This program was established in 2012 to address concerns among residents living near the Fos-sur-Mer–Étang de Berre area regarding a possible excess of certain types of cancer in that region. The surveillance focused on three types of cancer—kidney, bladder, and acute leukemia in adults—selected as potentially linked to industrial environmental exposure. Analyses conducted at a very fine geographic level¹over the 2013–2018 period confirm the results published in 2019, namely that there is no excess of cases of these three types of cancer in the Fos-sur-Mer–Étang de Berre area compared to the rest of the department.

While the Observatory’s mission is coming to an end, Santé publique France is continuing and strengthening cancer surveillance through a system covering the entire country and is undertaking new research on a larger scale to characterize potential links between environmental and occupational exposures and population health.

Cases of bladder and kidney cancer and acute leukemia are no more common in Fos-sur-Mer – Étang de Berre than in other areas of the department

Two sets of analyses were conducted by the REVELA13 Observatory; the first, based on cases reported by healthcare professionals during the 2013–2016 period, had already been published in 2019, and the second, covering an additional two years, focused on the 2013–2018 period. The quality of the collected data now allows us to confirm the initial results previously published.

However, this research shows, over the periods studied, an excess of bladder cancers in the municipalities of Marseille and the southeastern part of the department, linked to higher population density and where smoking rates are estimated to be high. According to the scientific literature, smoking is believed to be responsible for approximately 65% of bladder cancer cases in men and 30% in women in developed countries. Furthermore, exposure to air pollution—classified as a known carcinogen by the International Agency for Research on Cancer of the World Health ^{Organization2}—has been positively associated with the occurrence of bladder cancer. In 2025, Santé publique France will conduct an ecological study to cross-reference the epidemiological data collected by the REVELA13 observatory with air pollution data for the Bouches-du-Rhône department, drawing on a local research team.

The REVELA Observatory13 has achieved its initial objectives in addressing the incidence of these three cancers. However, it does not provide answers to all questions regarding the impact of environmental and industrial exposures in the Fos-sur-Mer - Étang de Berre on the health of local residents, which goes beyond the sole issue of measuring incidence for these three types of cancer. Furthermore, as a population-based observatory, it cannot establish a link between these diseases and environmental and occupational exposures at the individual level.

The REVELA13 observatory will therefore not be continued beyond the consolidation of 10 years of data and the completion of the ongoing ecological study.

Santé publique France continues and strengthens its surveillance of cancers and other diseases linked to environmental and industrial exposures

Today, at the national level, the epidemiological surveillance of cancer conducted by Santé publique France relies on a hybrid system that draws on registries and the National Health Data System (SNDS), which covers the entire country. This system already provides data at the regional and departmental levels. As part of a collaborative work program with INCa, Francim, and the Hospices Civils de Lyon, Santé Publique France is participating in efforts to better understand the distribution of these conditions across the country—including at a more granular level—and to better describe the links between exposures and their occurrence. Furthermore, beyond cancers, environmental and occupational exposures potentially impact cardiovascular and respiratory health, as well as pregnancy and neurodegenerative diseases. Thus, SNDS data (hospitalizations, medication dispensing, and treatments fully covered by health insurance) also enable the monitoring of other conditions. Santé Publique France is already actively working to eventually produce, using the SNDS, health indicators—including cancer rates—at a detailed geographic level (i.e., below the departmental level) and thereby identify areas of excess incidence.

Santé Publique France also contributes to advancing scientific knowledge on the potential health impacts of industrial activity. Santé Publique France is currently working to establish a first-of-its-kind national epidemiological surveillance system aimed at specifically studying and monitoring the impact of industrial zones on the health of nearby populations. Several industrial zones are included in these studies, including the following in the Bouches-du-Rhône department: Fos-sur-Mer, Berre l’Etang, Martigues Lavera, Gardanne, and Marseille A feasibility study is underway and, if successful, will enable the implementation starting in 2026 of repeated monitoring over time to track several health indicators among residents (adults and children) of these industrial areas.

Finally, Santé Publique France is also developing the Sicapro system, which cross-references data from cancer registries with occupational history data from the National Old-Age Insurance Fund (Cnav). Its objectives are to identify sectors of activity with elevated cancer risks and to estimate cancer incidence by sector of activity and occupation at the time of diagnosis. This system should provide indicators by sector of activity, some of which are present in the Fos-sur-Mer – Etang de Berre area.

Santé publique France reiterates that, as part of enhanced environmental monitoring and regulatory oversight, measures to reduce emissions at the source and limit the exposure of residents and workers to emissions from industrial sites must be implemented and continued without delay.