In 1998, the Directorate General of Labor (DGT) and the Directorate General of Health (DGS) of the respective ministries commissioned Santé publique France to establish a national surveillance program for the health effects of asbestos: the National Surveillance Program for Pleural Mesothelioma (PNSM), a specific marker of past asbestos exposure. To date, the PNSM has been in operation for twenty years. This report provides a comprehensive overview of the evolution of the epidemiological situation regarding pleural mesotheliomas in France between 1998 and 2017, in terms of incidence, survival, exposure of affected patients, and their medical and social recognition. Despite the ban on asbestos use in 1997 and due to the 30- to 40-year latency period between initial exposure and the onset of mesothelioma, the incidence of pleural mesothelioma continues to rise in France, and this increase is even more pronounced among women, with the number of new annual cases having doubled since 1998. Over the 2015–2016 period, an estimated 1,100 new cases of pleural mesothelioma occurred annually in France, 27% of which were in women. Furthermore, there is significant geographic variation in incidence. More than 90% of men have been occupationally exposed to asbestos during their careers. This proportion has remained stable since 1998, though there has been a shift in the problem from occupations involving the use and processing of asbestos to those involving work on materials containing asbestos (construction sector, asbestos removal, etc.). Among women, the proportion of occupational asbestos exposure remains low (approximately 40%), and 35% of women were exposed outside of work. This exposure most often occurs through living with spouses or relatives who are occupationally exposed, domestic exposure (objects or building materials in living spaces containing asbestos), or through DIY projects. For 25% of women, none of these exposure routes apply. The use of compensation mechanisms (recognition as an occupational disease and the Asbestos Victims Compensation Fund—FIVA) by people with pleural mesothelioma remains insufficient, with 27% of cases under the General Social Security Scheme (RGSS) taking no action and 53% of cases outside the RGSS not utilizing FIVA. There is a positive effect of the information provided by PNSM investigators regarding compensation schemes, resulting in a higher proportion of claims than in areas outside the PNSM. 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 essential to increase information efforts regarding the possibilities for utilizing existing medical-social recognition systems, both among healthcare professionals and among patients. The implementation of the National Mesothelioma Surveillance System (DNSM), integrating the PNSM and mandatory reporting (DO), will soon take effect. This will enable the modernization and optimization of surveillance for all types of mesothelioma (pleural, peritoneal, etc.) nationwide, adapt it to new challenges, refine the investigation system, and strengthen coordination with research efforts.