Wade Hanicker, a countertop fabricator near Tampa, Florida, spent about 15 years cutting and polishing large stone slabs for kitchens and bathrooms. Like many in the trade, he relied on simple face masks and worried more about being crushed by heavy slabs or cut by blades than about invisible dust. Most of his work involved manufactured quartz — a composite that contains far more crystalline silica than natural granite or marble — and silica dust is known to damage lungs when inhaled.
Hanicker didn’t realize the danger until pain and breathing problems forced medical visits. An initial diagnosis of pneumonia and a course of antibiotics did not help. A CT scan and lung biopsy later showed silicosis, an irreversible lung disease. He now experiences pain, weakness and shortness of breath, has developed a silica-related autoimmune condition, and will likely need a lung transplant. Hanicker says the illness has upended family life: he cannot play with his children the way he used to, and he has sued makers and distributors of quartz slabs.
California public health officials have documented an alarming cluster of similar cases. The state has identified more than 550 countertop workers with silicosis — most of them Hispanic men — with more than 30 deaths and over 50 lung transplants listed on a public dashboard. Many of those cases emerged in the last few years. Because of the scale and severity of illnesses, a group of doctors has petitioned California to ban cutting high-silica engineered stone, and a state workplace safety board planned a May 21 vote on whether to prohibit fabrication of the material.
Some clinicians believe the extreme severity seen in these workers may reflect exposure not only to silica but to other substances used in engineered stone, such as pigments and resins. Manufacturers and their lawyers counter that any material with a high silica content can be hazardous if proper controls aren’t used, and that engineered stone should not be singled out. In hearings, Cambria’s lawyer has disputed labels like “engineered stone silicosis,” and company representatives say products can be safe when shops use effective dust controls such as water suppression and local exhaust ventilation.
Outside California, reported case counts are far lower, but experts warn that most states are not actively looking for this disease. David Michaels, an occupational epidemiologist at George Washington University, says that because California has been rigorously identifying cases, it appears far worse there — but other states likely have many undetected cases. Michaels and other specialists estimate that thousands of U.S. countertop workers may already have lung damage. There are roughly 100,000 people employed in the industry nationwide, and overseas studies have found silicosis in more than 10% of countertop workers.
Misdiagnosis is common. Many physicians do not routinely ask about a patient’s job, and silicosis can be mistaken for other lung conditions. That delay in recognition has had severe consequences. In Colorado, a jury recently awarded damages to Tyler Jordan, a fabricator diagnosed with silicosis after years in his family’s shop. Jordan developed kidney failure related to silica exposure, required dialysis, and later received a kidney from his father. Occupational pulmonologists such as Cecile Rose, who helped report some of the earliest U.S. cases, say they have seen young, severely ill workers and even domestic cleaners exposed when they swept up dust.
Clinicians and lawyers involved in these cases say reporting is fragmented. Some physicians have created voluntary registries to share information, and attorneys representing affected workers in about 25 states say many employees are afraid to speak up: they fear job loss, retaliation, or deportation. A handful of states have recently announced a few cases — Massachusetts identified its first confirmed countertop silicosis case late last year and then found more, while New York and Washington reported only a few known cases each — but experts caution that those numbers reflect limited surveillance.
Regulatory inspections have found frequent workplace problems. Since 2023, the Department of Labor’s Occupational Safety and Health Administration launched a targeted inspection program focused on countertop shops. Inspectors visited more than 400 workplaces across at least 25 states, covering worksites of over 7,500 workers. About 20% of air samples taken exceeded the permissible exposure limit for silica, and roughly one-third were above the action level that triggers additional protections such as medical surveillance. OSHA issued more than 75 citations for failures to provide medical monitoring and other safeguards.
Researchers and workplace-health experts say the nation’s systems for tracking nonfatal occupational illnesses are weak and rely heavily on employer reporting, which misses many cases. Kenneth Rosenman, an occupational disease specialist, estimates the country may be missing the vast majority of silicosis cases and calls for systematic surveys of countertop fabricators across multiple states to accurately assess how many workers are affected.
Some specialists say a national study by the National Institute for Occupational Safety and Health (NIOSH) could fill the gap. They note that NIOSH’s capacity has been strained in recent years; staffing and funding setbacks hampered the agency’s work, although some positions were restored and proposed deep budget cuts were not enacted by Congress.
Given the evidence of severe disease in young workers and the inspection findings showing illegal or unsafe exposure levels, many experts support stronger actions to protect workers. Michaels says that without major reductions in exposures, the number of sick workers will grow, and there is no reason to expect that fabrication practices in other states will avoid the same outcomes seen in California.
For countertop workers, clinicians recommend medical evaluation that includes a detailed occupational history and appropriate imaging and testing if there has been significant exposure to silica dust. Public health advocates urge improved workplace controls, routine medical surveillance, enforcement of exposure limits, and research to determine how widespread disease is so policymakers can decide whether product bans, stricter regulations, or other measures are needed to prevent further harm.
