Fellone L. Silicosi e “marmi artificiali”: occorre lavorare in sicurezza. (Nessun rischio riportato per gli acquirenti finali) [Corretto] / Silicosis and “artificial marbles”: need for safety at work. (No risk reported for home customers) [Revised]. Updating medicina del Lavoro – online first. DOI: 10.5281/ZENODO.15030.

No risk reported for home customers [REVISED]

by Dr. Lucio Fellone ( 4th year resident physician in Occupational Medicine at University of Siena.

ABSTRACT: Silicosis is a well-known occupational lung disease still present among us. Many workers are involved in the manufacturing and handling of products with high content of silica. On the 25th of October 2013 the Local Health Unit (ASL) of Empoli (Tuscany) provided an updating seminar on new risks of silicosis in marble factories. The present paper collected from scientific literature cases of disease in workers exposed during production, assembling and installation of artificial quartz conglomerates.

KEY TERMS: Silicosis; artificial marbles;  free crystalline silica.

Silicosis is one of the most famous occupational lung diseases. Uncommonly the disease is also named “Pneumonoultramicroscopicsilicovolcanoconiosis”[1] (the longest word in the English language). Silicosis is caused by respirable fraction (particles diameter between 5 and 0.5 μm) of free crystalline silica. Cumulative dose of silica (respirable dust concentration multiplied by crystalline silica content and exposure duration) is the most important factor in the development of the disease[2]. For this reason the illness can occur in three main ways: simple chronic silicosis (latency period of at least 10 years and as long as 40 years), accelerated silicosis (latency period of only 5 to 1 0 years) and acute silicoproteinosis (at high exposure in a period of months to 2 years)[3]. Freshly fractured quartz produces greater quantities of active oxygen species and more lung damage then does aged quartz[2].

The International Agency for Research on Cancer (IARC) evaluated crystalline silica in the form of quartz and cristobalite dust in the Group 1 of carcinogens (“There is a sufficient evidence in humans for the carcinogenicity – for lung cancer – of crystalline silica in the form of quartz or cristobalite”)[4]. The potential of silica exposure should be assessed before a job begins, especially in industries that have previous reports of silicosis. Periodic monitoring of respirable silica should be done in all industries with silica exposure[2].
On May 2012 a press release form the Local Health Unit (ASL) of Empoli[5] reminded us that silicosis is still present despite worldwide efforts (such as the ILO/WHO Global Programme for the Elimination of Silicosis – GPES[6]). Among people at risk there are workers of ornamental stones exposed to powder from new materials with high content of free crystalline silica (about 70-90%[7]). These conglomerates are composed of micronized and granulated silica bound in polymer resin.
The new artificial products are known with different names: “artificial quartz conglomerates” or “artificial silica conglomerates”[7,8], “artificial marbles” or “artificial stones”[9], “engineered stones”[10], “quartz-containing synthetic stone like materials”[11], “quartz-resine composites”[12]).
The materials are widely used in kitchens, bathrooms, bars and shop countertops. The products much better than marble (composed of calcium carbonate – inert dust!) are well characterized for resistance to wear and tear, chemicals, heat and stains.
In Italy and around the World there are various big “artificial marble” factories specialized in manufacturing and a lot of familiar-small ones for marketing and installation of these surfaces.
Workers at risk of exposure to high level of crystalline silica may be involved both in industrial processing (stone cutting, shaping, finishing)[11] and in households installation and assembling. Almost all the studies reported cases of silicosis in workers in small-familiar companies involved all day in the placing of these countertops without safety measures.
Three cases cited from Spain in 2009, 2 with simple silicosis and 1 with complicated silicosis, involved active workers of about 35 years old with 17 years experience in arrangement artificial quartz surfaces in houses and buildings[8].
Another Spanish article[13] reported 5 cases of simple silicosis and 1 of progressive one in a family-run marble workshop with 11 exposed workers at all. Five patients were home assemblers and one patient worked in the cutting workshop. A study from the National Lung Transplantation Center in Israel[10] reported 25 cases of endstage silicosis from 1997 to 2010 in workers involved in dry cutting engineered decorative stone with very high silica content without personal respiratory protection.
Other Spanish authors, after a preliminary evaluation of 6 cases of silicosis in young workers of small ornamental synthetic stone workshops in Cadiz[14], collected 46 cases of silicosis (91,3% with simple chronic silicosis) between July 2009 and May 2012[7]. At the time of diagnosis all the patients were active employers in 12 small family industries located in the province. The median age was 33 with 11 median working years and all of them were involved in manufacturing and installing of quartz conglomerate countertops.
Tuscany is not exempt from this problem. In 2012 the ASL of Empoli1 2 reported 7 cases of silicosis in workers exposed to respirable fraction of crystalline silica in manufacturing countertops. During the finishing operations the level of exposure exceed 20-fold the Threshold Limit Value of the American Conference of Governmental Industrial
Hygienists (ACGIH) for this powder (TLV=0.025 mg/m3).
In almost all reported cases the respect of basic safety and protection measures was very low or absent: dry cutting operations, no measurement of dust level exposure at work, no ventilation systems, poor use of personal protective equipment (like FFP3 masks), . . .
Physicians could be aware that silicosis is not a sporadic disease in the field of new “marble” materials and that some patients with simple silicosis could be asymptomatic and undiagnosed for a lot of time.
All of this is more than a simple alarm bell about the reemergence of a classical occupational disease. In all papers no risks for home customers were reported.

