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REVIEW article
Front. Public Health
Sec. Occupational Health and Safety
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1554006
This article is part of the Research Topic Mineral Particles and Fibers and Human Health Risks: State-of-the-Art in Characterization, Analysis, Tissue Analytics, Exposure Thresholds for Risk, Epidemiology, and Risk Assessment for Science-Based Regulation and Disease Prevention and Implications for Occupational Health and Safety View all articles
Systematic review of the epidemiological evidence of associations between quantified occupational exposure to respirable crystalline silica and the risk of silicosis and lung cancer
Provisionally accepted- 1 University of Massachusetts Amherst, Amherst, Massachusetts, United States
- 2 Independent Consultant in Epidemiology, Hume, United States
- 3 Sri Guru Ram Das University of Health Sciences, Amritsar, Punjab, India
- 4 Division of Global health, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, United States
- 5 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy
- 6 Stony Brook University, Stony Brook, New York, United States
Cumulative RCS exposure was most commonly reported. Increasing silicosis risk with increasing cumulative RCS exposure was reported in all studies, with exposure thresholds indicated, but at different cumulative exposures. For most studies defining silicosis as International Labour Organization (ILO) score > 1/0, substantially increased risks were clear at or above 1 mg-/m 3 -yr. For lung cancer, exposure-response estimates were mixed with 4 studies reporting no statistically significantly increased relative risk of lung cancer at any cumulative RCS exposure. Three studies reported statistically significant increased risks but only for high cumulative RCS exposures. Residual confounding by smoking was not explicitly discussed in most studies. One case-control study presented an exposure-response analysis for silica and lung cancer limited to never-smokers with substantial silica exposure; risk was increased only among those in the highest RCS exposure category. Studies with more detailed smoking information available generally reported risks close to background levels except at the highest cumulative RCS exposure categories.Silicosis risk clearly and consistently increased above cumulative exposure thresholds of roughly 1 mg/m 3 -years across most studies. However, for lung cancer, results were heterogeneous with potential residual confounding by smoking complicating interpretation. Results suggest that lung cancer risk may not be increased at cumulative RCS exposures below the reported exposure thresholds for silicosis risk.
Keywords: Crystalline silica, Silicosis, lung cancer, Systematic review, Exposure-response, Epidemiology
Received: 31 Dec 2024; Accepted: 10 Feb 2025.
Copyright: © 2025 Mundt, Thompson, Dhawan, Checkoway and Boffetta. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Kenneth A Mundt, University of Massachusetts Amherst, Amherst, 01003, Massachusetts, United States
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