Doctors have called for a ban on artificial stone being used for kitchen counters and worktops because of the risk of silicosis during its manufacture and fitting.
Australia last month banned engineered-stone worktops and kitchen counters nationally because of their health risks, and the British Occupational Hygiene Society issued guidance in June after warning it was seeing the first confirmed cases in the UK.
Now a team of doctors have urged the UK to follow Australia’s lead in the journal Thorax after treating the first eight cases of artificial stone silicosis reported in the UK.
Silicosis is caused by breathing in crystalline silica dust. Millions of people around the world are at risk of developing it as a result of their jobs in mining, quarrying, stone-cutting and construction.
Silicosis
Guidance to prevent silicosis in kitchen worktop manufacture issued
The research highlighted how the growing popularity of engineered or artificial stone – crushed rocks bound together with resins and pigments that has fewer natural imperfections and is easier to work with and harder to damage – has been accompanied by the emergence of a severe and rapidly progressive form of silicosis, or artificial stone silicosis.
This has been largely driven by its high (more than 90%) silica content compared with marble (3%) and granite (30%), and the fine dust it generates when cut.
When worktops are prepared for installation, they are also often ‘dry’ cut and polished with an angle grinder or other hand tools without the use of water to suppress dust generation, further boosting the volume of fine dust, the research has explained.
Cases of artificial stone silicosis have been reported from Israel, Spain, Italy, the USA, China, Australia and Belgium since 2010. But, while artificial stone has been used in the UK for a similar period, no cases had been reported until mid-2023, when eight men were referred to a specialist occupational lung disease clinic.
Their average age was 34 but ranged from 27 to 56 at the time of diagnosis. Six were born outside the UK and seven smoked or used to smoke.
Their average cumulative exposure to stone dust was 12.5 years but ranged from four to 40 years. Four of them had been exposed to stone dust for between four and eight years and it was estimated that 50%-100% of the materials they had used were artificial stone with, in some, additional granite, marble, and other natural stones.
All the men worked for small companies with fewer than 10 employees. Although none worked in worktop manufacture or installation, they all carried out the ‘finishing’ process, specifically cutting and polishing the worktops before installation.
They all reported that this was done without consistent water suppression, and without what they felt was appropriate respiratory protection. Even where workshop ventilation was present, the men stated that the system had not been serviced or cleaned regularly. None of them was aware of active airborne dust monitoring in the workplace.
Against medical advice, three continue to work with artificial stone, and have subsequently reported reduced exposure to visible dust after the introduction of powered respirators and water suppression.
Two are no longer working; one has continued to work but is no longer exposed to the dust; one has died; and one has been lost to further check-ups, the team highlighted.
“Onset of disease is likely to relate to exposure levels, suggesting levels, at least for some of the UK cases (and in particular the case of acute silicoproteinosis), were extremely high and implying that employers failed to control dust exposure and to adhere to health and safety regulations,” the research, led by Dr Johanna Feary of Imperial College’s London National Heart and Lung Institute, argued.
“The AS [artificial stone] market is dominated by small companies in which regulation has been shown to be challenging to implement. Furthermore, at least some worktop manufacturers may fail to provide adequate technical information relating to potential risks.
“Even with cessation of exposure, disease progression has been noted in over 50% of cases over [an average] of four years. Prevention of disease is therefore critical,” the team emphasised.
“A concerted effort is required in the UK to prevent the epidemic seen in other countries. The cases we present illustrate the failure of the employer to take responsibility for exposure control in their workplaces. 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 AS silicosis, implementation of health and safety regulation with a focus on small companies, and a UK ban on AS (as introduced in Australia in 2024) must be considered,” the article concluded.
In an accompanying editorial in the same journal, Dr Christopher Barber, a consultant respiratory physician at Sheffield Teaching Hospitals, has argued that the arrival of artificial stone silicosis in the UK is something “which has been feared by clinicians for some time”.
Greater awareness of, and guidance around, the disease is required among healthcare professionals, he emphasised.
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