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This study reports an alarming prevalence of silicosis in Victoria, Australia at 28.2% among workers in the stone benchtop industry (SBI).  That prevalence is higher than reported in SBI workers in another Australian state of Queensland (22.7%).  The Victorian silicosis screening program reported respiratory function tests and chest x-rays to be of limited value in screening this high-risk population which has significant implications for health and safety policy. It also calls into question the adequacy of current screening programs in other Australian States and Territories.
In the adjoining state of New South Wales (NSW), Australia, there has been an obligation on the health and safety regulator (SafeWork NSW) to maintain a Dust Diseases Register and to provide a report on the Register at the end of each financial year since October 2020. This information is provided and published in the NSW Dust Disease Register Annual Report. However, no information is provided on the total number of workers screened (or the denominator) to enable understanding of the incidence and prevalence of silicosis in NSW.
A desk-based “case finding” study from May 2021 in NSW estimated the average incidence (new cases) of silicosis among engineered stone workers in NSW at between 4% and 9% for the three-year reporting period, and suggested that incidence values may also be considered as the estimated prevalence within SBI workers.  This prevalence estimate is significant...
A desk-based “case finding” study from May 2021 in NSW estimated the average incidence (new cases) of silicosis among engineered stone workers in NSW at between 4% and 9% for the three-year reporting period, and suggested that incidence values may also be considered as the estimated prevalence within SBI workers.  This prevalence estimate is significantly lower than that reported in the neighbouring states.
In late 2022, a member of the NSW Parliament requested documents relating to information held by Insurance and Care NSW (icare) for its silicosis screening program under Standing Order 52 (SO52).  This resulted in information becoming publicly available, including the documents created since 1 January 2020 relating to the NSW silicosis screening program.  Contained in these documents was data on the number of people screened from specific industries (including engineered stone), the number of cases reported, and information on screening methods used. That information was reviewed with regard to silicosis prevalence in the NSW SBI and compared the figures with the findings of that reported in the neighbouring states of Victoria and Queensland.
The SO52 information confirmed a prevalence of silica related diseases (SRD) of only 7% in NSW SBI workers. This prevalence represents approximately 25% of that reported by adjoining states for the same period.  This low reported prevalence in NSW is more likely to reflect differences in respiratory surveillance methods between NSW and neighbouring states rather than a difference in SRD statistics and health protection. For example, CT scans were offered to workers as part of the NSW icare health screening program, but were only used for 18.8% of NSW workers.  CT scans are more sensitive in comparison to chest x rays in detecting early disease, and reliance of x-ray may have influenced the NSW results. It should also be noted that in NSW, although it is mandatory for workers in the SBI to be screened, it is not mandatory for employers to use icare services, and private contractors can be employed. This can result in a statistical bias because there is no mandatory reporting for results to the NSW silicosis registry in the absence of diagnosed disease. This is despite recommendations having been made by the Thoracic Society of Australia and New Zealand (TSANZ) in 2020;  and as part of the review into the Dust Diseases Scheme in 2019 to include this data, along with the standardisation of health assessment method. 
The findings of the Victorian screening program confirmed that relying on symptoms, spirometry screening or chest X-ray will miss many cases of silicosis and silica-related disorders, and that the prevalence of silicosis and SRDIs in the SBI in Australia is shockingly high.  If the prevalence in NSW is truly closer to that reported in Queensland and Victoria (between 22 and 28%), then more than 400 cases of SRDIs are expected based on the numbers of workers screened by icare. This would represent a shortfall of over 200 undiagnosed workers in NSW that may not be receiving essential care and support. It seems likely that cases in NSW are being underestimated.
Existing systems for the discovery and reporting of SRDI cases need urgent updating. More comprehensive and accurate data is urgently needed on the prevalence of SRDI’s in NSW to better inform health policy and prevention efforts; and to reduce the burden of preventable disease on these workers and their families.
1. Hoy, R.F., et al., Prevalence and risk factors for silicosis among a large cohort of stone benchtop industry workers. Occupational and Environmental Medicine, 2023: p. oemed-2023-108892.
2. SafeWork NSW, NSW Dust Disease Register Annual Report 2020-21. 2021.
3. Golder Associates Pty Ltd, Case Finding Study - Respirable crystalline silica exposure in the NSW manufactured stone industry. 2021.
4. WorkSafe Queensland. Silicosis - Workcover Screening Outcomes. . 2022 [cited 2023 23 June]; Available from: https://www.worksafe.qld.gov.au/claims-and-insurance/work-related-injuri....
5. Parliament of New South Wales, Legislative Council Minutes No. 149. 2022. Available from: https://www.parliament.nsw.gov.au/tp/files/83469/Resolution - SafeWork NSW and Insurance and Care NSW (icare) - 16 November 2022.pdf
6. Department of Premier and Cabinet, Order for Papers - Supplementary Return - SafeWork NSW and Insurance and Care NSW (icare). 2023.Available from: https://www.parliament.nsw.gov.au/tp/files/83926/SO52%20Index%20-%20Supp...(icare)%20-%2012.01.2023.pdf
7. Perret, J.L., et al., Respiratory surveillance for coal mine dust and artificial stone exposed workers in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand*. Respirology, 2020. 25(11): p. 1193-1202.
8. Justice, S.C.o.L.a., 2019 Review of the Dust Diseases Scheme Silicosis in the manufactured stone industry. 2020. Available from: https://www.parliament.nsw.gov.au/lcdocs/inquiries/2538/Report%2073%20%E...