Australia’s decisive step to ban engineered stone products linked to silicosis has been a world-first response, but lung disease experts are urging “ongoing clinical vigilance and long-term support” for workers, warning that “the work has only just begun”.
Writing in Respirology [link here] thoracic transplant physician Professor Dan Chambers – who pioneered whole lung lavage to treat acute silicosis – and colleagues warn that, as next-generation engineered materials step in to replace banned silica-containing products, new safety concerns may emerge.
Pointing to a recent Australian study [link here], Professor Chambers says some materials with low silica content have been found to release metals and volatile organic compounds that trigger inflammation in laboratory tests.
Meanwhile, amorphous silica, or “quartz glass,” a proposed alternative to crystalline silica, showed similar toxicity in lab and animal studies. Additionally, binding polymer resins – which add UV protection and shine – can emit free radicals when inhaled. Experts caution that despite these advances, rigorous monitoring remains essential.
The findings are important given silicosis screening challenges continue to persist. Standard tools, such as chest X-rays and lung function tests, often fail to detect early-stage silicosis, leading the authors to advocate for safer, more accurate screening alternatives.
“Research into safe, accurate, low-risk and easily accessible screening tools is required,” they note, pointing to emerging methods like ultra-low-dose CT scans and breath analysis. These advancements, they say, could significantly enhance early detection and disease management.
However, challenges in treating the condition are confounded by the fact that many cases of silicosis in the engineered stone industry show varied severity, even among workers with similar exposure, suggesting genetic factors may play a role, they write.
“It has been common to see workers who have endured almost identical exposure while working side by side in the same factory for the same period of time and with the same (inadequate) respiratory protection, and yet one worker will have developed progressive massive fibrosis, whilst the other remains well with simple silicosis, or is even unaffected.”
They say further research into genetic risk factors could enable personalised health monitoring and targeted treatment strategies in the future.
Registry challenge
The team also underscores the significance of Australia’s new National Occupational Respiratory Disease Registry, which mandates silicosis reporting. The Registry offers doctors a powerful tool for tracking occupational lung diseases and detecting emerging risks. Its success, however, relies heavily on clinician engagement in consistent and timely reporting.
“For this Registry to be successful, and to ensure a timely response to potential new epidemics, education and incentivisation for reporting clinicians, and transparency of data use and reporting is essential,” the authors maintain.
The paper also highlights broader health risks faced by silica-exposed workers, including chronic obstructive pulmonary disease and autoimmune conditions. The authors recommend comprehensive, long-term monitoring for these patients, especially for those from culturally and linguistically diverse backgrounds who may face additional healthcare barriers.
Looking beyond engineered stone, the authors warn of similar risks in industries like construction, mining, and tunnelling.
Noting that while silicosis is often straightforward to diagnose once people become symptomatic – especially in workers with a history of heavy exposure to respirable crystalline silica and typical CT chest findings – other conditions like sarcoidosis and respiratory bronchiolitis interstitial lung disease can look similar and need to be ruled out.
“Misdiagnosis can have serious consequences for affected workers, impacting their health, job recommendations, and access to compensation or legal support. New diagnostic tools, like measuring crystal burden in lung fluid or using AI-supported imaging, could help make diagnoses more accurate and ease this uncertainty,” they add.