ASN Report 2018

deterministic effects and reduce the probabilities of cancers arising from exposure to ionising radiation, which are also known as radiation-induced (or radio-induced) cancers; the results of the studies as a whole seem to indicate that radiation-induced cancers represent the predominant health risk associated with exposure to ionising radiation. 1.2  ̶  Evolution of risks linked to ionising radiation The monitoring of cancer epidemiology in France is based on disease registries, on the monitoring of causes of death and also, more recently, on the utilisation of data from the PMSI (Medicalised Programme for Information Systems) of healthcare facilities and the Long-Term Disease (LTD) notifications. The registries are structures that provide “ a continuous and exhaustive collection of nominative data concerning one or more health events in a geographically defined population, for purposes of research and public health, managed by a team with the appropriate skills ”. At present there are 32 cancer registries in France. Some are “general registers”, concerning all types of cancer and covering one département or more; others are “specialised registers”, focusing on a particular type of cancer. Their geographical perimeter can vary (town, département , region, or even nationwide). Of the three national registers, one concerns pleural mesothelioma in the context primarily of exposure to asbestos fibres, while the other two cover all the cancerous pathologies in the child and adolescent up to 18 years of age (source: INCa). The aim of the register for a given area is to highlight differences in spatial distribution, to reveal changes over time in terms of increased or reduced rate of incidence in the different cancer locations, or to identify clusters of cases. Some registers, depending on the quality of their population database and their age, are used in numerous studies exploring cancer risk factors (including environmental risks). However, the registers do not necessarily cover the areas close to nuclear installations. French cancer registries (2018) 69 01 74 73 38 05 26 07 42 04 06 83 13 84 2B 2A 30 48 34 11 66 09 31 65 64 40 32 82 81 12 46 47 33 24 19 15 43 63 03 23 87 16 17 85 79 86 36 18 58 71 39 25 21 70 90 68 88 52 89 45 41 37 49 44 56 29 22 35 50 53 72 61 14 27 28 76 80 60 62 59 02 77 91 78 95 93 94 92 75 51 08 10 55 54 57 67 Guadeloupe Martinique La Réunion Guyane Nouvelle‑Calédonie General registry of tumours Specialised registry: (e.g. registry of cancers of the thyroid and the digestive tract, registry of haematological malignancies) including 3 national registries – Registry of solid tumours in children – Registry of haematological malignancies in children – National multicentric registry of mesothelioma ASN report on the state of nuclear safety and radiation protection in France in 2018  91 01 – NUCLEAR ACTIVITIES: IONISING RADIATION AND HEALTH AND ENVIRONMENTAL RISKS 01