- Department of Public Health
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Katheleen Conti, Assistant Director of Media Relations
BOSTON — The Massachusetts Department of Public Health (DPH) today issued a safety alert urging employers in the stone countertop fabrication industry to protect workers from silica dust exposure, following the first confirmed case of silicosis among this workforce in Massachusetts.
Silicosis is a preventable, yet incurable and progressive lung disease caused by inhaling crystalline silica, which is found naturally in granite and other stones. The state’s first confirmed case associated with occupational exposure in this industry was recently diagnosed in a Hispanic man in his 40s who, for the past 14 years, worked for stone countertop fabrication and installation companies in Massachusetts.
Processes like cutting, polishing, or grinding stone can generate silica dust, which can cause silicosis if breathed into the lungs. Historically, silicosis was associated with mining and construction, but in recent years, the disease has become more prevalent among stone fabrication workers due to the rise in popularity of countertops made from engineered stone (also known as quartz or artificial stone), which contains significantly more silica than other types of stone – over 90 percent compared to less than 45 percent in granite.
While this is the state’s first confirmed case of silicosis among this workforce, the growing number of cases recently reported in other states and countries linked to this industry suggests that additional, unconfirmed cases could exist in Massachusetts.
There is a long latency period between silica exposure and the development of silicosis. Silicosis is an often disabling and sometimes fatal disease that is characterized by scarring of the lungs. Early symptoms include an irritating cough, mucus, and shortness of breath. As the disease progresses, people may have difficulty breathing and can experience fatigue, chest pain, leg swelling, and blueish lips. Silicosis increases the risk for other lung diseases, such as lung cancer and tuberculosis.
Most engineered stone workers with silicosis in the U.S. were exposed to silica at their jobs for over ten years, although some were exposed for less time. There is no cure for silicosis, but exposure to silica dust can be minimized through proper workplace controls.
“Silicosis is a devastating, life-altering disease – and one that is also absolutely preventable,” said Public Health Commissioner Robbie Goldstein, MD, PhD. “Massachusetts employers in industries where workers are exposed to silica dust have a responsibility to protect their workforce, including from harmful airborne dust. No worker should have to suffer from a chronic and insidious lung disease or possibly die because of a preventable exposure at work.”
“The confirmation of this case in Massachusetts is a tragic reminder that silicosis is not just a distant threat – it is here, and it is seriously impacting the health of workers in Massachusetts,” said Emily H. Sparer-Fine, Director of DPH’s Occupational Health Surveillance Program. “Beyond the critical role employers play, everyone involved in the supply chain – from consumers and designers to contractors – can help reduce the danger by opting for materials that contain less silica and pose fewer health hazards.”
Most cases of silicosis are work-related – it is very rare for silicosis to occur outside of workplace exposure. The first reported case of silicosis in the U.S. associated with exposure to silica dust from engineering stone was identified in Texas in 2014. Since then, other states have reported hundreds of cases, and dozens of deaths, particularly in California. Cases have also been reported globally, with Australia going as far as banning the use and manufacture of engineered stone last year.
In the U.S., most engineered stone workers with silicosis are relatively young, male, and Hispanic/Latino. This largely reflects the demographic composition of this industry’s workforce. In 2023, over half of workers in this industry were under 45 years old, nearly three-quarters were men, and more than 1 in 3 were Hispanic/Latino, according to the U.S. Census Bureau.
Workers in other industries, such as construction and masonry, might also be at risk of exposure to silica dust when working with silica-containing construction materials, such as sand, stone, concrete, brick, or mortar.
By issuing this safety alert, DPH’s Occupational Health Surveillance Program is sounding the alarm to raise awareness among employers in Massachusetts about the hazards of silica and how to protect their workers’ health and safety. The program has also issued a hazard alert for countertop industry workers in English, Spanish, and Portuguese with information about silica dust, silicosis, and employees’ rights to a safe workplace. Preventing this disease is dependent on employers putting effective workplace controls in place.
In 2016, the U.S. Occupational Safety and Health Administration (OSHA) updated relevant rules to help keep stone countertop fabrication workers safer – for example, by requiring ventilation and other methods to limit exposure to respirable silica dust.
Other key workplace controls recommendations:
- Use effective dust control methods, such as wet cutting or proper dust collection systems.
- Make sure fabrication work takes place in well-ventilated areas.
- Follow housekeeping practices that minimize dust in the air, such as wet sweeping or using a HEPA-filtered vacuum (instead of dry sweeping).
- Periodically assess the levels of silica dust in the workplace.
- Enroll workers in a medical surveillance program that includes periodic exams by a qualified health care provider.
- Develop and implement a written exposure control plan.
- Train employees in their preferred languages on the health effects associated with silica dust and related control methods as part of a hazard communication program.
- Provide workers with appropriate respirators based on the task and ensure they are used correctly with an accompanying respiratory protection program.
Employers are also encouraged to utilize the state’s Department of Labor Standards’ On-Site Consultation Program, a free and confidential service designed to help them recognize and control possible safety and health hazards at their worksites and establish and improve safety and health programs. The goal of the service is to prevent injuries and illnesses that are the result of hazardous workplace conditions and practices.
Health care providers also play an important role in active surveillance of silicosis by being vigilant about asking their adult patients about their work, particularly if they have respiratory symptoms. Because symptoms can take years to appear, silicosis diagnosis is often delayed. Early diagnosis and timely intervention can help slow down the progression of the disease. Silicosis is a reportable condition in Massachusetts, and providers are mandated to report suspected cases to DPH.
Between the long latency period before symptoms show and the current demand for engineered stone products, additional cases of engineered stone-associated silicosis are, unfortunately, expected to emerge in the future. This is a growing occupational health concern that emphasizes the importance of coordinated efforts among public health, health care providers, employers, and regulatory agencies to prevent further cases and protect worker health.
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