Screening remains the best hope for slowing progression of this incurable lung disease.
The recent spotlight on silicosis emerging in cutters of artificial stone, tunnel workers and other affected trades is not fearmongering but a kick up the pants for government regulators and employers, a respiratory expert tells ARR.
Dr Ryan Hoy, a respiratory and sleep disorders physician and senior research fellow at the Monash Centre for Occupational and Environmental Health, told ARR the numbers of cases of silicosis had dramatically increased since the emergence of the first case in Australia in 2015.
“In 2018, we reported a paper with seven cases around the country,” said Dr Hoy. “We just ended a review late last year to find how many cases had been reported publicly around the country at that time, and it was 579.
“There was quite a bit of media interest in the story back in 2018 and 2019. We were making quite a lot of headway in terms of increasing awareness about the problem at that time. “We had a national silicosis taskforce that was chaired by the Federal Chief Medical Officer. And then a certain virus hit.”
That caused significant delays, said Dr Hoy.
“Understandably, there were other concerns that developed in 2020. So, it’s been very good that there has been a resurgence of media interest about the issue, because it hasn’t gone away, and it hasn’t been completely addressed.”
Unions have also raised the alarm following a joint investigation by Nine Newspapers and 60 Minutes. Dr Graeme Edwards, a former member of the national taskforce, told Nine newspapers that the government’s lack of response was “tantamount to industrial manslaughter”.
Dr Hoy said the increase in cases was entirely preventable.
“One of the parts that is extremely frustrating and disappointing is that there are very well established regulations for silica exposure,” Dr Hoy told ARR.
“Crystalline silica is a defined hazardous substance. Under occupational health and safety law, you cannot be exposed over a certain, actually very small, amount. Workers in this industry will have been exposed to hundreds or thousands of times higher levels than that.
“Clearly there were failings in terms of recognition and enforcement of those regulations. Governments need to look at it as a systemic failing. [The increase in case numbers] is an indicator of systemic problems in terms of protection of workers from occupational diseases.”
The identification of a case was “a sentinel health event” requiring rapid response and investigation, he said.
“That definitely did not happen when it came to artificial stone silicosis. Again, the first case was identified back in 2015 and was reported at an international conference at that time, and it took several years before there was any significant action around the country.”
The bottom line for doctors facing the prospect of rising numbers of affected patients is screening. Early detection of silicosis is key to slowing the progression of the disease, said Dr Hoy.
“When it’s detected early, frequently, [the disease] won’t progress if the exposure is ceased.”
By the time symptoms appear, it is too late to stop progression, he said.
Red flags include signs of autoimmune diseases, particularly scleroderma, lupus and rheumatoid arthritis.
“We’re not sure as to the mechanism of that. We certainly know some of these workers have inhaled such a large burden of silica that it’s resulted in this inflammatory progressive disease.
“We’re still learning how we can identify those people that are more at risk of progressive disease. From a research point of view, it’s very early days of understanding this form of silicosis,” he said.
Patients who work in the stone benchtop industry need to be asked if they have been screened for silica-related disease, said Dr Hoy.
“That would be my first question. And if they haven’t, then now’s the time to have that discussion.”
Public consultations have been invited for the development of a national silicosis prevention strategy. Stakeholders can access the process via a consultation hub hosted by the Lung Foundation Australia.
“I encourage as many people as possible to, to have a look at it,” said Dr Hoy. We’ve got an opportunity at the moment to really help in terms of protecting workers from this exposure, which can cause such significant harm.”