Asbestos and mesothelioma in South Africa

Our plain-English summary of Asbestos and mesothelioma in South Africa, by R.P. Abratt, D.A. Vorobiof, N. White (Lung Cancer, 2004).

The study

• Authors: R.P. Abratt, D.A. Vorobiof, N. White
• Journal: Lung Cancer
• Published: 2004;45 Suppl 1:S3-6
• Type of article: Review
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Asbestos has been used by man since 4000 before the Christian era (BCE) in many different parts of the world and for a wide range of functions. Blue asbestos (crocidolite) was first discovered in South Africa in 1805 and within a few years was being mined there extensively. Mining reached its peak in 1977 with >380,000 tons being exported and 20,000 miners employed in the industry. South Africa also has large deposits of white asbestos (chrysotile) and brown asbestos (amosite) both of which have been mined extensively. At the turn of the 20th century, it was noted that those working with asbestos suffered lung disease and in 1960, the link between asbestosis and mesothelioma was established in the Kimberley area of South Africa. Further studies in the 1970s and 1980s showed an alarming incidence of mesothelioma based on pathology reports. The majority of the reported mesothelioma cases result from exposure to asbestos in its many uses in secondary industry although incidence of the condition among miners is also significant. A high proportion of mesothelioma in patients in South Africa is attributed to environmental origin with a high incidence of women and children affected.

In plain English

This article was a review, not a new study. The authors described the history of asbestos use and of asbestos mining in South Africa, and summarised earlier South African reports on mesothelioma. They wrote that crocidolite (blue), chrysotile (white) and amosite (brown or grey) asbestos were all mined there, and that mining peaked in 1977, with more than 380,000 tons exported and 20,000 miners employed. Citing a 1976 to 1984 series of 1347 cases by Zwi and colleagues, they reported that the age-standardised rate in white males rose from 23.6 per million in 1976 to 40.5 in 1984. Drawing on published case series of more than 500 cases, they stated that mining accounted for 40% of cases with known exposure, mostly linked to crocidolite. Most reported cases came from secondary industry. They reported that 26% of cases were attributed to environmental exposure, and that women and children made up more than 70% of those. The authors concluded that more than 2700 South Africans had died of mesothelioma and called the story "dismal indeed".

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of the history of asbestos and of published South African mesothelioma case series and registry data. No new study was reported.
• Who was studied: Mesothelioma cases in South Africa as reported in earlier sources: Webster's 232 cases from pathology reports, Zwi's 1347 cases diagnosed 1976 to 1984, South African National Cancer Registry cases since 1986, and case series covering more than 500 histologically proven cases
• Exposure: Crocidolite, chrysotile and amosite asbestos mined in South Africa. Exposures came from mining, from secondary industry (steam locomotive and railway maintenance, the asbestos cement industry, boilermakers and other artisans using asbestos insulation) and from the environment, particularly crocidolite in the Northern Cape.
• Main results:
  • South African asbestos mining peaked in 1977, with more than 380,000 tons exported and 20,000 miners employed
  • In Zwi's study (cited), the age-standardised incidence rate in white males rose from 23.6 per million in 1976 to 40.5 per million in 1984
  • In Zwi's study (cited), only 59% of biopsy-proven cases were known to the Central Asbestos Tumour Board
  • The male to female ratio of mesothelioma in South Africa was given as 2.5 to 1
  • In a 1960 Pneumoconiosis Research Unit survey (cited), 4.8% of the population outside the asbestos industry had asbestos fibres in their sputum
  • Across published case series, mining-related exposures made up 40% of mesotheliomas with known exposure. The majority of these were related to crocidolite.
  • The majority of reported mesothelioma cases resulted from exposure in secondary industry
  • 26% of mesothelioma in South African patients was attributed to environmental origin
  • Of all environmental cases, 93% originated from crocidolite exposure in the Northern Cape area
  • Women and children made up more than 70% of all reported environmental cases. The authors presumed this was due to asbestos brought home in miners' hair and clothes.
  • More than 2700 South Africans had died of mesothelioma
• The authors' conclusion: The authors concluded that the story of mesothelioma in South Africa was dismal. In their view, government officials had failed to prevent the disease, mine owners had focused excessively on profit, the legal system had offered no redress for environmental cases, and the medical community had had minimal impact. They noted some more positive recent developments, including closure of the last functioning mine (Msauli) and a settlement by Cape Asbestos PLC.
• Limitations the authors state:
  • The National Cancer Registry relied on passive reporting of pathology reports, which the authors said would under-report proven cases
  • Mesothelioma incidence in black South Africans was described as particularly under-diagnosed

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Crocidolite, Chrysotile, Amosite, Kimberley, Pathology Report.

Related studies

• Compensation for environmental asbestos-related diseases in South Africa: a neglected issue — N. Ndlovu, J.T. Naude, et al. (2013)
• Health effects of amosite mining and milling in South Africa — J. Murray, G. Nelson (2008)
• Excess mortality from stomach cancer, lung cancer, and asbestosis and/or mesothelioma in crocidolite mining districts in South Africa — J.L. Botha, L.M. Irwig, et al. (1986)
• Asbestos-related disease in South Africa: the social production of an invisible epidemic — L. Braun, S. Kisting (2006)
• Asbestosis in South Africa--certain geographical and environmental considerations — G.K. Sluis-Cremer (1965)
• Case-control study of mesothelioma in South Africa — D. Rees, J.E. Myers, et al. (1999)

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