By KERO SUN
A constant shortness of breath took Jay* to the respiratory clinic of The Alfred hospital, hoping to find out what the problem was.
After thee hours of medical check-ups and anxious waiting, Jay – a stonemason – was diagnosed with silicosis, a disease that can be fatal.
Silicosis, once largely confined to coal miners, is on the rise, largely due to the fashion for stone benchtops among people renovating their homes.
Like Jay, a range of men recently diagnosed with silicosis at The Alfred are all in their mid-30s and 40s and work as stonemasons in the benchtop industry in Melbourne. They have been referred for lung transplants.
Dust and destruction
Silicosis is an incurable disease that is caused by inhaling the tiny crystallised silica particles often found in the coal mining and construction industries.
In the current Australian benchtop market, the most popular product – usually made of artificial stone – contains silica dust as high as 85 per cent, whereas those made of granite and marble have only 30 and 2 per cent respectively.
The Alfred respiratory specialist Dr Eli Dabscheck says it can be easy to miss the early signs. “There are no symptoms in the early stage of the disease, so stonemasons may not be aware of it,” he says.
Accompanied by a cough and a progressive shortening of breath, the severe stage of the disease is extremely painful and will cause patients to gasp for air. The tiny particles of silica dust lodge in the lungs and generate scar tissue, which reduces the capacity to receive oxygen.
Trades Hall Council occupational health and safety lead organiser Dr Paul Sutton says new controls were needed in the industry.
“The current safety standard in relation to crystalline silica dust is outdated, and the dust disease controls in the working environment haven’t kept pace with technology," he says. “We need a new one.”
Jay, who still works in the industry, contacted Dr Sutton immediately after he was diagnosed. Jay is in his 30s and has only worked in this industry for four years.
The 2017 BMJ medical report Artificial stone-associated silicosis: a rapidly emerging occupational lung disease recommended "urgent action" to increase awareness of the risk of silicosis and the "stringent" implementation of effective dust control and health surveillance measures.
The Victorian Trades Hall Council launched a new safety standard in August this year, which reduces the current safety exposure by four times to 0.025 mg/m3 within an eight-hour time-weighted average.
Diagnoses on the rise
About 3.6 million current Australian workers have been exposed to cancer-causing components in their workplace. Crystalline silica is is one of the least recognised carcinogens in the construction industry.
The silica dust is generated in the stone cutting process, where stonemasons cut and finish the product before it is installed.
Respiratory disorders specialist Dr Ryan Hoy says the problem is widespread in the industry.
“Under these levels of dust exposure I would not be surprised that a quarter or third workers who work in the industry have silicosis,” Dr Hoy says.
Silicosis develops quickly compared to other lung diseases such as asbestosis, which usually takes decades to develop.
“We have got people in their 30s that have got severe lung disease caused by their work. The only solution is lung transplantation which will extend their lives for 10 more years,” Dr Hoy says.
Seven new silicosis cases were identified after an interview Dr Hoy had with The Age last year, and the number of patients keeps increasing.
“I’ve seen many patients this year; every week I see new cases,” he says.
The dry cutting procedure used in the industry is one factor driving an increase in patients. “The issue is not in the manufacturing, which is operated overseas. It is the cutting and processing locally without adequate protection mechanisms.”
Dr Dabscheck encourages stonemasons to use wet cutting procedures to prevent high-volume inhaling of silica dust and to minimise the potential lung damage the silica dust would do.
Call for a national registry
Law firm Slater and Gordon has registered more than 100 silicosis cases this year.
However, according to Dr Sutton, the reality is a lot darker. “The current registered number is only the tip of the iceberg,” he says.
Slater and Gordon principal Claire Setches says much more has to be done.
“There is an urgent need for better standards and policing for controlling dangerous dust emissions and improved health surveillance and monitoring for workers,” she says.
However, the total number of patients Australia-wide who are diagnosed with silicosis is unknown, and silicosis-related data is often outdated.
The Surveillance of Australian Workplace Based Respiratory Events (SABRE) program was a lung disease registry system set up by Australian Lung Foundation and operated by respiratory professionals.
This voluntary reporting registry stopped 10 years ago because of a lack of funding and resources.
SABRE's former chief investigator, Professor Malcolm Sim, says it would be “beneficial” to rebuild a registry.
“The registry can help identify new cases. By looking at the identifier of the patients, the data collection will ease the process and identify the particular disease," he says.
"We can also monitor the trends over time in the industry to ensure we have the necessary control measures.”
The Faulty of Occupational and Environmental Medicine (AFOEM) of the Royal Australasian College of Physicians (RACP) and the Thoracic Society of Australia and New Zealand (TSANZ) are putting together a proposal to build a national silicosis registry.
Dr Sutton says it's time to change the response to silicosis.
“It’s better that we are trying to prevent silicosis rather than just mopping up the human carnage that spurs from it," he says.
"This illness is completely preventable. We can stop it.”
*Not his real name.