Lung cancer

Active case finding urgently needed for silicosis epidemic: TSANZ

The silicosis epidemic uncovered among artificial stone cutting workers in Queensland is likely to be replicated in NSW but the state government has been accused of having no idea of the numbers.

An audit of 140 workplaces in Queensland has so far led to 25 workers having a diagnosis of progressive massive fibrosis and 151 being diagnosed with silicosis.

The audit of the engineered stone benchtop fabrication industry was started after respiratory physicians in Queensland noticed increasing numbers of accelerated silicosis cases in young workers exposed to silica dust.

But in NSW the government has admitted it recorded only 18 cases of silicosis in 2018 despite thousands of workers also being exposed to silica dust.

In a parliamentary inquiry into dust diseases, NSW public health officials said they had no plans as yet to follow the example of Queensland and Victoria in implementing recommendations from medical groups for active case finding and mandatory notification for silicosis.

The Lung Foundation of Australia and TSANZ recommended in a submission to the inquiry that a similar program to Queensland be implemented in NSW, where active case finding is undertaken, targeting workplaces involved in the manufacturing stone industry

Dr Jeremy McAnulty, director of health protection at NSW Health told a hearing these issues were being discussed at a national level and by the National Dust Disease Taskforce, and  said the responsibility for screening lay with the regulator SafeWork NSW.

However lawyers representing silicosis patients say the health and safety watchdog has failed to release precise details of its monitoring of workers for silicosis.

“It’s not clear if SafeWork NSW’s idea of “health monitoring” is simply a questionnaire or a thorough lung function analysis and CT scanning,” said Maurice Blackburn Principal, Jonathan Walsh .

“It’s time the NSW government took this issue seriously and immediately conducted a full audit and publicly released the figures so the true extent of the epidemic can be understood and planning can get underway to deal with it,” he said.

“The earlier the diagnosis, the more assistance can be offered to the worker who may still be a young adult or has a family to support.”

Dr McAnulty also told the inquiry that a mandatory notification and registry system for silicosis would be costly to operate and of uncertain benefit.

“[Our] experience, despite even where we put lots of effort into raising awareness among doctors, is that they are still very poor at complying with mandatory notification because they are busy doing clinical work and it is not on their minds,” he said.

“Relying on notification from doctors for silicosis, where there is no lab test, we believe is very likely to have a very low compliance rate and therefore be misleading—if the purpose of a register is to identify what the burden of disease is, misleading in how it would capture what level of disease there is in the community.”

The RACP backed the TSANZ recommendation for active case finding, saying in a submission that initial indications from the Victorian and South Australian screening programs indicate a similar crude prevalence of silicosis as seen in Queensland.

“With a sizeable manufactured stone industry in NSW, it is very likely there will be a significant number of cases in NSW. Professor Brendan Murphy, Australia’s Chief Medical Officer has described it as an epidemic, and in our view, it represents a crisis in the system that protects Australian workers,” it said.

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