all of France. It will rely on mandatory notification of mesothelioma to estimate incidence at all sites in the body, on pathology diagnoses, and on regional occupational and environmental disease centres (CRPPE) to collect exposure information from newly diagnosed patients with pleural mesothelioma.[9]
Frequently Asked Questions
How many people in France develop pleural mesothelioma each year? The PNSM report gives about 1,100 new patients a year on average. The national figure is estimated from the program's sample, not counted directly.[3][5]
Is mesothelioma still increasing in France after the asbestos ban? Yes. France banned asbestos use in 1997. After adjusting for population ageing, incidence rose by 2% in men and 16% in women between 1998-2001 and 2018-2021.[3]
How often are women with mesothelioma exposed to asbestos at work? In about one case in three. For women, asbestos exposure outside work is the majority circumstance. The report cautions that the number of women in the program is small.[3]
How many French mesothelioma patients claim compensation? Among 4,569 patients under the general Social Security scheme, 56% filed an occupational disease claim before December 31, 2024, and 90% of these patients had their claims accepted.[10] One quarter took no step toward compensation at all.[3]
Does living near an asbestos site on the SPEA map mean a person was exposed? No. The map records site locations. The report uses site density as a proxy indicator and states that emission potential could not be characterised.[8][11]
Related Pages
- Pleural Mesothelioma
- Asbestos Exposure
- Secondary Asbestos Exposure
- Environmental Asbestos Exposure
- Shipyard Workers
External Links
The following resources offer additional information for patients and families.
- Danziger & De Llano, mesothelioma legal help: U.S. asbestos and mesothelioma law firm, for asbestos exposure that happened in the United States.
- Santé publique France: PNSM report summary (English): the agency's summary of the 2026 report.
- Santé publique France: mesothelioma publications: the agency's mesothelioma reports, in French.
References
- ↑ 1.0 1.1 1.2 Goldberg M, Imbernon E, Rolland P, et al. The French National Mesothelioma Surveillance Program. Occup Environ Med. 2006;63(6):390-395. PMID 16469823.
- ↑ Santé publique France. Cartographie nationale des sites potentiellement exposants à l'amiante : méthodologie et base de données géoréférencée (France hexagonale, 2023). September 2026. Abbreviations, p. 4.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 Santé publique France. Programme national de surveillance du mésothéliome pleural (PNSM) : 26 années de surveillance des patients ayant un mésothéliome, de leurs conditions d'exposition et des processus d'indemnisation (1998-2023). September 2026. Summary, p. 2.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Santé publique France. PNSM 1998-2023 report. September 2026. Section I.3 (inclusion criteria and geographic coverage), p. 20.
- ↑ 5.0 5.1 5.2 Santé publique France. PNSM 1998-2023 report. September 2026. Section I.4.1 (estimation of national incidence), p. 21.
- ↑ 6.0 6.1 6.2 6.3 6.4 Santé publique France. Cartographie nationale des sites potentiellement exposants à l'amiante (France hexagonale, 2023). September 2026. Section 4.1, p. 25.
- ↑ 7.0 7.1 7.2 Santé publique France. PNSM 1998-2023 report. September 2026. Section II.4.2 (exposure assessment), p. 46.
- ↑ 8.0 8.1 8.2 8.3 Santé publique France. Cartographie nationale des sites potentiellement exposants à l'amiante (France hexagonale, 2023). September 2026. Section 4.2 (geocoding), p. 26.
- ↑ 9.0 9.1 Santé publique France. PNSM 1998-2023 report. September 2026. Conclusion and outlook, p. 70.
- ↑ 10.0 10.1 10.2 10.3 10.4 Santé publique France. PNSM 1998-2023 report. September 2026. Compensation chapter, p. 61.
- ↑ 11.0 11.1 11.2 Santé publique France. Cartographie nationale des sites potentiellement exposants à l'amiante (France hexagonale, 2023). September 2026. Section 5.2 (limits of the database), p. 32.