Accelerated Silicosis is an emerging epidemic that affects workers and stonemasons using manufactured stone materials, which are commonly found in kitchen, bathroom and laundry stone benchtops.
Accelerated silicosis is preventable with strict and appropriate work practices to control silica dust generation. Currently, there is major concern that dust control practices have generally been very poor in this industry resulting in many workers being exposed to extremely high levels of silica dust.
Accelerated Silicosis is an aggressive form of pneumoconiosis. It is caused by the inhalation of large amounts of respirable crystalline silica (very fine silica dust). This scars the lungs and causes progressive respiratory impairment. Accelerated silicosis progresses more quickly than chronic silicosis, developing within 3-10 years of exposure.
Once the disease has become established, symptoms include cough, breathlessness, tiredness and weight loss. These may develop after exposure to respirable crystalline silica has ceased, although continued exposure hastens the progression of the disease. There is currently no known treatment to arrest the progression of accelerated silicosis, apart from lung transplantation.
Historically, accelerated silicosis has been a rare disease in Australia. Now Australian jurisdictions are seeing a sudden spike in confirmed cases amongst workers involved in the production and installation of artificial stone benchtops. Cutting, grinding and polishing dry artificial stone exposes workers to respirable crystalline silica in far higher quantities than those found in natural stone. Installed benchtops present no risk to the general population.
In a recent health surveillance program in two Queensland stone masonry businesses, conducted by a senior occupational physician, one third (12 out of 35; 34%) of the workers assessed had accelerated or complicated silicosis.
At least 22 workers’ compensation claims for silicosis were lodged in Queensland in August – September 2018. Cases have also been diagnosed in NSW and Victoria. However, the prevalence and incidence of accelerated silicosis across Australia and New Zealand remain unknown.
AFOEM and TSANZ recommend that medical practitioners and occupational nurses ask all attending building industry workers about work with artificial stone.
If a patient has been exposed to artificial stone medical professionals are advised to:
- ask about respiratory symptoms, bearing in mind that in the early stages of the condition the patient will be asymptomatic;
assess the patient using CT and full lung function testing including diffusion capacity DLCO. Spirometry performed in a non-laboratory setting is associated with a significant false negative rate and may falsely reassure you and your patient. As outlined in the Royal Australian and New Zealand College of Radiologists’ (RANZCR) Position Statement on Imaging of Occupational Lung Disease, “CT is strongly recommended for screening all workers at risk of occupational lung disease from engineered stone exposure. Any concerns about the relatively higher radiation dose received from CT must be balanced against the benefits of a more sensitive test that reliably detects disease in exposed workers.” The RANZCR also recommends undertaking a baseline chest x-ray in combination with CT although chest x-ray lacks sensitivity and cannot characterise disease as accurately as CT. The RANZCR advises that “in selected cases this could allow a chest x-ray to be used as an alternative to CT in ongoing follow-up” and that “a quality PA chest x-ray optimised for assessing the lungs is recommended as a baseline test in conjunction with a CT chest.” Please refer to the RANZCR’s Position Statement on Imaging of Occupational Lung Disease for further information on imaging.
- if there are any concerns, refer to an occupational physician or respiratory physician for further assessment.
AFOEM and TSANZ also call for the establishment of:
- A national respiratory health surveillance program, with standardised methods of data collection; and
- A national occupationally acquired respiratory disease registry for notification of cases.
AFOEM and TSANZ have urged regulators throughout the country to follow the lead of the Queensland Government and immediately ensure silica dust levels are maintained at a safe level at all benchtop fabrication workplaces. Workplace silica dust levels must be measured independently to demonstrate compliance with the current regulations.
See frequently asked questions about the prevention, diagnosis and management of accelerated silicosis is attached.
Note: The information included on this page is valid as of February 2020. Clinical guidelines are currently being developed for engineered stone workers at risk of exposure to silica and the information on this page will be updated once these guidelines become available.