Early Detection of Certain Medical Conditions Related to Environmental Health Hazards

Libby, Montana was the site of a vermiculite mining and processing operation from the early 1920's through1990. While it was in operation, Libby was the world's largest source of vermiculite. In spite of commercial uses that include insulation, fire proofing, and as a soil conditioner, Libby vermiculite is contaminated with amphibole asbestos. This has resulted in asbestos-related morbidity and mortality in vermiculite workers, their family members, and area residents with neither occupational nor para-occupational exposure. In June 2009, the U.S Environmental Protection Administration declared a public health emergency for the Libby Asbestos Site, which includes the cities of Libby and Troy (June 19, 2009 memo from Lisa Jackson, EPA Administrator).Reports of pervasive asbestos-related health outcomes in Libby prompted a concerted response by the federal government in 1999. A large component of this response was community-based screening conducted by the Agency for Toxic Substances and Disease Registry (ATSDR) in 2000 and 2001 in which 7,307 persons were screened. Additional screening was funded by ATSDR via a grant to the Montana Department of Health and Human Services 2003-2008 and to the Lincoln County Health Department 2009-2011. Language was included in the Affordable Care Act (ACA, Public Law 111-148; https://www.hhs.gov/sites/default/files/ppacacon.pdf) to continue to make screening available to persons with potential past exposure to vermiculite while they resided in the Libby area. Persons with positive screening results may be eligible for Medicare benefits.In 2011, a grant was awarded to the Center for Asbestos Related Disease (CARD) to conduct screening activities under ACA. This screening included the use of a standardized health survey, spirometry, and chest radiography as well as high-resolution computed tomography (HRCT) and the fecal occult blood test (FOBT). Screening activities were expanded under ACA to include community outreach and health education. Further, the scope of ACA screening was expanded from being Libby-based to also include persons who emigrated from Libby.The present NOFO is for the continuation of the activities begun under previous NOFOs by CARD. This program is expected to result in improved survival of participants with asbestos-related cancers, reduced rates of smoking-related diseases, and improved quality of life for participants.