A review of silicosis and other silica-related diseases in the engineered stone countertop processing industry

Engineered stone (ES), a material that has become widespread for its use in kitchen and bathroom countertops since the 1980s, is composed of over 90% crystalline silica by weight, significantly exceeding the silica content of natural stones such as granite (40–50%) and marble (< 10%). Workers fabricating ES are exposed to dangerously high levels of respirable crystalline silica (RCS) and other toxic chemicals, which increases the risk of developing silicosis and other lung and systemic diseases. The purpose of this review is to explore the epidemiology, occupational risks, regulatory gaps, diagnostic evaluation, and clinical challenges associated with ES dust exposure. ES silicosis was first described in the early 2010s among ES countertop workers in Spain, Italy, and Israel. Since then, hundreds of cases have emerged worldwide, namely in China, Australia, the United States, the United Kingdom, and Belgium. Silicosis from ES dust is accelerated and diagnosed after 7–19 years of exposure, often affecting young individuals (median age 33–55 years) from marginalized or immigrant communities. Morbidity and mortality are poor, with high rates of lung transplantation and death. Industrial hygiene air sample monitoring data shows that despite engineering controls such as wet saws and exhaust ventilation, exposure to respirable crystalline silica when cutting ES frequently exceeds safe exposure levels. Diagnostic evaluation and treatment are clinically challenging due to delayed medical screening, misdiagnosis, and lack of treatment options. This review underscores the urgent need for enhanced occupational safety regulations, active screening, and healthcare support to address the rising burden of ES silicosis among vulnerable worker populations globally.