A participatory approach

The monitoring committee brings together all stakeholders: members of the expanded project team responsible for the investigation, the “Stop Childhood Cancers” parents’ group, the prefecture (general secretariat), DREAL, elected officials (mayors and members of parliament), healthcare professionals (general practitioners, nurses, etc.), schools (school health coordinators, the regional education authority, URADEL—private education), and PMI. It was created with the aim of providing a space for dialogue and information-sharing with everyone.

Furthermore, to determine which studies to conduct, Santé publique France is engaging other agencies, notably: the IRSN, the DREAL…

Initial environmental investigations to “clear up doubts”

Based on specifications developed by Santé publique France, the ARS will conduct, in collaboration with relevant agencies (IRSN, laboratories, etc.), environmental investigations and sampling in the Sainte-Pazanne area. These initial investigations will draw in particular on the results of the first survey conducted in 2017 by the ARS and reports recently submitted by the “Stop Cancer in Our Children” collective.

These investigations are intended to quickly “clear up doubts” regarding certain environmental exposures and to implement management measures if necessary.

They will focus primarily on water, indoor and outdoor air, ionizing radiation, and electromagnetic fields in the living environments of children with cancer.

At the same time, the DREAL will conduct investigations into former industrial sites.

Three studies to better understand pediatric cancers in Loire-Atlantique

As part of the referral, Santé publique France is relying on a technical committee bringing together all of the agency’s expertise as well as the local registry. Following several working meetings, it was decided to launch two epidemiological studies and a sociological survey. These three studies will be conducted in parallel.

Two epidemiological investigations will be conducted by Santé publique France

• A first study to identify a possible common source of exposure that could explain the excess of reported childhood cancer cases.

The study’s methodology was presented to those present at the monitoring committee meeting on May 21. It covers all types of pediatric cancers identified between 2015 and 2019. The geographic study area includes 7 municipalities: Sainte-Pazanne, Port-Saint-Père, Saint-Mars-de-Coutais, Machecoul-Saint-Même, Villeneuve-en-Retz, St-Hilaire-de-Chaléons, and the municipality of Rouans, which is located near Sainte-Pazanne.
The municipalities bordering Sainte-Pazanne were included in the study area regardless of whether pediatric cancers had been diagnosed there, in order to maximize the chances of identifying a potential source of exposure that could be responsible for the observed cancers.

The epidemiological questionnaire currently being developed by the technical committee will be discussed with the Monitoring Committee. Interviews with the affected families will begin in June to gather information on their lifestyle, habits, and environment.

This initial study should provide data to help identify potential hypotheses to be investigated in a second phase through research studies.

• A second study at the departmental level will be conducted with the support of the registries. Its objective is to verify whether there is an excess incidence of pediatric cancers in the study area defined for the first study.

Finally, a local context study will be launched in May by Santé publique France. Its objective is to identify all local concerns, questions, expectations, local knowledge, and actions implemented locally. The data collected will supplement the information already identified during discussions with the Collective and site visits. It will be taken into account in the epidemiological studies.