In France, between 11,000 and 23,000 of the 280,000 new cancer cases diagnosed each year are believed to be caused by occupational carcinogens. Although these cancers most often develop after retirement, there is currently no standardized system for post-occupational surveillance of individuals enrolled in the various Social Security schemes. A regulatory framework dating from 1995 exists, but it applies only to former employees and is still rarely implemented, particularly because those affected are largely unaware of it, just as they are of their past exposures. Following the recommendations of the French Institute for Public Health Surveillance (InVS) in 2001 (the Espaces study), the Social Security Scheme for the Self-Employed (RSI) asked the InVS’s Department of Occupational Health (DST) in 2003 to establish the Espri program (Epidemiology and Surveillance of the Self-Employed). In its current phase, Espri focuses on the surveillance of tradespeople who have been exposed to asbestos during their careers, based on the recommendations of the 1999 Consensus Conference on the medical follow-up of people exposed to asbestos (the only existing reference protocol). The Espri program has two objectives: (i) a public health intervention, involving the identification of tradespeople who have been exposed to asbestos during their careers, in order to provide them with medical follow-up; (ii) an epidemiological study, involving the follow-up of the cohort identified, to describe past exposures and their long-term health effects, and to evaluate the program’s impact in terms of health benefits and compensation (as tradespeople have access to the Asbestos Victims Compensation Fund). In its pilot phase, Espri involved 2,334 craftsmen (88% men) from the Aquitaine, Limousin, and Poitou-Charentes regions who retired in 2004, representing approximately 15% of the eligible population across France. The subjects’ professional careers, collected via a self-administered postal questionnaire, were assessed for asbestos exposure, and a medical evaluation at no cost was offered to those who met the criteria. The launch of Espri, which took place in September 2005, was accompanied by a broad national and regional communication campaign. Based on data as of February 2007, Espri’s initial results are largely positive, with a 67% response rate to the occupational questionnaire (1,567 participants). Consistent with the target population, the majority of respondents are men (87%). On average, they are 61 years old (range: 55–91 years) and have been employed for 43 years. After reviewing each individual’s occupational history, a medical evaluation was offered to three-quarters of the subjects (1,155 subjects), who were considered to have been potentially exposed to an “intermediate” or “high” level of risk; nearly one in two subjects actually underwent the examination (471 subjects), most often with a general practitioner. For one-quarter of the 313 subjects for whom all examination data are available (78 subjects), the medical examination indicated the presence of at least one abnormality or condition that could be linked to asbestos exposure. Initial estimates of the prevalence of exposure among men in the population of retired craftsmen covered by the RSI indicate that approximately one in two individuals was exposed to asbestos during their professional career, for an average of 25 years. Based on the results of the pilot phase, the InVS recommends expanding the Espri program to all new RSI retirees. The high level of concern among artisans regarding "asbestos risk" and the generation of new epidemiological data in this population are the program’s major strengths. Moreover, this is one of the few programs in the field of occupational risks that combines individual medical follow-up with population-level epidemiological surveillance. With approximately 17,000 new retirees per year, the gradual expansion of Espri requires adapting the procedures and tools used, as well as a constant effort to raise awareness among healthcare professionals (particularly general practitioners, who are central to medical follow-up) and to train staff at participating facilities. In particular, Espri will need to take into account the recommendations of the High Authority for Health regarding post-occupational monitoring related to asbestos exposure, expected in 2008, which will revise the 1999 Consensus Conference. Finally, the prospect of rolling out the Espri program on a wider scale requires strengthening the partnership between the RSI and the InVS, and establishing a dedicated organizational structure. (R.A.)