Post-retirement surveillance of workers exposed to asbestos or wood dust: first results of the French national SPIRALE Program.

Objectives: in France, 15 000-20 000 cancers attributable to occupational exposure occur each year. These cancers appear most often after the worker has retired. Since 1995, a system of post-retirement medical surveillance (PRMS) has been set up for former workers, but it remains largely underused. Design: the SPIRALE program is a public health intervention aimed at identifying the former workers having been exposed to asbestos or wood dust during their working life and to propose them a PRMS. Additionally, it is also an epidemiologic research on the long-term effects of occupational exposure. We report the results of first years of the program conducted in 2006-2008, in 13 districts. Setting and participants: a self-administered questionnaire was sent to 50 000 newly retired men, to identify potential past occupational carcinogen exposure. For respondents detected as possibly exposed, exposure was assessed in Health Screening Centres and a PRMS was recommended if necessary. Main outcome measures: participation rate, rate of confirmed exposure, increased rate of PRMS, satisfaction about the program. Results: the participation rate was 24%. From 12 002 questionnaires analysed, 72% of respondents were identified as possibly exposed: 3% to wood dust, 50% to asbestos and 19% to both exposures. Exposure to asbestos was confirmed for 73.4%, and according to the level of exposure, PRMS was recommended for 47.1%. Wood dust exposure was confirmed for 56.7%. In these districts, PRMS for asbestos increased by 45% and for wood dust by 600%. Additional surveys showed that participants showed a high degree of satisfaction about the program. Conclusions: The results are positive in terms of detection, information and medical surveillance of exposed workers.