MANUFACTURED stone used in kitchens should be banned, says a senior Hunter respiratory clinician as a new report reveals screening of manufactured stone workers for deadly silicosis has missed 40 per cent of cases.
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Banning is "probably what should happen" said Dr Geoff Tyler, who has seen up to 18 new cases of silicosis each month this year in his role as a medical advisory member of icare, the former NSW Dust Diseases Authority.
His view backs that of Hunter respiratory clinician Dr Susan Miles, who told a NSW parliamentary inquiry in September that manufactured stone was a "dangerous product" and banning was "foreseeable".
"We really do not have any idea of the size of this problem, particularly in NSW," Dr Miles said.
The inquiry was told four silicosis cases involving manufactured stone workers were reported in Newcastle in June and July. Dr Tyler said he expected the figure to grow if recommendations to the inquiry for "active case-finding" are adopted so that kitchen installers and joiners are screened.
"I think the installers, workers in the factories, people directly involved with the product, they're the ones who should be seen," Dr Tyler said.
"I would say carpenters, plumbers, electricians and others who might be on a building site while these products are being installed, their risk is extremely low."
But a Royal Australian and New Zealand College of Radiologists report on Friday has shown current screening processes are failing manufactured stone workers, many young men in their 20s and 30s.
The report showed screening of manufactured stone workers for silicosis using chest x-rays, which is the screening process used by icare, was "failing to reliably detect disease".
More than 40 per cent of one group of Queensland workers returned normal chest x-rays but had silicosis visible in subsequent medical imaging or CT scans, the college said.
Most workers contracted the deadly condition while working with manufactured stone kitchen benchtops.
NSW Greens MP and justice spokesperson David Shoebridge said the college review of 6500 cases was "the clearest possible evidence that lung screening needs to move immediately from x-rays to low dose CT scans to ensure not a single case is undiagnosed".
"We have known for some time that x-rays are a substandard diagnostic tool, but the NSW Government has refused to invest in the mobile CT-technology on its much publicised lung bus.
"As soon as the CT technology is installed there needs to be a comprehensive effort to retest the thousands of workers already on the system, and that testing needs to be free of charge."
Dr Miles, representing Lung Foundation Australia and the Thoracic Society of Australia and New Zealand, told the parliamentary inquiry silicosis from manufactured stone products was a "national and international emergency".
No patient should be told they do not have silicosis based on an x-ray alone, she said.
A negative silicosis diagnosis could only be made after "a proper assessment with a high-resolution CAT scan, a detailed occupational medicine history, a good clinical examination and formal laboratory pulmonary function tests", Dr Miles told the inquiry.
"At the moment icare Dust Diseases Care does an initial screening, in some cases at the Pitt Street practice or with the bus coming throughout regional New South Wales, which involves a chest x-ray and lung function tests and does include what is called diffusing capacity which is a measure of oxygen into the bloodstream and lung size, which we would recommend.
"There are some problems in that system," she said.
Dr Miles supported "active case-finding" and mandatory notification of cases by doctors to regulators because some workers were frightened of losing their jobs or working visas.
"It is very difficult for people to want to present in the first place, and case finding, especially if it is mandatory, would allow us to do that," she said.
The Thoracic Society recommended active case-finding and mandatory reporting to prompt an audit of workplaces and free screening of all workers.
A case-finding exercise "will certainly detect a great many more cases", she told the inquiry.
There were some similarities between the risks of asbestos and silica, but "this is different", Dr Miles said.
"This is young people at the peak of their careers with dependants who thought they were going to live a long life but are not. I think what we are seeing is the tip of the iceberg."
The Master Builders Association of NSW recommended "reducing red tape by applying existing asbestos safety controls to the generation, management and disposal of silica dust".
It recommended against changing the current workplace exposure standard for silica in the air because technology is not yet available to accurately test silica at a level recommended by occupational hygienists.
The manufactured stone risk was first considered by a NSW parliamentary inquiry in early 2017.
