The current scientific debate upon silica and cancer has often taken minds off the persistence of risks of lung fibrosis caused or, at least, triggered by crystalline silica dusts. Certainly, in Western Europe quartz dust exposures are now less frequent and, on average, less heavy than in the past, but this doesn't mean a vanishing of the possibility of new silicosis cases, in severe forms too. Short but intense quartz exposures are always possible from occasionally uncontrolled work circumstances and accidents. Quartz dusts can develop in unusual work settings, where the hazard is more often unacknowledged and then neglected. Increasing rates of progressive massive fibrosis are being reported in the United States, partly attributable to occupational silica exposure; certainly this problem in not confined to the United States and it is probably understudied and underestimated in several parts of the world.