Silicosis in the Artificial Stone Countertop Industry: An Official American Thoracic Society Workshop Report
Year: 2026
Type: article
Abstract: Artificial stone-associated silicosis (AS silicosis) has emerged over the past decade as a severe, rapidly progressive, and preventable occupational lung disease affecting workers who manufacture, fabricate, and install artificial stone countertops. Characterized by short latency, accelerated progression, and high morbidity and mortality, AS silicosis disproportionately affects young workers employed in precarious conditions. In response to the growing global burden of disease, this American Thoracic Society workshop was convened in 2025 to review the current state of knowledge regarding AS silicosis, synthesize the current evidence, and identify priorities for research, clinical care, public health surveillance, and prevention. Workshop participants reviewed data spanning exposure science, epidemiology, clinical manifestations, health equity, and policy responses. Evidence demonstrates that artificial stone (AS) dust is highly toxic, containing high concentrations of respirable crystalline silica, resin-derived volatile compounds, and trace metals, resulting in exposures that routinely exceed occupational exposure limits. Despite widespread implementation of wet methods, ventilation, and respiratory protection, hazardous exposures persist across diverse settings globally, highlighting fundamental limitations of existing control strategies. Clinically, AS silicosis is associated with high rates of progressive massive fibrosis, autoimmune disease, infection, respiratory failure, and increasing need for lung transplantation. Treatment options remain limited, underscoring the importance of early detection and exposure cessation. The workshop identified critical gaps in medical screening and public health surveillance worldwide, with inconsistent regulatory frameworks, low compliance, underreporting, and delayed diagnoses. Case detection is often dependent on symptomatic presentation rather than proactive screening, exacerbating disease severity and inequities in care. International experiences illustrate both the consequences of regulatory inaction and the potential impact of decisive interventions, including Australia's prohibition of crystalline silica-containing artificial stone. This report concludes that AS silicosis represents a failure of primary prevention and calls for coordinated global action. Key priorities include strengthening surveillance systems, ensuring equitable access to screening and care, developing effective therapeutics, advancing exposure science, and implementing higher-order preventive strategies, including the elimination or substitution of high-silica AS. Without urgent and sustained intervention, these products will continue to impose devastating and avoidable harm on workers worldwide.
Authors: Sheiphali A Gandhi, Gabrielle Y Liu, Jane C Fazio, Olawale Amubieya, Hayley Barnes, Catherine Cavalin, Robert A Cohen, Elizabeth Fireman, Sandra R Garcia, Robert J Harrison, Jenny L Houlroyd, Jeremy T Hua, Catherine M Jones, Ling Mao, Chandnee Ramkissoon, Marc Schenker, Johanna Feary, R Reid Harvey, Alfredo Menéndez-Navarro, Benoit Nemery, Carrie A Redlich, Carl J Reynolds, Ryan F Hoy, Kristin J Cummings, American Thoracic Society Assembly on Environmental, Occupational and Population Health, Olawale Amubieya, Hayley Barnes, Catherine Cavalin, Robert A Cohen, Elizabeth Fireman, Sandra R Garcia, Robert J Harrison, Jenny L Houlroyd, Jeremy T Hua, Catherine M Jones, Ling Mao, Chandnee Ramkissoon, Marc Schenker, Johanna Feary, R Reid Harvey, Alfredo Menéndez-Navarro, Benoit Nemery
Institutions: University of California, San Francisco, University of California Davis Medical Center, University of California, Davis, University of California, Los Angeles, Olive View-UCLA Medical Center, Monash University, Centre de Recherche Médecine, Sciences, Santé, Santé Mentale, Société, Northwestern University, University of Illinois Chicago, Tel Aviv University, Georgia Institute of Technology, Colorado School of Public Health, National Jewish Health, University of Colorado Anschutz, University of Colorado Denver, The University of Sydney, Tongji University, Shanghai Pulmonary Hospital, The University of Adelaide, Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Imperial College London, West Virginia University, Universidad de Granada, KU Leuven, Yale University, Queen Mary University of London, Homerton University Hospital NHS Foundation Trust, The Alfred Hospital, Alfred Health, California Department of Public Health
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7166343480