Back in 1995, the World Health Organization launched an initiative aimed at eliminating silicosis worldwide by 2030. Despite this effort, silicosis continues to pose a significant global health problem [9]. As of today, it is estimated that 49,5 million small-scale miners have exposure to high silica content in their workplace [10]. There is no good quality data regarding the prevalence of silicosis globally, but it is estimated that there are around 2·6 million prevalent cases according to the Global Burden of Disease [10].

There has been a marked global rise in new silicosis cases, increasing by 64.61% from 84,426 in 1990 to 138,971 in 2019, while the disease continued to account for a substantial burden in terms of disability-adjusted life years (DALYs) [11]. A recent increase in silicosis cases has been reported among younger workers involved in the fabrication of engineered stone, or quartz, countertops in California and in countries such as Australia, Israel, and Spain [12]. The first case of silicosis in Australia linked to artificial stone used in benchtop fabrication was reported in 2015, being that by 2022, a total of 579 cases had been documented nationwide [13]. Additionally, from 2019 to 2022, 52 cases of silicosis linked to engineered stone were identified in California [14].

Unfortunately, no specific prevalence or incidence data for silicosis in Portugal were identified in the available indexed medical literature and one 2006 portuguese article even confirmed there was no official data on silica exposure in Portugal, although silicosis is one of the most frequently reported work-related diseases [15]. The most recent global studies on silicosis (2024-2025) analyze data from 204 countries and territories through the Global Burden of Disease Study, but do not provide disaggregated data by individual country, including Portugal [11]. One study presented the Silicosis notification rate in the Northern Region of Portugal which was about 2.4 (per 100 000) in 2012, this being their latest data [16].

Expanding on this, in the Northern Region of Portugal, located in the Tâmega subregion there are the municipalities of Penafiel and Marco de Canaveses which present a large sector of activity in the mining industry, specifically in the exploitation of granite quarries. Therefore, a higher number of mine workers compared to the rest of the northern region and country. Along with other factors such as higher population density, lower elderly dependence ratio, and a smaller number of clinicians, this leads to higher silicosis notification and prevalence rates in this locality [16]. The Tâmega subregion is also the most deprived area in the Northern Portugal in domains such as income, employment, health and disability, education and skills, habitation and environment and access to goods and services [17].

The European Agency for Safety & Health at Work highlights the need to install and maintain dust extraction and air filtration systems to control exposure. It also stresses the use of tools with built-in dust extraction and the availability and proper use of suitable equipment, including personal protective equipment. According to Directive 89/391/EEC of the European Commission, fitness for work assessment and regular health surveillance should include periodic chest X-rays, symptom questionnaires, and lung function tests. The responsible health professional must explain the test results to the individual [18]. Current evidence does not adequately define how effective or how often these measures, especially chest radiography, should be used to screen workers exposed to high concentrations of respirable crystalline silica from artificial stone who are at risk of accelerated silicosis. Early reports in this population show that many workers present with normal chest X-rays despite having clear signs of silicosis on high resolution CT scans [9].

There is no systematic national surveillance of silicosis, no studies on adherence to personal protective equipment in the Portuguese context, and no data on the real-world effectiveness of preventive measures. Evidence on the actual effectiveness of these measures remains limited, especially in Portugal, and adherence among workers and employers is not well characterized.

In the epidemiological context of Tâmega, the local and regional Public Health Services implemented the Menos Tuberculose Pedreiras 2018–2020 project. This project consisted of annual screening for TB disease and TB infection in stone quarry workers in the subregion. According to the results of this project, the estimated prevalence of silicosis among workers is 25% [19]. Considering that around 2,400 stone industry workers are active in Penafiel and Marco de Canaveses, this suggests that approximately 600 active workers have silicosis [20].

In Penafiel and Marco de Canaveses there is an ongoing program called +Saúde whose objective is to reduce the burden of silicosis and tuberculosis in the working population of the stone industry in Penafiel and Marco de Canaveses, through an extensive screening program [20].