[Review and perspective of a long-term follow-up of two cohorts of workers heavily exposed to asbestos].

National screening programs for detection of breast, colon and cervical cancers have been set up in France. Occupational cancers are excluded from these programs. Surveillance is left to the initiative of former employees who can initiate post-professional medical monitoring. This study describes an experience of such monitoring organised by the health insurance in collaboration with "victims". The long term follow-up, every two years, of 324 workers directly and heavily exposed to asbestos confirms the high risk of developing lung cancer, mesothelioma or asbestosis, the latter at times rapidly evolving. The early discovery of 3 bronchopulmonary cancers points to the interest of an annual or biannual routine screening. While new imaging techniques reduce by a factor of 8 irradiation, without significantly affecting the diagnostic capacity, the health benefit provided by annual monitoring scanner in heavy smokers favors an early detection program for lung cancers. The population targeted for such a screening (active or former smoker with pleural plaques) should be defined in more detail. The increasingly frequent observation of lung or pleural changes besides the populations at risk should also be considered. Therefore the detecting procedures applied to those workers indirectly or discontinuously exposed should be reassessed (only 1 TDM at 60 y, or on retirement, for the relevant occupations). These data suggest that the recommendation HAS 2010 for post-professional screening of workers occupationally exposed to asbestos should be reconsidered, particularly in case of pleural plaques. An organized screening program needs to be overhauled.