Design and prioritization of the French surveillance program of health effects in the context of exposure to endocrine disruptors using a Delphi study

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BACKGROUND: Rapidly increasing evidence has documented that endocrine disruptors (EDs) contribute substantially to disease and disability, particularly neurodevelopmental disorders, metabolic diseases, reproductive disorders, immune and thyroid dysfunctions, as well as hormone-related cancers. These conditions can lead to chronic impairments and disability, such as learning and behavioral difficulties, infertility, long-term treatment dependence, or reduced functional capacity. Biomonitoring studies conducted in France have shown widespread exposure of the general population to several endocrine disruptors (phthalates, bisphenols, pesticides, PCBs, etc.), with particularly high levels observed among children. However, there is still too little epidemiological surveillance data. To address this gap, Santé publique France has undertaken a project to prioritize the health effects to be surveilled in relation to EDs, considering both scientific and societal criteria. Scientific criteria included the strength of evidence for ED-related causality, severity of health outcomes, and data availability. Societal criteria considered public concern, perceived vulnerability, and relevance to policymaking. METHODS: We conducted a consultation with experts and French stakeholders in the field of EDs using the Delphi consensus method from November 2021 to June 2022. A list of 59 health effects was submitted for prioritization. RESULTS: Several effects were prioritized by all the participants according to scientific, epidemiological and societal criteria, including certain effects on neurodevelopment in children (attention deficit disorder with or without hyperactivity, autism spectrum disorder), the metabolic system (e.g. overweight and obesity) and reproductive health (e.g. endometriosis, breast cancer, alteration in sperm quality, etc.). CONCLUSION: Based on the results of this consultation, Sante publique France will develop an integrated ED-related health surveillance strategy to identify and prioritize effective prevention strategies and actions in a context of uncertainty and lack of knowledge.

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