Engineered stone (ES) is a popular building product, due to its architectural versatility and generally lower cost. However, the fabrication of organic resin-based ES kitchen benchtops from slabs has been associated with alarming rates of silicosis among workers. In 2024, fifteen years after the first reported ES-related cases in the world, Australia became the first country to ban the use and importation of ES. A range of interacting factors are relevant for ES-associated silicosis, including ES material composition, characteristics of dust exposure and lung cell-particle response. In turn, these are influenced by consumer demand, work practices, particle size and chemistry, dust control measures, industry regulation and worker-related characteristics. This literature review provides an evidence synthesis using a narrative approach, with the themes of product, exposure and host. Exposure pathways and pathogenesis are explored. Apart from crystalline silica content, consideration is given to non-siliceous ES components such as resins and metals that may modify chemical interactions and disease risk. Preventive effort can be aligned with each theme and associated evidence.

There has been considerable debate as to the main drivers of disease severity and prevalence amongst workers fabricating ES benchtops.

Early studies considered fabrication practices (e.g., wet versus dry cutting) , dust exposure levels and the high level of crystalline silica in many of the slabs (unfinished products) on the market.

However, more recent studies have shown that the situation is more nuanced than this with evidence that fabrication of ES finished products leads to the emission of vapours (e.g., volatile organic compounds (VOCs) and airborne particulate matter other than silica that pose a threat to respiratory health.

In addition, the over-representation of immigrant workers amongst silicosis cases suggests that there are non-material-related factors contributing to disease risk.