The National Mesothelioma Surveillance Program (PNSM) was established in 1998 by the French Institute for Public Health Surveillance. Its objectives are to estimate trends in incidence and the proportion attributable to occupational exposure, to contribute to research and the improvement of diagnostic techniques, and to evaluate the medical and administrative management of the disease. The PNSM records new cases in some twenty departments covering a population of 16 million inhabitants according to standardized procedures. This report presents the organization of the PNSM and a summary of the main findings from 1998 to 2006 regarding the annual number of new mesothelioma cases, their distribution by histological type, the industrial sectors and occupations with the highest risk, as well as the proportion of mesothelioma risk attributable to occupational exposure to asbestos and an assessment of the compensation process for occupational diseases. The PNSM is a large-scale surveillance system with several unique features, generating important information for improving knowledge of pleural mesothelioma, such as monitoring trends in its incidence, identifying at-risk occupations and industrial sectors, and improving pathological diagnostic techniques and medical-administrative management. (R.A.)