Occupational exposure to asbestos is responsible for the significant and steady increase in the incidence of pleural mesothelioma in industrialized countries. Available projections indicate that in France, the incidence of mesothelioma will continue to rise for at least another 2 to 3 decades. 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 the incidence of pleural mesothelioma and the proportion attributable to occupational exposure, to contribute to research and the improvement of diagnostic techniques, and to evaluate its medical and administrative management. In 2005, the PNSM recorded new cases of pleural mesothelioma in 18 departments covering a population of 16 million people. A standardized procedure for pathological and clinical diagnostic certification is implemented for each case. Lifetime exposure to asbestos and other risk factors (synthetic fibers, ionizing radiation, SV40 virus) is reconstructed, and a case-control study has been established. A specific study on the recognition of mesothelioma as an occupational disease is also being conducted. This report presents the main findings of the PNSM regarding the annual number of new mesothelioma cases, the industrial sectors and occupations with the highest risk, as well as the proportion of mesothelioma risk attributable to occupational exposure to asbestos. It also includes the results of pathological and clinical assessments, as well as an evaluation of the occupational disease compensation process. The PNSM is a large-scale surveillance system with several unique features, providing 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.)