Mesothelioma in South Africa

The incidence of mesothelioma in South Africa ranks among the highest in the world. The hefty mesothelioma count stems from the country’s extensive history of asbestos mining and production over more than a century.

South Africa reports approximately 200 cases of mesothelioma per year. One 2002 study cites that more than 2,700 South Africans have died of mesothelioma, and researchers believe the cancer is vastly underreported.

Nearly 30 percent of mesothelioma cases in South Africa are tied to environmental exposure, most commonly in the Northern Cape area. More than 70 percent of reported environmental cases affect women and children, who most likely were exposed when miners brought home the fibers on their hair and clothes. Diseases like HIV and tuberculosis are serious health issues for the country, so exposed workers who die of these conditions before developing mesothelioma can skew statistics on the rare cancer’s true incidence.

A former global leader in asbestos production, South Africa once operated a thriving industry for more than a century. Extensive mining and use of the mineral in the past have resulted in thousands of deaths from mesothelioma, a rare and aggressive cancer almost exclusively caused by asbestos exposure.

Cause of Mesothelioma

Although doctors around the world noticed unusually high rates of lung disease in asbestos-exposed workers as far back as the early 1900s, Christopher Wagner, a South African pathologist, did not discover a definitive link between the exposure and cancer until 1960.

His journal article on the subject, “Diffuse Pleural Mesothelioma and Asbestos Exposure in the North Western Cape Province,” became the most quoted paper in occupational medicine and triggered a massive wave of research on related disease.

Wagner’s findings stemmed from a 1956 autopsy he performed on a South African man who worked at a gold mine — the setting for many harmful exposures. Tuberculosis was a serious endemic disease at the time, but doctors struggled to explain why patients living and working west of South Africa’s Kimberley area did not respond to treatment as well as those living elsewhere.

Wagner’s autopsy revealed no signs of tuberculosis, but instead a tumor in the patient’s right chest and a collapsed lung. He gained further evidence for his study from Dr. C.A. Sleggs, the chief medical officer of Kimberley Tuberculosis Hospital.

After collecting imaging scans from 14 patients who lived near an asbestos mine, Sleggs performed biopsies and confirmed the presence of mesothelioma. Shortly after, Wagner reported the link between the exposure and mesothelioma.

Many were shocked at South Africa’s response to Wagner’s findings. Senior officers of the Department of Health demanded industry review of future research papers. Despite evidence of serious risks to workers, the industry ramped up the output of crocidolite asbestos from 60,389 tons in 1960 to 155,477 tons in 1974.

Mesothelioma Treatment Centers in South Africa

Mesothelioma patients in South Africa can seek treatment from a number of cancer centers, including:

  • Sandton Oncology Centre (Johannesburg)
  • Chris Hani Baragwanath Hospital (Johannesburg)
  • Arwyp Medical Centre (Gauteng)
  • Wilmed Park Private Hospital (Klerksdorp)
  • Steve Biko Academic Hospital (Pretoria)
  • GVI Oncology (Bellville)
  • Netcare Unitas Hospital (Pretoria)
  • Lenmed Health (Johannesburg)

While these and other leading centers in South Africa can provide cutting-edge therapies to cancer patients, not all facilities have doctors who specialize in mesothelioma. Because this cancer is so rare, doctors sometimes misdiagnose patients or fail to identify the disease altogether.

Who Is at Risk?

South Africans most at risk for developing some form of mesothelioma are former asbestos miners. As miners excavated massive deposits of the mineral from the earth, they released clouds of toxic dust into the air. Workers and other people who inhaled the contaminated air significantly increased their risk of developing mesothelioma, sometimes 40 or 50 years later because of the disease’s lengthy latency period.

It was not only those miners who faced an elevated risk of developing mesothelioma and other respiratory illnesses later in life, but also miners of gold, diamonds and other minerals. Because the deadly mineral can form alongside a variety of underground mineral deposits, miners sometimes disturbed these deposits and suffered dangerous exposures.

Even outside of the mines, it was hard for people to escape danger. While the risks to miners were significant, the majority of mesothelioma cases in South Africa have stemmed from asbestos use in secondary industry. Three such industries known for high risks of exposure include:

  • Steam locomotive maintenance and other types of railway work
  • The asbestos cement industry
  • Artisans who used extensively used asbestos insulation, such as boilermakers

While miners and workers involved in manufacturing faced substantial risks for developing mesothelioma and other serious respiratory illnesses later in life, workers in dozens of professions in South Africa have lost their lives after harmful exposures. Those occupations include:

  • Asbestos milling
  • Construction
  • Insulation installation, repair and removal
  • Asbestos product manufacturing
  • Brake pad manufacturing and repair
  • Textile manufacturing and repair
  • Power station maintenance
  • Shipbuilding and repair
  • Power station maintenance
  • Construction
  • Welding

Environmental Exposure

During the mining process, asbestos would regularly go airborne and spread to nearby towns. When people inhaled the dust, they experienced what is known as environmental exposure. One field study conducted from 1960 to 1962 in the Northern Cape cities of Prieska, Kuruman and Koegas confirmed that people living in proximity to these mines and mills faced risks of contracting asbestosis, a noncancerous asbestos-related disease.

The authors also reported that “an alarmingly high number of cases with mesothelioma of the pleura had been discovered among people who have lived in the Northern Cape and that there is evidence that this condition is associated with exposure to asbestos dust inhalation which need not be industrial.”

