​Key Messages

• Individuals with a history of working in cutting and finishing countertops are at risk for silicosis, a severe, incurable lung disease.

• More than 70 cases have been identified among California workers, including at least 10 deaths.

• Providers should educate and ask patients about their work and suspect silicosis in countertop fabrication workers.

• Providers and local health departments should report identified cases to the California Department of Public Health (CDPH).​
  

Back​ground

Since 2010, more than 1,000 cases of silicosis in workers who fabricate countertops have been reported worldwide. Workers in this industry can inhale crystalline silica dust as they cut and finish countertops, which places them at risk for silicosis, a severe, incurable lung disease.

 More than 70 cases of silicosis have been identified in California by CDPH since 2019, and at least 10 California workers have died, most of whom were in their 30s and 40s.

The workers with silicosis identified so far in California are characterized by:

• History of cutting and finishing stone countertops

• Working with engineered stone (also called “quartz"), an increasingly popular material with very high crystalline silica content, places workers at particularly high risk.
  

• Young age (median age at diagnosis is 45)

• Immigrant men, including from Mexico and Central America

• Symptoms of cough and shortness of breath

• Delayed diagnosis

• Common alternative initial diagnoses: pulmonary infections (pneumonia, tuberculosis (TB), non-TB mycobacterial infections), asthma, sarcoidosis

• Accelerated course, including severe impairment and need for supplemental oxygen, referral for lung transplantation, and/or death, sometimes within several years of diagnosis.

While silicosis is a serious disease, it is preventable with appropriate controls to reduce silica dust exposure. Identifying and reporting cases helps CDPH understand where workers are at risk and protect worker health.

Recommendations

Active surveillance by healthcare providers

• Identify countertop workers by asking patients about their current and previous occupations (“Have you done work cutting or finishing countertops?").
  

• Consider silicosis in both asymptomatic and symptomatic at-risk workers.

• Screen patients and make the diagnosis using imaging (chest X-ray, chest CT) and pulmonary function tests (spirometry, diffusing capacity).

• Refer early to pulmonary and occupational medicine providers for diagnosis and coordination of care.

• Share educational resources about workplace safety with all at-risk patients and advise them that:

• Inhaling any silica dust is dangerous; workers can help protect themselves by always using water to cut or grind countertops, using special vacuums to clean dust, and wearing a respirator, which must be fit-tested to be effective.

• Employers are required to reduce silica dust to keep workers safe. If a worker has concerns about workplace safety, they can contact Cal/OSHA for assistance.

• Report cases to CDPH by calling 1-800-970-6680 or emailing silicosis@cdph.ca.gov (please send via secure email if including any patient information).

Dissemination of Information and Case Reporting by Local Health Departments

• Disseminate information to healthcare providers in your community; primary care, urgent care, and emergency healthcare providers are often the first to evaluate workers with undiagnosed silicosis once they become symptomatic.

• Report cases to CDPH by calling 1-800-970-6680 or emailing silicosis@cdph.ca.gov (please send via secure email if including any patient information).
  

Resour​​ces

For more information, including educational resources for employers and workers on how to reduce silica exposures during countertop fabrication, and references for providers, please visit the CDPH Occupational Health Branch website. Additional information about silica and silicosis can also be found on the Centers for Disease Control and Prevention (CDC) NIOSH website, including information for healthcare providers about medical monitoring.  

Reference​s

Fazio J, Gandhi SA, Flattery J, et al. Silicosis among immigrant engineered stone (quartz) countertop fabrication workers in California. JAMA Internal Medicine. Published online July 24, 2023. doi:10.1001/jamainternmed.2023.3295​​