Occupational cancers: can targeting and claim-requests be improved by using the French health insurance fund’s medical data?

Aims: To estimate the proportion of unrecognized occupational cancers which are inappropriately considered to come under the category of long-term illnesses (ALD) in the Montpellier area of France (approximately 550,000 covered individuals). Method: Between October 1, 2001 and October 1, 2002, we studied 212 requests for coverage under the category of long-term illnesses (ALD) for cancers which are included in the list of occupational cancers. The concerned patients were given the opportunity to be seen by one of the health insurance’s salaried advisor-physicians to provide answers to a medico-professional questionnaire (patients who were unable to come to the practitioner’s office received mail requests). If the answers to the questionnaire suggested the possibility of an occupational cause for the cancer, a thorough administrative study was undertaken to determine if the disorder should be processed as an occupational cancer claim. Results: We were able to study 134 questionnaires. The most frequently found cancers were lung cancer, cancer of the urinary bladder and leukemia (respectively 39 %, 38 % and 18 %). Occupation cancer was deemed possible in five cases (3.7 %); four of them were eventually recognized to be occupational cancers (3.0 %). Conclusion: This study showed that occupational cancers are under-recognized in the Montpellier area. In addition to sensitizing occupational and primary-care physicians to this fact, the health insurance’s medical service in Montpellier decided to systematically send a "screening" questionnaire to all attending physicians who requested coverage for patients with lung or bladder cancer under the heading of the long-term illnesses in order to assist in deciding whether an occupational disease is present. An assessment of the impact of these measures will be performed in late 2005.