Wade Hanicker used power saws and polishers for about 15 years cutting stone slabs into kitchen and bathroom countertops. He wore only simple face masks and worried more about being crushed by a slab than about breathing dust. When chest pain and shortness of breath developed five years ago, doctors first treated him for pneumonia. A CT scan, then a biopsy, revealed silicosis — an irreversible lung disease caused by inhaling silica dust. Hanicker, 39, now faces chronic pain, fatigue and eventual need for a lung transplant. He has sued manufacturers and distributors of quartz slabs.
Much of the concern centers on manufactured quartz — slabs made from mined quartz mixed with resins and pigments — which can contain far higher concentrations of crystalline silica than many natural stones. California health investigators say the state has documented more than 550 countertop workers with silicosis, mostly Hispanic men, with more than 30 deaths and over 50 people receiving lung transplants. Those numbers have been climbing on a public dashboard maintained by state health officials.
A California workplace safety board is scheduled to vote on whether to ban cutting high-silica engineered stone, after doctors petitioned for the restriction. Some physicians treating affected workers argue the extreme severity of disease in many patients suggests other toxic components in engineered quartz — such as pigments or resins — may also play a role. Major quartz manufacturers dispute singling out engineered stone, saying that any high-silica material can be dangerous if proper controls are not used. They contend their products are safe when fabricators employ adequate dust controls like wet cutting and industrial vacuums.
But experts in occupational health warn that many states are not actively searching for cases, so the official counts outside California probably understate the true scope. David Michaels, an epidemiologist at George Washington University and former head of OSHA, estimates the U.S. countertop industry — about 100,000 workers — could easily include thousands of people with undiagnosed silicosis, possibly 10,000 or more. Studies from Australia have found lung disease in over 10% of some countertop worker groups, supporting concerns about wider spread.
Misdiagnosis is common because many clinicians do not routinely ask about patients’ work histories or recognize silicosis. Hanicker’s initial care providers treated him for common infections before imaging and biopsy established the occupational cause. For workers, the consequences can be devastating: progressive respiratory failure, autoimmune complications, kidney damage in some cases, and loss of ability to work or care for family. Tyler Jordan, a countertop worker in Colorado, developed silicosis after years in fabrication, later suffered silica-related kidney failure, required dialysis, and ultimately received a kidney transplant from his father. A jury in Colorado recently awarded damages in a case linking fabricator practices and product handling to his illnesses.
Physicians who first described these severe cases in the U.S. say the problem has spread across many states. National registries and voluntary reporting have identified cases from Illinois, Missouri, Montana, New Mexico, South Carolina, Wyoming and others. Yet reporting remains patchy; clinicians and public health officials rely largely on word of mouth and ad hoc reporting. Attorneys and advocates also say many workers are reluctant to speak up because they fear losing jobs or, for immigrant employees, deportation.
Federal enforcement has begun to probe the industry. Since a targeted program started in 2023, OSHA has inspected more than 400 countertop shops in at least 25 states, evaluating worksites that employ more than 7,500 workers. Sampling showed about 20% of air measurements exceeded the permissible exposure limit (PEL) for silica, and roughly 33% were above the action level that triggers additional protections such as medical surveillance. Inspectors issued more than 75 citations for failures including lack of medical surveillance. Occupational health researchers say most small countertop shops do not provide routine medical exams to detect early disease.
Experts warn that the country’s surveillance systems miss most cases of occupational illness because reporting depends heavily on employers. Kenneth Rosenman, a silicosis specialist at Michigan State University, estimates the U.S. likely misses the vast majority of silicosis cases — possibly 95% — and calls for systematic surveys and active screening of fabricator employees.
Some state health officials have begun to act. Massachusetts publicly announced its first confirmed countertop-industry silicosis case in December and has since identified additional patients. New York and Washington report a handful of known cases, and federal investigators have cited problems at specific Chicago fabricators.
Occupational medicine leaders say a coordinated response is needed: workplace inspections, stronger enforcement of dust controls, routine medical surveillance for exposed workers, and well-designed prevalence studies to estimate how many workers are affected. They point to the role a federal research agency, the National Institute for Occupational Safety and Health (NIOSH), could play in conducting representative surveys — though NIOSH’s staffing and funding have faced challenges in recent years.
Given the magnitude of illness surfacing in California and in scattered reports elsewhere, many public health and labor experts support stronger measures to prevent exposure. David Michaels has endorsed California’s consideration of a ban on cutting engineered stone, arguing that without substantial changes in workplace practices or product restrictions, the same severe outcomes seen in California are likely to appear nationwide.
For affected workers and families, the human toll is immediate and irreversible: lost health, lost income, and reduced ability to participate in family life. Clinicians, investigators and lawyers continue to press for better protections, improved surveillance, and broader awareness so that other workers do not face the same fate without detection or recourse.