Asbestos has heavily contaminated many parts of South Africa, most notably the Northern Cape Province. One report on the town of Penge concluded that ongoing risks of environmental exposure have rendered the area unfit for habitation. Even with the last asbestos mine closed, the Northern Cape still struggles with exposure risks from the region’s 82 remaining asbestos mine dumps.

Asbestos Use in South Africa

South Africa is a country rich with minerals, known worldwide for its ample deposits of gold and diamonds. The nation also has a long history of mining and exporting asbestos, a toxic mineral fiber linked to the rare and aggressive cancer mesothelioma and various other diseases.

Although South Africa officially banned the use, processing and manufacturing of asbestos-containing products in 2008, past exposures from decades ago eventually raised the country’s incidence of mesothelioma to one of the highest rates in the world.

Out of the six types of asbestos minerals used commercially, South Africa has mined three on a large scale: amosite, chrysotile and crocidolite. While South Africa has used asbestos domestically for a variety of different purposes, the vast majority of its mined reserves were exported to other countries.

South Africa was the third largest asbestos producer in the 1970s, behind Canada and the USSR. The nation was once a global leader in the production of crocidolite and amosite, supplying approximately 97 percent of the world’s crocidolite and practically all of the world’s amosite.

The asbestos mining industry in South Africa reached its peak in 1977, when it employed 20,000 miners and achieved an output of 380,000 tons. Exports began to decline soon after, as evidence of serious health complications prompted countries around the world to enact restrictive legislation on asbestos use.

Between 1910 and 2002, South Africa mined more than 10 million tons of asbestos. The last of the nation’s asbestos mines ceased production in 2001 and closed down the following year. South Africa outlawed all types of asbestos by 2008, but the once-lucrative industry has left the environment polluted. Asbestos exposure risks continue to threaten the well-being of South Africans to this day.

Exposure in South Africa

South Africa once operated numerous mines that provided the bulk of the world’s supply of the mineral. Over the years, mining at these sites caused large-scale occupational and environmental exposures to toxic dust.

The South African asbestos mines were owned by subsidiaries of major European corporations, including Griqualand Exploration and Finance Company Ltd., Turner & Newall Ltd. and the Cape Asbestos Company. These corporations cared little about the welfare of their South African workers or the people who lived near the mines. Health and safety standards at the South African mines were incredibly poor, especially compared with the mines the companies operated in Europe.

Because many of the South African mine workers — including women and children — were largely undocumented, it is difficult to assess the true scope of harm the mines caused. The country reports about 200 cases of mesothelioma per year, but most likely this is an underestimate.

Products

Asbestos’s natural resistance to heat, chemicals, acid and electricity made it a highly desirable material that served a wide range of uses. Manufacturers primarily used the mineral for insulation and fireproofing applications, but it has more than 3,000 documented uses.

In South Africa and worldwide, asbestos was once a popular material in:

  • Boilers
  • Steam pipes
  • Asbestos cement
  • Roofing and other construction materials
  • Steel supports in buildings
  • Air conditioning ducts
  • Textiles
  • Brakes, gaskets and clutch pads

However, the main pathway of asbestos exposure for South Africans has historically been work-related, primarily in professions like mining, milling, insulation work and asbestos cement manufacturing.

Legacy of Mining in South Africa

Many decades of asbestos mining and use in South Africa have taken a serious toll on the region and its people. And the spread of asbestos-related disease has extended far beyond the asbestos mines and mills. The mineral fiber contaminated many other areas as workers transported it by donkey, wagon, truck, train and ship.

Although South Africa has banned all mining, manufacture, import and export of asbestos and products that contain it, the toxic mineral persists in the environment. There are still massive asbestos deposits underground, and legal mining operations continue to unintentionally disturb them and stir up toxic dust.

Many older buildings and structures likely contain asbestos materials, which pose serious health risks to construction workers involved in demolition and repairs. Even though South Africa has outlawed the recycling of asbestos-containing materials, it still occurs because of a shortage of housing and building materials in the country. Additionally, the disposal of asbestos materials and the maintenance of asbestos dump sites continue to threaten the health of South Africans.

Litigation, class actions and out-of-court settlements have prompted some companies that once mined asbestos in South Africa to establish asbestos trust funds, including the Asbestos Relief Trust (ART) and the Kgalagadi Relief Trust (KRT). These trusts provide monetary compensation to qualified individuals who developed an asbestos-related condition after occupational exposures.

Access to the trust money is restricted to past employees of participating mines and people who lived near the mines who suffered environmental asbestos exposure. The trusts have also allocated some money to manage environmental contamination, but much more is needed to clean up the contaminated land, railways, mines and asbestos waste dumps that remain.

Additional Resources

  1. Abratt, R., Vorobiof, D. and White, N. (2002, May 10-11). Asbestos and Mesothelioma in South Africa. Science Direct. Retrieved from http://www.sciencedirect.com/science/article/pii/S0169500204001631
  2. Nelson, G., Murray, J. and Phillips, J. (2011). The Risk of Asbestos Exposure in South African Diamond Mine Workers. The Annals of Occupational Hygiene. Retrieved from http://annhyg.oxfordjournals.org/content/55/6/569.full
  3. Kahn, T. (2013, April 4). Sufferers in Lonely Battle with Asbestos-related Diseases. Retrieved from http://www.bdlive.co.za/national/health/2013/04/04/sufferers-in-lonely-battle-with-asbestos-related-diseases
  4. SouthAfrica.info. (2008, March 28). SA Bans All Use of Asbestos. Retrieved from http://www.southafrica.info/services/health/asbestos-280308.htm#.Uo90_-Igrpt

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