When I first arrived in Altoona in the late 1970’s, many of the occupational lung diseases came from industries no longer represented in great numbers today. The railroad was a frequent source of asbestos-related diseases, owing to the repairs required on the steam engines of the day. Likewise, many coal mines were active at the time, and patients were commonly referred for evaluations related to coal dust inhalation. Brick refractories were still operative in the surrounding area, and silicosis plagued many of the workers in the brick-making industry.

Most of these industries are gone or operating at a minimum today. Many of the workers from those days are no longer with us, having passed on due to their occupational diseases or other causes. Interestingly, since 2019 a number of cases of severe silicosis have been reported in fabricators of engineered stone. Engineered stone, also known as quartz, is increasingly used in home renovation and new construction.

Quartz crystals, mixed with a resin, produces a product which may contain as much as 90% silica, much more than granite or sandstone. Cutting and polishing engineered stone without proper protection can result in a significant exposure to respirable silica with the development of potentially severe silicosis. OSHA has mandated surveillance for at-risk workers, but many operations are small businesses with fewer than 10 employees. A good number of these workers may have had significant silica exposure and could go on to have severe disease in the future.