Santé publique France presents the results of the epidemiological study

At the 5^th monitoring committee meeting, Santé publique France presented the results of the epidemiological investigation conducted since March 2019. These results were initially shared on November 8 with the participating families.

The epidemiological analysis confirms that the number of pediatric cancers in the area comprising the seven municipalities over the 2015–2019 period is higher than the average observed in France.

At the same time, the epidemiological questionnaire sought to identify the presence of a risk factor documented in the scientific literature for the area that would be common to the children. This work was conducted with the 13 families between July and September 2019. Analysis of this extensive data set did not identify exposure to any such risk factor that could explain the observed cluster of cancers.

The results of this work lead Santé publique France to conclude that there is a spatiotemporal cluster with no identified common cause. Thus, according to the Santé publique France investigation guide and, more broadly, international methodology, it is recommended:

• Not to continue epidemiological investigations locally

• Not to undertake additional environmental investigations or sampling

In this context, Santé publique France proposes to implement active surveillance in collaboration with the Nantes University Hospital to identify any new cases of cancer in the area. The same epidemiological investigation procedures will be repeated, and a questionnaire will be sent to them to document their exposures and the risk factors under investigation.

Current scientific knowledge regarding the causes of childhood cancers and the potential role of environmental exposures in this process remains limited. Fundamental research into the causes of pediatric cancers should, in the future, expand our understanding and thereby improve the investigative tools available to address public concerns regarding clusters of pediatric cancer cases.

Santé publique France is also working to expand knowledge and support research:

• The biomonitoring component of the Esteban study uses samples (urine, blood, hair) to measure the population’s exposure to various pollutants and metals. While these measurements do not predict health effects, they enable the formulation of recommendations to reduce exposure, provide reference values for the general population, and monitor changes in exposure to the substances in our environment.

• GEOCAP-AGRI is a national study conducted in partnership with the National Registry of Childhood Cancers and ANSES. It examines the risk of childhood cancers based on proximity to certain types of crops.

In September, Santé publique France launched the “Agir pour bébé” website: https://agir-pour-bebe.fr. The goal is to inform expectant parents and parents of newborns about the influence of environments (chemical, physical, social, emotional, etc.) during pregnancy and early childhood on their health and that of their child. The website features a wealth of practical advice based on scientifically validated information.

Analyses in housing units built on the former Leduc industrial site: no health risks identified

Investigations conducted by the DREAL regarding the former Leduc site, where roof trusses were manufactured, continued in September 2019 in the homes built adjacent to the industrial site. These analyses rule out the existence of any health risk linked to the former Leduc site for the residents of these homes. The results obtained demonstrate that the decontamination work carried out when operations ceased was effective. Through 78 samples, the in-depth investigations focused on soil, water (drinking and groundwater), and indoor and outdoor air.

The investigations conducted to date therefore rule out the Leduc site as a potential source of pollution. Further analyses are scheduled for January 2020 during the winter season to confirm the initial results. As a reminder, samples taken in July had already demonstrated that the Leduc site posed no health risk to Notre-Dame de Lourdes School.

The DREAL is also continuing its investigations into other potentially polluted industrial sites within the study area, given that the analyses conducted so far rule out these sites as potential sources of exposure for the population.

Investigations continue at the school and in the homes

Assessments were conducted by the ARS over the summer in 17 homes of children with cancer. Environmental measurements of water, indoor air, ionizing radiation, and electromagnetic fields are scheduled to be completed by the end of January 2020.

In addition, the second investigation campaign at Notre-Dame de Lourdes School will continue through the end of January 2020. It began with the installation of radon dosimeters in early October.

Taking Preventive Action to Improve Living Environments

At the request of stakeholders and elected officials, the ARS presented preventive measures that could be implemented to improve the living environments of residents in Ste-Pazanne and surrounding municipalities: radon risk screening, reducing pesticide exposure, health-promoting urban planning, combating substandard housing… These measures can be implemented in public buildings (schools, daycare centers, facilities open to the public, etc.), in private homes, and, more generally, in public spaces.

To support this initiative focused on prevention, the ARS and the mayors involved (Pornic Agglo Pays de Retz Urban Community) have decided to launch a process aimed at signing a Local Health Contract (LHC) in 2020. This collaborative and participatory initiative will begin with a shared assessment of health challenges and the expectations of residents in the urban community.

More information on the Local Health Contract: www.pays-de-la-loire.ars.sante.fr/le-contrat-local-de-sante-cls