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Overview
Since cases were first described in the scientific literature in 2010, artificial stone – associated silicosis( AS silicosis) has emerged as a globally important epidemic of preventable occupational lung disease. AS silicosis progresses rapidly, affecting young workers with relatively short exposure periods. The American Thoracic Society( ATS) convened a multidisciplinary, international workshop to review the state of knowledge and prioritize research, clinical, and policy needs.
Key findings
• AS silicosis is a largely preventable yet severe global epidemic that has rapidly outpaced existing occupational health and regulatory frameworks, with thousands of cases reported worldwide and many more likely unrecognized.
• AS dust has exceptionally heightened toxicity, driven by high crystalline silica content, ultrafine particles, trace metals, and resin-derived emissions, resulting in exposures that are more hazardous than those from natural stone.
• Existing exposure controls have failed to adequately protect workers, as engineering measures such as wet methods and ventilation do not consistently reduce respirable crystalline silica( RCS) levels below occupational limits, with overexposures documented despite the use of exposure controls.
• Health impacts are profound and often rapidly progressive, with accelerated disease trajectories, limited treatment options, frequent progression to progressive massive fibrosis, and cases requiring lung transplantation or resulting in premature death.
• The disease burden falls disproportionately on vulnerable worker populations, particularly immigrant and migrant men working in precarious or informal employment, who face limited regulatory protections and substantial barriers to healthcare access.
• Elimination of the hazard represents the most effective means of protecting all workers, and where elimination is not immediately achievable, coordinated action is urgently needed, including material substitution, enforceable regulation, robust medical surveillance, and equity-focused research and clinical care.
This document synthesizes discussions across four domains to highlight challenges and define actionable priorities: 1) exposure science, 2) clinical care, 3) health equity, and 4) policy / prevention.
Box 1: Key Terms
Artificial stone( AS): Composite stone slabs made of crystalline silica mixed with resins and pigments; used for countertops( also known as benchtops and worktops) and other decorative surfaces. Also called“ engineered stone,”“ reconstituted stone,”“ agglomerated stone,”“ silica conglomerates,”“ quartz agglomerates,”“ manufactured surfaces,”“ artificial marble,” or more commonly,“ quartz,” as in“ quartz countertops.”
AS Silicosis: Silicosis caused by exposure to AS dust, most commonly among countertop fabrication and installation workers. Compared to silicosis in many other industries, AS silicosis is notable for its shorter latency, more rapid progression, and poorer outcomes.
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Fabrication: Process of cutting, grinding, and polishing AS slabs to create customized countertops and other decorative surfaces.
Installation: Process of fitting a customized countertop or other decorative surface into place at the final destination, such as a residential kitchen. Often requires additional cutting, grinding, and polishing onsite, beyond that done during fabrication in the workshop.