ERRATA FROM EDITORIAL BOARD: The presentv article is a correction of a previous one published on the Open Access Journal Updating Medicina del Lavoro on December 2013 that improperly cited the OKITE® market brand owned by Seieffe industries and supplied by Sic.S.r.l.. Seieffe industries and Sic. S.r.l., respectively manufacturer and supplier of the OKITE® market brand, point out that during all the manufacturing process current measures of safety and health protection are widely used to prevent any workers’damage .
We clarify that all health risks highlighted in this article concern workers in the sector and not concern home customers. In all scientific papers no risks for home customers were reported.

* The first version (13 October 2014) of the article is available on this link: 10.5281/zenodo.12245.

2. Leung CC, Yu IT, Chen W Silicosis. Lancet. 2012 May 26; 379(9830):2008-18. Epub 2012 Apr 24. www. 40-6736(1 2)60235-9/abstract.
3. Glazer CS, Newman LS Occupational interstitial lung disease. Clin Chest Med.2004 Sep; 25(3):467-78.
* Traduzione italiana dell’articolo: updatingmdl.
4. Silica Dust, Crystalline, in the form of Quartz or Cristobalite In. IARC 100 C monograph Crystalline silica. A review of human carcinogens – metals, arsenic, dusts and fibres. International Agency for Research on Cancer (IARC). (2011 ) IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Lyon, France: World Health Organization. Volume 100C. monographs. iarc. fr/ENG/Monographs/vol100C/mono100C-14.pdf.
5. Azienda USL 11 di Empoli, Silicosi, nuovi rischi nel comparto dei lapidei. Emersi 9 casi. COMUNICATO STAMPA del 15 maggio 2012.

6.ILO/WHO Global Programme for the Elimination of Silicosis (GPES) www.who. int/occupational_health/publications/newsletter/gohnet12e.pdf.

7. Pérez-Alonso A, Córdoba-Doña JA, Millares-Lorenzo JL, Figueroa-Murillo E, García-Vadillo C, Romero-Morillos J. Outbreak of silicosis in Spanish Quartz conglomerate workers. Int J Occup Environ Health. 2014 Jan-Mar;20(1):26-32.
8. Martìnez C. Prieto A. et al. Silicosis: a Disease with an Active Present. Arch Bronconeumol. 2010 Feb;46(2):97-100.
9http: //
10. Kramer MR, Blanc PD, Fireman E, Amital A, Guber A, Rhahman NA, Shitrit D Artificial stone silicosis [corrected]: disease resurgence among artificial stone workers. Chest. 2012 Aug;142(2):41 9-24. http: //
11. Phillips ML, Johnson DL, Johnson AC Determinants of respirable silica exposure in stone countertop fabrication: a preliminary study. J Occup Environ Hyg. 2013 ;10(7):368-73.  doi: 10.1080/15459624.2013.789706. [Pubmed].
12. Bartoli D, Banchi B, Di Benedetto F, Farina G A, Iaia T E, Poli C, Romanelli M, Scancarello G, Tarchi M Silicosis in employees in the processing of kitchen, bar and shop countertops made from quartz resin composite. Provisional results of the environmental and health survey conducted within the territory of USL1 1 of Empoli in Tuscany among employees in the processing of quartz resin composite materials and review of the literature. I tal. J. Occup. Environ. Hyg. 2012;138-143. [Abstract].
13. Pascual S, Urrutia I , Ballaz A, Arrizubieta I , Altube L, Salinas C  Prevalence of silicosis in a marble factory after exposure to quartz conglomerates. Arch Bronconeumol.2011 Jan;47(1)
14. García Vadillo C, Sánchez Gómez J, Romero Morillo J Letters to the Editor: Silicosis en trabajadores de conglomerados de cuarzo Arch Bronconeumol.2011;


Notes from the field: Silicosis in a Countertop Fabricator — Texas, 2014. MMWR Morb Mortal Wkly Rep.2015 Feb 13;64(5):129-30.

Worker Exposure to Silica during Countertop Manufacturing, Finishing and Installation-OSHA • NIOSH – DTSEM 02/2015.

Seminar reports – EU-Israel Workshop on Issues Associated with Silica and Artificial Stone – EU-OSHA – 28 January 2015.

Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.



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