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points. The structure was designed to maximize active dialogue, promote consensus-building, and engage participants across international time zones.
After the conclusion of the virtual sessions, the co-chairs convened a writing committee composed of themselves and selected presenters from each thematic area. The committee drafted the Workshop Report, organized around the four main themes: exposure science, clinical care, health equity, and policy / prevention. Drafts were circulated to all participants for iterative review and revision, with consensus reached through feedback and discussion. The final report was prepared for submission to the ATS for review and publication.
To develop an international case count, we searched PubMed through December 2025 using the following search terms:(( silicosis) AND( artificial stone OR engineered stone OR quartz OR countertop) AND( case)) and reviewed the resulting 99 articles and their references for case counts. This search included publications of any language. We supplemented this search of the published literature with a review of publicly available dashboards and reports and outreach to subject-matter experts, clinicians who care for patients with occupational lung disease, and public health officials in multiple localities. To examine patterns over time, we requested available data on case counts by year from workshop participants. We included cases identified through various mechanisms, including clinical care, regional or national screening programs, disease surveillance by public health authorities, and administrative records.
Epidemiology and Work Conditions
AS silicosis was first detected in Spain in 2002, as part of an investigation by the Labor and Social Security Inspectorate of Almería into a countertop slab manufacturer, describing three cases among workers at the factory. 13 The first publication of AS silicosis in the scientific literature was a 2010 case series of three young countertop fabricators from Asturias, Spain, which was shortly followed by reports of 58 more cases throughout Spain from 2011-2014. 14 – 17 These early reports were noteworthy, highlighting an accelerated form of silicosis occurring in young workers( mean age 29-39 years) with relatively short work tenures of 9 to 12 years on average. Subsequently, the Israeli National Lung Transplantation Service reported 25 patients with end-stage AS silicosis who were referred for lung transplant from 1997 to 2010. 18 All patients from the Israeli transplant center reported performing dry cutting of AS and had short exposure durations, highlighting the dangers of countertop fabrication.
Since the initial recognition of AS silicosis among Spanish and Israeli workers, cases have been identified in countries worldwide( Table 1, Figure 1a). An estimated 6,351 cases have been attributed to AS in the Americas, Europe, the Middle East, Asia, and the Pacific regions, with the highest case counts in Spain, Australia, China, Israel, and the United States. The precision of this estimate is subject to several factors. The use of administrative claims data in a few countries may have led to the inadvertent inclusion of some cases of silicosis unrelated to AS, thereby overestimating AS silicosis counts to some degree. This limitation is particularly relevant for Spain, where the reported figures also include compensation claims for silicosis related to the processing of natural stone, as these data cannot be disaggregated from cases specifically attributable to AS. 19 Conversely, the lack of systematic screening, universal healthcare access, and / or disease surveillance infrastructure in most countries, discussed in more detail below, means that cases go undetected or unreported, leading to more substantial underestimation of AS silicosis counts globally. 5 Therefore, although the true global burden of AS silicosis is not known, it is likely to be substantially higher than the nearly 6,400 cases estimated from available sources and to impact many other countries beyond the 12 listed. Furthermore, a temporal pattern of rapidly increasing case counts is notable in multiple locations( Figure 1b). The year of epidemic onset varies, with cumulative case counts rising first in Spain and Israel, followed by China( Shanghai), Australia, and the United States( California), likely reflecting, in part, differences in when AS was introduced in each location. 11
Several international studies have demonstrated a high prevalence of silicosis among AS-exposed workers. Initial reports from Spain documented prevalences ranging from 20 % to 55 % of exposed workers.
15, 17
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