Surveillance of occupational cancers is a nationally recognized priority and is part of the various government Cancer Plans. In France, the current surveillance system is essentially based on the study of cancer mortality according to occupation. Except for mesotheliomas, there is no surveillance system for cancers linked to professional activity and sector of activity.
Public Health France has studied the feasibility of developing such a system in order to complete the indicators it produces and to reliably identify professional groups at increased risk of cancer: this is the Sicapro project, the results of the study driver are released today.
Occupational cancers in France
- In 2010, 12% of employees had been exposed to at least one carcinogenic nuisance (chemical carcinogens, ionizing radiation or night work for women).
- The proportion of cancer cases attributed to occupational factors is estimated at between 4% and 8.5%, or 15,000 to 33,000 new cases each year.
- It should be noted that several factors such as the latency period between exposure and the onset of cancer, lack of knowledge of exposure, etc., may indicate that a high proportion of occupational cancers are not recognized as such.
What is the Sicapro study based on and what are the results?
Linking data from cancer registries and CNAV data on professional careers
The surveillance system envisaged is based on the coupling at the individual level, of medical data from cancer registers with data on professional careers from the National Old Age Insurance Fund for employees of the general scheme (Cnav).
A pilot study was carried out with two voluntary registries (General Cancer Registry of Lille and its region and Tumor Registry of Doubs and the Territory of Belfort) which provided data concerning all cancer cases recorded for the years 2010-2014. The objectives of this study were:
- to study the performance of the matching using data on the civil status of people with cancer from the registers and those appearing in the CNAV data;
- to identify the professional history data available in the CNAV databases and to study the quality of this administrative data for the purpose of epidemiological surveillance;
- to develop the various indicators that could be constructed routinely for the final monitoring system and to study the limits of the approach, particularly in the identification of occupational exposure.
Eventually, an extension to all cancer registries and to all employee schemes will allow broader coverage with the aim of studying the incidence for rarer cancer locations and/or for business sectors at a finer level.
A reliable professional history over the last 20 years of careers
During this pilot study, 96.9% of cancer cases were found in the Cnav databases, which testifies to an excellent matching rate between the databases. The reconstruction of career histories, carried out with a view to measuring associations between the occurrence of cancer and sector of activity, also proved to be very satisfactory from the year 1999.
This study shows that it is therefore possible to have a reliable professional history over the last 20 years of careers, which seems sufficient including for studies relating to diseases with long latency periods such as cancers. The socio-professional category (CSP), useful for the production of cancer incidence indicators by CSP at the time of diagnosis, is also a parameter that can be used from the year 2012.
Sicapro: a monitoring system deemed effective
Despite the limitations highlighted during the pilot phase, the Sicapro monitoring system demonstrates its effectiveness in several respects:
- Little work overload because of an integrated system based solely on pre-existing data of very good quality and completeness
- Limitation to the maximum of all restrictive measures for patients and healthcare personnel
- Exhaustive collection by the registries of incident cases of cancer in their area
- Representative of the employee population under the general scheme and ultimately representative of all employees
Towards an extension to all registers and all employees for national coverage
Public Health France wishes to perpetuate the Sicapro surveillance system, by extending it to all registers for national coverage (including certain overseas departments – Guadeloupe, Martinique and Guyana), and to all employees . This last prospect is made possible thanks to the implementation by the Cnav from 2022 of the single career management directory (RGCU) aimed at centralizing the data of the careers of the insured persons of all the schemes.
Estimates of the incidence of cancers by profession or sector of activity represent information of interest for the description and understanding of the relationships between occupational risk factors and the appearance of cancer in the French population. They will make it possible to identify the professions or sectors of activity with a high incidence of cancer, and the changes over time in order to guide public policies intended to improve and evaluate the prevention and recognition of cancers of occupational origin. .
Thanks to the sustainability of this Sicapro monitoring system, France would have a specific monitoring system for cancers linked to professional activity. This would make it possible to strengthen the surveillance systems for cancers of occupational origin and to be part of the new ten-year strategy for the fight against cancer (2021-2030), in particular in the action aimed at better recognizing occupational exposure in order to better prevent occupational cancers.