Occupational and environmental medicine
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Despite significant progress made in reducing dust exposures in underground coal miners in the United States, severe cases of coal workers' pneumoconiosis (CWP), including progressive massive fibrosis (PMF), continue to occur among coal miners. ⋯ Cases of rapidly progressive CWP can be regarded as sentinel health events, indicating inadequate prevention measures in specific regions. Such events should prompt investigations to identify causal factors and initiate appropriate additional measures to prevent further disease.