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The Asbestos Post Exposure Survey (APEXS) screening program for asbestos-related diseases was organized at the request of the French Ministry of Labour and National Health Insurance between October 2003 and December 2005 in four regions of France: Aquitaine, Rhône-Alpes, Haute-Normandie, and Basse-Normandie.Retired or unemployed workers previously occupationally exposed to asbestos and covered by the General National Health Insurance fund (which covers more than 80% of the French population) were eligible for the screening program.Pleural plaques are circumscribed areas of thickening of parietal or diaphragmatic pleura composed of avascular collagen connective tissue.They are the most common disease in asbestos-exposed subjects ( 4 ).The epidemiology of asbestos-related diseases has been largely documented over recent decades ( 2 , 3 , 5 ).
As previously described, volunteers who agreed to participate had a free medical check-up that included chest CT scan and pulmonary function tests ( 12–14 ).
A large-scale pilot screening program for asbestos-related diseases was initiated in four regions of France in 2001 after a national consensus conference on the clinical surveillance strategy for workers previously exposed to asbestos, which proposed periodic chest CT scans and pulmonary function tests for workers with moderate to high exposure to asbestos ( 12 ).
This study was designed to examine the association between pleural plaques, detected on CT scan, and the risk of pleural mesothelioma in a 7-year follow-up study of formerly asbestos-exposed workers.
A cumulative exposure index (CEI) to asbestos was calculated for each subject over his working life as the sum of exposures calculated for each exposed job (duration × weighting factor).
Because of the absence of atmospheric measurements and the lack of detailed information on the frequency of exposure to asbestos (percentage of the working time), the CEI was expressed in exposure units × years rather than in fibers/m L × years.
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A statistically significant association was observed between mesothelioma and pleural plaques (unadjusted hazard ratio (HR) = 8.9, 95% confidence interval [CI] = 3.0 to 26.5; adjusted HR = 6.8, 95% CI = 2.2 to 21.4 after adjustment for time since first exposure and cumulative exposure index to asbestos).