Occupational disease
. Role of the physician making the diagnosis of mesothelioma
Pleural mesothelioma is recognized as an occupational disease in the event of exposure to asbestos: table MP 30 of the general regime and table MP 47 of the agricultural regime.
In tables MP 30 and MP 47, this refers to syndrome D with a theoretical management period of 40 years, with no duration of exposure.
Pleural, pericardial and peritoneal mesotheliomas have the same title in both tables of occupational diseases.
A professional pathology consultation can help establish recognition knowing that the list of work described in the tables is indicative and not exhaustive:
Consultation CHU de Besançon Prof. Jean-Charles DALPHIN 03.81.66.88.02
Dijon CHU consultation Pr Henri SMOLIK 03.80.67.37.48
Nancy CHRU consultation
Department of occupational pathology Dr THAON Isabelle 03.83.15.71.69
Strasbourg HU consultation Dr Gabriel NISAND 03.88.11.66.99
Consultation CHU de Reims - Hôpital Robert Debré Pr DESCHAMPS Frédéric 03.26.78.89.33
The declaration is to be made on a certificate in duplicate with the full contact details and registration of the patient, certificate sent by the patient to the AT-MP service doctor. The administrative form of AT or MP is not essential. The nature of the disease is indicated after notifying the patient. The patient must be registered in the National Mesothelioma Surveillance Program (PNSM), if it is in place locally and possibly registered in a register if it exists.
6.2. Role of the patient
The patient has a copy of the initial certificate, the main documents of his file for presentation during the consultation with the medical adviser and then possibly with a medical consultant.
If necessary, he receives the administrative investigator at his home to establish the professional summary and find the exposure.
He can request a case from FIVA, the asbestos victims compensation fund, created in 2000 (www.fiva.fr). FIVA provides compensation in addition to social security plans, regardless of occupational or environmental exposure and regardless of the patient's social protection. A toll-free number is available: 0800 500 200.
He can have recourse to the assistance of patient associations and request social and financial assistance from the League against Cancer.
6.3. Role of the Fund
Upon receipt of the certificate, the fund has three months to rule on the professional character and render its decision; it may decide to seek the advice of the Regional Committee for the Recognition of Occupational Diseases (CRRMP).
It ensures the investigation of the occupational risk with the patient, the occupational physician, the professional environment. Even occasional exposure to asbestos is sufficient to admit the occupational origin of mesothelioma.
The medical adviser, after possible advice from a consulting specialist, establishes a service in the form of a PPI, the rate of which depends on the symptoms and the treatment, the initial rate being between 70 and 100%.
6.4. Interactive methods of post-professional follow-up and screening "ASBESTOS"
According to HAS recommendations: April 2010
Issuance by social protection organizations of post-professional care.
Complete information allowing knowingly to carry out or not the proposed exams.
No demonstrated medical benefit from screening by thoracic CT examination for malignant pathologies (such as mesothelioma) in subjects who have been exposed to asbestos. However, taking into account the right of the subject exposed to asbestos to know his state of health and the existence of repair devices, a chest CT examination is proposed as part of the post-professional follow-up (SPP) according to the procedures fixed by the recommendations.
First scanner if minimum cumulative exposure duration of one year with minimum latency of 30 years or 20 years if high exposure, then periodicity of 5 years.
Possible management of a medical examination in the event of the appearance of intercurrent respiratory clinical signs.
Immediate medico-legal and social benefit of recognition regardless of lesions found to be benign or malignant and providing a better knowledge of the possible prognostic role of pleural plaques in mesothelioma.
7. Monitoring
If monitoring is to be performed, the appropriate examination is the CT scan.
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