Objectives - Established in 1998, the National Mesothelioma Surveillance Program (PNSM) has been in operation for twenty years. This article reviews the evolution of the epidemiological situation of malignant pleural mesotheliomas between 1998 and 2017 in France, in terms of incidence, survival, exposure of affected patients, and their use of medical-social compensation schemes. Methods - In the 21 departments covered by the program, a standardized procedure for active case finding and pathological and clinical confirmation of primary pleural tumors is implemented. Lifetime occupational and non-occupational exposures to asbestos and other factors under study are recorded. Recourse by mesothelioma patients to compensation schemes (occupational disease and the Asbestos Victims Compensation Fund—FIVA) is recorded and analyzed. Results - Among the 5,625 new cases recorded during the 1998–2017 period, diagnostic certification procedures (pathological followed by clinical) confirmed 82% of cases and excluded 6%, with 12% remaining uncertain. There was an increase in the estimated annual number of cases over the entire period, rising from 800 to 1,112 cases between the 1998–2002 and 2013–2016 periods. While occupational exposure to asbestos is still found in more than 90% of men, it is only 40% among women, and for 25% of them, no exposure was found. The use of compensation schemes remains insufficient, with 27% of patients covered by the General Social Security Scheme (RGSS) taking no action and 53% of those outside the RGSS not utilizing the Fiva. Conclusion - It is essential to strengthen prevention efforts targeting current asbestos exposure, among workers and young people in training as well as the general population and healthcare professionals. It is also important to increase information efforts, targeting healthcare professionals and patients, regarding the possibilities for utilizing medical-social recognition schemes. The implementation in 2021 of the National Mesothelioma Surveillance System (DNSM), which integrates the PNSM and mandatory reporting (DO), will make it possible to modernize and optimize the surveillance of all mesotheliomas (pleural and other sites) nationwide, adapt it to new challenges (including environmental exposures), refine the national exposure investigation system, and strengthen its integration with research efforts.