The largest and most comprehensive study to date of workers in the stone benchtop industry has found an “alarmingly high” prevalence of silicosis and that the mandated screening tests are failing to diagnose those with the disease, meaning that current estimates of the incidence of silicosis are likely wide of the mark. The Monash University led study found that more than one quarter of people who had worked with artificial stone benchtops developed the preventable and potentially deadly disease, silicosis. Because of the rising rates of silicosis, all state and territories are currently working with the federal government to investigate the feasibility of banning or licensing artificial stone, which can contain up to 95 per cent silica, and is widely used to make kitchen and bathroom benchtops. This study, led by Dr Ryan Hoy and Emeritus Professor Malcolm Sim AM, from the Monash University School of Public Health and Preventive Medicine and published in the international journal, Occupational and Environmental Medicine, studied 544 stone benchtop workers to determine how many had silicosis and how accurate the current screening methods are in detecting silicosis. Currently, employers are mandated to screen workers at risk of silica exposure, which must include respiratory function testing (RFT) and chest x- ray (CXR). In addition, for this study, stone benchtop workers who hadhigh silica exposure also underwent secondary screening including high-resolution CT (HRCT) chest and respiratory physician assessment.
迄今为止，对石材工作台行业工人进行的最大规模、最全面的研究发现，矽肺病的患病率“高 得令人震惊”，而强制性的筛查测试未能诊断出患有这种疾病的人，这意味着目前对矽肺病发病 率的估计可能大错特错。 莫纳什大学领导的这项研究发现，在使用人造石工作台的人中，超过四分之一的人患上了可 预防的潜在致命疾病——矽肺病。 由于矽肺病的发病率不断上升，所有州和地区目前都在与联邦政府合作，调查禁止或许可使 用人造石的可行性。人造石含有高达 95%的二氧化硅，被广泛用于厨房和浴室的台面。 这项研究由莫纳什大学公共卫生与预防医学学院的 Ryan Hoy 博士和名誉教授 Malcolm Sim AM 领导，并发表在国际期刊《职业与环境医学》上，研究了 544 名石质工作台面工人，以确定 有多少人患有矽肺病，以及目前的筛查方法在检测矽肺病方面的准确性。 目前，雇主被要求对有二氧化硅暴露风险的工人进行筛查，其中必须包括呼吸功能测试(RFT) 和胸部 x 光检查(CXR)。此外，在本研究中，高硅暴露的石质工作台工人也接受了二次筛查，包 括高分辨率 CT (HRCT)胸部和呼吸内科医生评估。
The study found that, of the 544 stone benchtop workers screened: 95 per cent worked with artificial stone 86 per cent were exposed to dry processing of stone 76 per cent required secondary screening 117 out of the 414 workers (28 per cent) that had secondary screening with CT chest were diagnosed with silicosis. Of those diagnosed with silicosis, all were male mainly aged between 35 to 50 years. The average duration of work at the time of diagnosis of silicosis was just 12 years, and was as short as three years. Almost 60 per cent of people with silicosis were born overseas, mostly from Asian countries. Importantly, the study raised major concerns regarding the accuracy of mandated screening tests to detect the early signs of disease. In those diagnosed with silicosis using CT imaging, 72 per cent had normal respiratory function tests. “We also found that almost 40 per cent of people diagnosed with early stage silicosis by CT had a normal chest x-ray, meaning that the current screening approaches have limited value in this high-risk population,” Dr Hoy said. Silicosis may not cause any symptoms until late in the disease, so early accurate detection by use of screening tests is required.
研究发现，在筛选的 544 名石质工作台工人中: 1、95%的人使用人造石 2、86%的人接触过 石头的干法加工 3、76%需要二次筛查 在接受胸部 CT 二次筛查的 414 名工人中，有 117 人(28%)被诊断为矽肺。 在被诊断为矽肺病的患者中，所有患者都是年龄在 35 至 50 岁之间的男性。诊断为矽肺病时 的平均工作时间仅为 12 年，短至 3 年。近 60%的矽肺病患者出生在海外，主要来自亚洲国家。 重要的是，该研究提出了对检测疾病早期迹象的强制性筛查测试的准确性的主要关注。在使 用 CT 成像诊断为矽肺病的患者中，72%的呼吸功能检查正常。 Hoy 博士说:“我们还发现，近 40%通过 CT 诊断为早期矽肺的人胸部 x 线检查正常，这意味 着目前的筛查方法对这一高危人群的价值有限。” 矽肺病可能直到疾病晚期才引起任何症状，因此需要使用筛选试验进行早期准确检测。
“Although early detection provides the best outlook for a worker, there should be no cases of silicosis occurring. Detection of a single worker with silicosis is completely unacceptable and is a clear indication of failings in the systems that should be protecting workers,” Dr Hoy said. The first Australian case of silicosis associated with artificial (engineered or reconstituted) stone in the benchtop fabrication industry was reported in 2015. By last year 579 cases were identified in Australia and there have been increasingly frequent reports of silicosis in the stone benchtop industry internationally. According to Professor Sim, in comparison to silicosis associated with natural silica sources, such as mining, artificial stone silicosis has been found to be associated with a shorter duration of exposure, more rapid disease progression, and likely higher mortality . “Despite these health concerns, the use of artificial stone has grown at a rapid rate since its introduction to Australia in the early 2000s. Poor dust control measures have been widely reported in the industry, in particular the practice of ‘dry processing’, where water dust suppression has not been used during cutting, grinding or polishing of stone,” Professor Sim said.“This study of a large group of workers confirms an alarmingly high prevalence of silicosis. The sensitivity and positive predictive values of respiratory function tests and chest X-ray as screening tests to detect silicosis in this high-risk occupational group are inadequate.” The study’s authors recommended that “urgent action is required to improve occupational health and safety measures in the stone benchtop industry internationally, including the elimination of high silica content artificial stone”, and the inclusion of more sensitive chest imaging for mandated screening.
“尽管早期发现为工人提供了最好的前景，但不应该发生矽肺病例。发现一名工人患有矽肺 病是完全不可接受的，这清楚地表明本应保护工人的制度存在缺陷，”Hoy 博士说。 2015 年报道了澳大利亚首例与台式制造行业的人造(工程或重组)石材相关的矽肺病病例。截 至去年，澳大利亚共发现 579 例矽肺病病例，国际上关于石材工作台行业矽肺病的报道也越来越 频繁。 据 Sim 教授介绍，与天然硅源(如采矿)相关的矽肺病相比，人造石矽肺病已被发现与接触时 间较短、疾病进展较快以及可能较高的死亡率相关。 “尽管存在这些健康问题，但自 21 世纪初引入澳大利亚以来，人造石的使用一直在快速增长。 沈教授说:“业界普遍报导，粉尘控制措施不佳，特别是‘干式加工’的做法，在切割、研磨或抛光 石材时，没有采用水粉尘抑制措施。” “这项对一大群工人的研究证实，矽肺病的患病率高得惊人。在这一高危职业人群中，呼吸 功能检查和胸部 x 线检查作为矽肺病筛查试验的敏感性和阳性预测值是不够的。” 该研究的作者建议，“需要采取紧急行动，改善国际上石材工作台行业的职业健康和安全措 施，包括消除高硅含量的人造石”，并将更敏感的胸部成像纳入强制性筛查。