Lung cancer

Warning of normal X-rays in silicosis patients

Chest X-ray findings range from “normal” in 43% of silicosis cases through to progressive massive fibrosis in 21% of the 78 cases identified in Queensland stonemasons since December 2018.

According to a retrospective review of the cases, chest radiographs appear to have a low sensitivity for silicosis in these workers.

“In these cases, the treating respiratory physician relied on high-resolution computed tomography (HRCT) and spirometry results for diagnosis,” the authors wrote in a Scientific Letter to the editor of Respirology.

“This is not a foreign concept, as other studies have reported higher sensitivity of HRCT than chest radiograph for screening of pneumoconiosis.”

“Further analysis comparing chest radiographs and HRCT in our subjects is underway and is expected to shed light on this observation and guide future pneumoconiosis screening programmes.”

The Queensland cases of either accelerated or chronic silicosis were all in men with a mean age of 34.1 years and about 13 years in the industry.

All men reported exposure to at least one high-risk work practice and most men (68%) reported exposure to all three known high-risk practices – occupational exposure to artificial stone for more than half their work history, using personal protective equipment for less than half their work time, and performing more than half their work using dry cutting techniques.

“It is in this frightening context that we have seen silicosis emerging as a health crisis amongst stonemasons,” the authors said.

They warned that the Australian Bureau of Statistics estimates only 13% of Australian stonemasons and bricklayers reside in Queensland.

“This suggests that Queensland’s stonemason health crisis may be dwarfed by other states once effective screening has been implemented.”

They said prevention of exposure to respirable crystalline silica was of the utmost importance given the lack of specific treatment.

“The appropriate response lies not only with those responsible for dust mitigation but also with the medical professionals entrusted to recognize occupational lung disease.”

“It is hoped by the authors that the health surveillance of these workers will be prompt and thorough, and that appropriate changes in this industry will prevent further significant exposures like those which have led to this industrial failure.”

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