From West Texas to West Virginia, from California to New York, in industries from oil refining to coal mining and work settings from foundries to shipyards, the United States is experiencing an epidemic of silicosis, a preventable disease. Silica sand has been linked to cancer, and the International Agency for Research on Cancer has named silica as a probable human carcinogen. This article analyzes the reawakening of national concern about silicosis and the social, economic, and epidemiologic factors that have led scientists, policy makers, industrial hygienists, and labor and industry representatives to reassess the danger that silica sand poses to the health of an estimated two million workers in this country.