Screening

Workers exposed to silica, coal, or beryllium in the US

The US Occupational Safety and Health Administration (OSHA) requires medical screening for workers exposed to silica or beryllium.[46][47] The US Mine Safety and Health Administration (MSHA) requires medical screening for new miners and voluntary medical screening for miners who were hired before 2014 and have been exposed to coal.[48]

The screening for coal workers consists of:[48]

  • Chest x-ray, spirometry, symptom assessment, and occupational history at baseline, then at 3 years, then 2 years later, then every 5 years.

The required medical screening for workers exposed to silica consists of:[46]

  • Medical and work history, with a focus on:

    • Past, present, and anticipated exposure to respirable crystalline silica, dust, and other agents that can affect the respiratory system

    • Any history of respiratory problems, including signs and symptoms of respiratory disease (e.g., shortness of breath, cough, wheezing)

    • History of tuberculosis (TB)

    • Smoking status and history.

  • Physical examination, with a focus on the respiratory system. Initial examination at baseline and every 3 years thereafter.

  • TB testing: initial test at baseline.

  • Spirometry: initial test at baseline and every 3 years thereafter.

    • Must be administered by a spirometry technician with a current certificate from a National Institute for Occupational Health and Safety (NIOSH)-approved course.

  • Posteroanterior (PA) radiograph of the chest at full inspiration.

    • Initial CXR at baseline and every 3 years thereafter.

    • Must be interpreted and classified according to the ILO International Classification of Radiographs by a NIOSH-certified "B" reader. A "B" reader is a NIOSH-certified physician who is proficient in classifying radiographs of the pneumoconioses.

  • Any additional testing that the provider deems appropriate.

The required medical screening for beryllium-exposed workers consists of:[47]

  • Medical and work history, with a focus on:

    • Past and present airborne exposure to or dermal contact with beryllium

    • Smoking history

    • Any history of respiratory problems.

  • Physical examination, with a focus on the respiratory system.

  • Physical examination for skin rashes.

  • Spirometry, performed according to American Thoracic Society (ATS) guidelines:

    • Including measurement of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1).

  • A standardised beryllium lymphocyte proliferation test (BeLPT) or equivalent test, at baseline and at least every 2 years thereafter, unless the employee is confirmed positive.

    • If the results of the BeLPT are not normal, a follow-up BeLPT must be offered within 30 days, unless the employee has been confirmed positive.

    • Samples must be analysed in a laboratory certified under the College of American Pathologists/Clinical Laboratory Improvement Amendments (CLIA) guidelines to perform the BeLPT.

  • A low dose computed tomography (LDCT) scan, when recommended by the healthcare professional after considering the employee's history of exposure to beryllium along with other risk factors, such as smoking history, family medical history, sex, age, and presence of existing lung disease.

  • Any additional testing that the provider deems appropriate.

Workers exposed to silica in the UK

Health surveillance for silicosis may be considered in the following circumstances:[49]

  • For workers who are involved in high-risk occupations, including construction, foundry work, brick and tile work, ceramics, slate, manufacturing, quarries and stonework

  • Where workers are regularly exposed to silica dust and there is a reasonable likelihood that silicosis may develop

  • Where there have been previous cases of work-related ill-health in the workplace

  • Where there is reliance on respiratory protective equipment as an exposure control measure for silica

  • Where there is evidence of work-related ill health in the industry.

The required medical screening for silica-exposed workers consists of:[49]

  • At baseline:

    • Respiratory questionnaire

    • Lung function testing with spirometry according to ATS/European Respiratory Society guidelines

    • Chest x-ray.

  • Annually:

    • Respiratory questionnaire

    • Lung function testing with spirometry according to ATS/European Respiratory Society guidelines.

  • After 15 years:

    • Respiratory questionnaire

    • Lung function testing with spirometry according to ATS/European Respiratory Society guidelines

    • Chest x-ray.

Respiratory questionnaires and lung function testing should continue annually after the initial 15 years of exposure. Chest x-ray should be repeated at 3-year intervals.[49]

There is no recommendation for TB testing in silica-exposed workers.[49]

General population

Screening of former workers with silica, coal, or beryllium exposure can be helpful to:

  • Target people who should minimise any future exposure

  • Emphasise the importance of smoking cessation

  • Identify people who are at increased risk of silica-associated cancers or other associated conditions

  • Identify people who are eligible for workers' compensation, or who are entitled to take legal action against suppliers of the minerals.

Use of this content is subject to our disclaimer