Maladies professionnelles
12/12/2024
Expert assessment
4 min

Recognition of occupational diseases: scientific evidence for revising the tables

Occupational diseases suffer from under-reporting and a lack of recognition. The procedures are based on occupational disease tables, some of which are obsolete in relation to current scientific knowledge and medical practice. ANSES has made several proposals with a view to making it easier to update the existing tables. As part of its expert appraisal work, it also identified some diseases not covered by the tables, which therefore need to be included in the work programmes of the occupational disease committees.

Recognition of occupational diseases is mainly based on a system of tables appended to the French Social Security Code and Rural and Maritime Fishing Code. If a person meets all the administrative conditions set out in the table for their disease, their case will benefit from automatic recognition. They do not need to prove the link between their illness and their occupational activity, as this is presumed.

However, advances in scientific and medical knowledge have rendered a number of the existing tables obsolete. This situation makes it harder to gain recognition as an occupational disease for employees who are victims of diseases giving rise to compensation, and ultimately contributes to the general lack of recognition of occupational diseases. This observation has been made on several occasions, notably by the Commission responsible for assessing the real cost of under-reporting of occupational accidents and diseases.

This led the Directorate General for Labour, the Social Security Directorate and the General Secretariat of the Ministry of Agriculture to make a formal request to ANSES, in order to obtain scientific evidence that could justify updating these tables. Any revision of the tables is based on a decision by the State, following an opinion from the occupational disease committees.

Several general recommendations for all tables

ANSES has made some general recommendations for updating the existing tables. It identified improvements to each of the three columns defining the administrative conditions for recognition:

  • the disease designation, which describes the symptoms or disorders that the patient must have,
  • The time limit for compensation, which is the maximum period between cessation of exposure and the first medical diagnosis of the disease,
  • the work/task likely to have caused the disease.

For the disease designation, the experts noted that certain tables require medical diagnostic procedures that are no longer carried out today. In order to take account of changes in medical practice, ANSES recommends that the diagnostic procedures no longer be detailed and that only the name of the disease be stated, accompanied where needed by the words "confirmed by the examinations recommended by scientific organisations or the High Authority for Health at the time of diagnosis".

With regard to the time limits for compensation, for a given disease, certain time limits differ between the tables of the general and agricultural schemes and even within the same scheme. Moreover, in some cases there is not enough time to carry out the medical examinations needed to ascertain the disease. The Agency therefore recommends reviewing all the time limits for compensation, in order to harmonise them and adapt them to medical care procedures for treatment purposes, as well as to the onset time of diseases. ANSES also recommends setting a compensation time limit of 50 years for all "solid" cancers, i.e. excluding blood cancers.

Lastly, the lists of tasks likely to have caused the disease are sometimes incomplete and do not mention all the activities currently known to pose a risk, particularly those involving exposure to harmful agents (e.g. chemical or physical agents). The Agency therefore recommends that these lists should no longer be restrictive but indicative, to enable them to include tasks involving exposure comparable to the activities listed. It also advocates exploring issues of multiple exposure in the workplace and interactions between exposures responsible for multifactorial diseases such as cancer and degenerative diseases.

Identifying occupational diseases not covered by the tables

In its expert appraisal, the Agency identified around 40 diseases with a proven or probable link to occupational exposure that were not covered by an occupational disease table. These diseases were primarily identified through work published by the International Agency for Research on Cancer (IARC) and ANSES, or from the lists of diseases eligible for compensation as occupational diseases in other European countries. These include cancers affecting various organs, as well as non-cancerous diseases such as cardiovascular disorders, mental and cognitive disorders, and respiratory diseases like asthma. ANSES recommends including this list of diseases in discussions on the work priorities of the occupational disease committees, and then where necessary initiating expert appraisal work that could lead to the creation of new occupational disease tables.