Clinicians at the Royal Brompton hospital in London have warned about the dangers of silica exposure in a recent study published in Thorax. They are currently treating the first identified cases of silicosis caused by working with engineered stone in the UK and have called for a ban on artificial stone to ward off the potential for an increase in silicosis cases.
Opinion
Silicosis – time to wake up
By
on 01 September 2024
Engineered stone has increased in popularity in recent years and has been accompanied by the emergence of a severe and rapidly progressive form of silicosis, largely driven by its high (more than 90 per cent) silica content compared with marble (three per cent) and granite (30 per cent), and the fine dust it generates when cut.
This has led to a ban on engineered stone in California and Australia and has led to wider calls for a ban in the UK.
Jim Shannon MP is the Democratic Unionist Party MP for Strangford and chair of the All-Party Parliamentary Group for Respiratory Health.
While artificial stone has been used in the UK since 2010, no cases had been reported until mid-2023, when eight men were referred to a specialist occupational lung disease clinic. As silicosis is not a notifiable disease, there is no way of knowing if there were cases before 2023.
Their average age was 34 but ranged from 27 to 56 at the time of diagnosis.
The authors of the study stated that: “Onset of disease is likely to relate to exposure levels, suggesting levels, at least for some of the UK cases… were extremely high and implying that employers failed to control dust exposure and to adhere to health and safety regulations…The cases we present illustrate the failure of the employer to take responsibility for exposure control in their workplaces.”
Four improvements
The clinicians are calling for four improvements:
- National guidelines are urgently needed, as well as work to enumerate the at-risk population and identify cases early
- The introduction of a legal requirement to report cases of [artificial stone] silicosis
- Implementation of health and safety regulation with a focus on small companies
- A UK ban on artificial stone (as introduced in Australia in 2024) must be considered.
Yet, while these workers were being treated in hospital, a question was raised in the House of Lords in connection with engineered stone where the official answer was given that, “our information is that there are no official cases of silicosis reported in GB due to artificial stone exposure”.
This was clearly not correct at the time of the question and shows that there is a disconnect as the Government was not aware of the facts. This gives extra leverage to the recommendations of the clinicians.
There appears to be an overall lack of focus around silicosis and the Government, the Health and Safety Executive (HSE) and the silica-related industries need to wake up to the dangers before it is too late.
The All-Party Parliamentary Group (APPG) for Respiratory Health published a report on silicosis last year and discovered that silicosis is considered to be the most common chronic occupational lung disease worldwide.
It is a progressive, degenerative clinical respiratory condition which causes crippling health conditions and co-morbidities and can lead to death.
The NHS defines silicosis as “a long-term lung disease caused by inhaling large amounts of crystalline silica dust, usually over many years”.
HSE refers to silica as “the biggest risk to construction workers after asbestos”.
We found that an estimated 600,000 workers are exposed to silica in the UK each year and many more cases of silicosis could be undiagnosed and unrecorded.
The recent rise in the number of silicosis cases caused by engineered stone is alarming and when we consider that silicosis is progressive even if the worker is no longer exposed, the effects of silicosis are irreversible, so there is an imperative to act now to protect workers’ health and lives.
In all our considerations, the wellbeing and safety of workers and those exposed to respirable crystalline silica (RCS) is paramount and the APPG fully supports the first three of the recommendations – the introduction of a legal requirement to report silicosis cases is one of the recommendations we made in our report. It stopped being notifiable under the industry reporting system RIDDOR in 2013 and we are calling for the re-introduction of compulsory reporting under RIDDOR.
A ban is not the right way forward
The APPG does not agree, however, with the calls for a ban on engineered stone. A ban is not the right way forward as this would drive the engineered stone off-market and would diminish the need for vigilance when existing engineered stone fittings need to be renovated/removed.
It would therefore represent an unacceptable additional, unregulated, hazardous risk for workers which would place them at greater risk.
We are calling on all employers to take the necessary precautions to prevent silica exposure when cutting stone kitchen worktops.
There is new evidence that even in properly controlled environments working in industries with lower levels of RCS than engineered stone, workers might be in danger. A recent US study showed that construction sites that implemented all of the OSHA guidelines to control RCS regularly reported levels above the workplace exposure limit – with workers unaware of their exposure.
Robust detection system
We are also calling for a more robust detection system and are calling for real-time detection to be introduced into the industry as a better protection for workers.
At present, the method of detection for RCS is gravimetric sampling, where the results (and the indication of risk) can take weeks to be reported back. It only works retrospectively, and it can be a considerable time before workers know if they have been in a hazardous environment.
This is surely not good enough.
The APPG has spoken with a number of companies, both in the UK and abroad, which manufacture real-time detectors, using the latest technology, which can warn workers immediately if they are subject to over-exposure.
These systems offer a step change in detection and warnings would improve the current systems, rather than replacing them.
Silicosis is entirely preventable, and it is perhaps the only identified workplace preventable carcinogen that is not compulsorily tracked. As a consequence, it appears that the reality of what is happening in the UK in relation to silicosis is not known.
Greater awareness of the dangers of silicosis is needed across the silica-related industries but we believe that the impact of silicosis is being hidden.
Silicosis is rarely the recorded reason for death, but it causes significant co-morbidities – it increases the likelihood of developing other health issues such as tuberculosis, chest infections, heart failure, arthritis, kidney disease, chronic bronchitis, chronic obstructive pulmonary disease (COPD) and lung cancer.
There are discussions taking place to re-classify silicosis for regulatory purposes as interstitial lung disease. This would place it in the same context as fibrotic lung conditions and sarcoidosis. There is an enormous risk that if this is allowed to happen then the true nature of incidence and the figures of silicosis occurrence will be lost.
The Government has opportunities to get this right – the move to neighbourhood health services should recognise the regional variation in silicosis risk and enable local centres to concentrate more on diagnosis and treatment.
GP records should be updated to identify people who work in a silica-related industry, to act as flags for potential silicosis diagnosis on presentation in the following years. GPs need to better recognise the symptoms and the treatment options.
Most of all though prevention is everything.
While recognising that it is possible that the cases identified so far may have arisen from employers not effectively exercising the hierarchy of controls, much more needs to be done to effectively safeguard workers and increase prevention methods.
There appears to be a collective blindness to the dangers of silicosis, and it is time to wake up to its dangers and implement simple methods to prevent silicosis before more lives are ruined and lost – the Government needs to be brave enough to make the right decisions to make this happen.
Jim Shannon MP is the Democratic Unionist Party MP for Strangford and chair of the All-Party Parliamentary Group for Respiratory Health.
APPG report, Improving Silicosis Outcomes in the UK:
Follow Jim Shannon MP at:
