Studies have shown subradiological silicosis is an important component for future radiologically detectable silicosis, lung cancer, lung tuberculosis, autoimmune disease, nephropathy etc. Lung function test shows reduction of both FVC & FEV1 although x-ray shows no abnormalities. So, if we need to prevent above diseases, subradiological silicosis should not be ignored. This may be treated as missed opportunity. Please leave your comments and understanding.
Perhaps a logical starting point is to evaluate the population at risk with HR-CT of lung. Those with positive signals at imaging can be prospectively followed up for the evolution of imaging abnormalities.
I agree with you fully, Dr. Polasa. We need to initiate a longitudinal study as indicated by you, provided funding is available for this kind of study by some suitable funding agencies. Thanks Dr Polasa for your kind suggestion.
Just adding to my above response, which I missed earlier. We need to remember that HRCT although have a higher sensitivity than chest x-rat to detect early stage silicosis, but it can not detect all subradiological silicosis cases. Hence, we need to find out some possible marker to predict early stage silicosis before it becomes radiologically detectable, which usually takes more than 10 - 15 years of occupational silica dust exposure. Based on our working experience, CC16 may be an option for that as a proxy marker, which may be studied further in depth.
Kamalesh Sarkar in this sense, nothing works better than a predictive risk score calculated by the occupational physician after studying occupational exposure
Riccardo Polosa We’ve already had an almost certain response from the autopsy and clinical series. There are ancient publications that prove the magnitude of the phenomenon of infra-scannographic silicosis
Subradiological silicosis indicated in group of people having exposure of silicosis in any form is prerequisite for diagnosis. HRCT lung will be best tool for diagnosis of silicosis in such conditions because of HRCT detect lung parenchyma l disease
I am sure you will be interested to hear that there are currently ongoing longitudinal studies in silica exposed workers in Australia and that these will also include a predictive risk score. There will be several hundred workers involved. Hopefully these will answer some of these important questions, at least for artificial stone. Have a look at the Australian National Taskforce on Artificial Stone report (published 2021).
Dear Dr Yates,
That would be really a great effort conducting that kind of longitudinal study involving silica dust exposed workers including artificial stone workers. Thanks for your information. Best regards,