[Truncated abstract] This thesis examines the health outcomes of women exposed to blue asbestos at Wittenoom, Western Australia. Blue asbestos was mined and milled from 1943 to 1966 by the Australian Blue Asbestos Company (ABA) at Wittenoom, 1,600km from Perth in the remote Pilbara region of Western Australia. The original work for this thesis is presented in six manuscripts, some of which have been published in peer-reviewed Journals. The following aims have been investigated. 1. (a) To compare the all-cause mortality rates of women who lived at Wittenoom compared with all-cause mortality rates of the Western Australian female population (b) To assess the exposure-response relationship between asbestos and mortality in women. 2. (a) To compare the incidence rates of common cancers in women who lived at Wittenoom, compared with the incidence rates of these cancers in the Western Australian female population. (b) To assess the exposure-response relationship between asbestos and cancer incidence at various sites in women. 3. (a) To determine if reproductive cancers (ovarian, uterine cervical and corpus and breast) and gestational trophoblastic diseases are associated with asbestos exposure. v (b) To determine if ovarian cancer has been misclassified as malignant peritoneal mesothelioma or vice versa. (c) To determine if colon cancer has been misclassified as malignant peritoneal mesothelioma or vice versa. (d) To assess the exposure-response relationship between asbestos and reproductive cancer incidence. 4. To assess the susceptibility of women to asbestos exposure in comparison with men with similar exposure histories. 5. To predict the future mortality from malignant mesothelioma among women who lived at Wittenoom. '...' The Wittenoom crocidolite industry has had a damaging impact upon the health of the women workers and residents who lived there. Wittenoom women are more likely to die from malignant mesothelioma and lung cancer, all cancers and all causes than women in the Western Australian population. This brief period of crocidolite mining in Western Australia's history will continue to exert a detrimental impact upon the future of the women who lived there, with another 66 to 87 mesotheliomas predicted to occur to the end of 2030.

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The commercial mining of asbestos occurred in four Provinces of South Africa (Northern Cape, North West, Limpopo and Mpumalanga). It was initiated in the late 1800's and lasted for over a hundred years into the beginning of this century. As a producer of amphibole asbestos, South Africa far outpaced every other country being responsible for 97% of global production. The last crocidolite mine closed in 1996 and chrysotile in 2002. Anecdotal information concerning environmental contamination as a result of the former mining activities and the improper disposal of mine waste tailings has been reported by a variety of authors. Few comprehensive or systematic surveys have been conducted to date to document this issue and very little quantifiable research has been completed on the communities located in close proximity to the former mine sites to determine the extent of contamination. In 2004-2006 communities were surveyed within the Northern Cape and North West Provinces to determine the extent and severity of environmental contamination. This research developed and applied a methodology to select those communities suspected of environmental contamination, a targeted survey methodology, and a protocol for rapid sample laboratory analysis. A total of 41 communities were initially predicted by the model to be suspected for environmental asbestos contamination. Based on the inclusion of local knowledge, a final 36 communities were selected for a screening-level field assessment, 34 of which were found to contain environmental asbestos contamination at rates ranging from 20 to 100% of the surveyed locations. A total of 1 843 samples of soil and building material were collected in the screening level assessment. One community (Ga-Mopedi) was selected as being representative of the total cohort and a more detailed house to house survey was completed. A total of 1 486 samples were collected during the detailed survey. Results of the detailed survey revealed 26.2% of the homes were contaminated with asbestos containing soil and/or building material. A theoretical quantitative cumulative exposure assessment was developed to estimate the disease burden within the study area population of 126,130 individuals within the surveyed communities resulting in a predicted range of 25-52.4 excess deaths per year from lung cancer and mesothelioma due solely to environmental exposures to asbestos pollution.