Libby research effort to span 40 years

LIBBY — The Center for Asbestos Related Disease will begin recruiting subjects this month for the Libby Epidemiology Research Project.

The project involves a set of studies that will focus on low-level childhood exposure, compare exposure of Libby amphibole asbestos to that of more common commercial forms, and look into the presence of autoimmune disorders.

Subjects of the research project must have spent the majority of their high school years in Libby between 1950 and 1990 and then moved away without coming back in their adult years to live or work.

CARD worked with the superintendent’s office of Libby schools to get information on 13,518 people that graduated from Libby High School during that 40-year timeframe.

“We are working with this roster and through local alumni associations to track these folks for participation in the LERP high school grad project,” said Kimberly Rowse, clinical coordinator at CARD.

Though the center has the graduates’ names, last known place of residence and the names of their parents, it will take much collaboration to find potential subjects, which are scattered throughout the country. Rowse hopes the community will help.

“It will be real interesting to see how many we get, but we’ve probably identified at least 30 or 35 already from the clinic that have come back in the summer to visit family,” Rowse said. “They decide to get screened and they fit this population. We’ve got a pretty good jump on it.”

In addition to helping further knowledge of Libby amphibole asbestos, subjects will receive a free screening. Those who meet the requirements or who know of someone who does can contact CARD at (406) 293-9274.

The Agency for Toxic Substances and Disease Registry, a branch of the federal Centers for Disease Control, is supporting the five-year project through a $4.8 million grant.

The grant was secured last September, but the months since then have been spent coordinating with partners and obtaining approval of the investigation review board, the governing body that protects human subjects.

“Something that I’m learning is that the first year is a lot of the logistics that you have to set up, like your protocols and your investigational review board approval,” Rowse said. “There’s also a lot of contracting with the universities that you’re working with.”

CARD is working with investigators from Mount Sinai School of Medicine in New York, the University of Montana and Idaho State University. Dr. Stephen Levin, a nationally known expert in asbestos-related diseases from Mount Sinai, is the principal investigator.

“First year is logistics,” Rowse said. “The second, third, fourth is gathering information, and usually the fifth is crunching the numbers and doing the stats.”

In the first phase, researchers will compare the high school roster against the national death index to identify people who already have died. Not only will it save time in contacting individuals, it will provide a cause of death.

“So that way, if there’s a large population that died of cancers or identification of mesotheliomas that we may not have captured or lung diseases,” Rowse said, “that is good information to understand — the prevalence of the diseases or the cancers within our population.”

Understanding the effects of low-level asbestos exposure on vulnerable populations, such as children whose lungs aren’t fully developed, will be useful in identifying a safe level of exposure.

“The big question at large is how clean is clean,” Rowse said. “To figure that out, you need to identify those folks that have a lower exposure or those folks that are vulnerable populations. Young children are a vulnerable population because as we develop that structurally and functionally, our lungs can be impaired by the asbestos.”

The project also will help gain insight into the progression of lung scarring from asbestos exposure by comparing data of individuals with different latency periods. Researchers hope to further document what clinical observations have shown — that Libby amphibole asbestos is more aggressive than more common forms of asbestos, such as chrysotile asbestos used to insulate pipes.

CARD will work with the University of Montana to assign scores to CT scans of the lungs of participants, which will be compared to those who have been exposed to chrysotile asbestos as pipe insulators. Levin, an expert in occupational medicine, manages a large population of insulators in New York.  

“We will compare the Libby disease and what we see on radiographs with the asbestos-affected disease from pipe-fitting, the chrysotile, in New York,” Rowse said. “That will help define some of the radiographic changes that we see in our disease here versus the chrysotile.”

A third study in the project will look into the relationship of autoimmune disorders, such as rheumatoid arthritis and lupus, with the degree of Libby asbestos exposure and disease development. The data will be compared to instances of autoimmune disorders among the insulator population in New York. Jean Pfau of Idaho State University began the initial studies while she was with the University of Montana.

Results won’t be released until some years down the road since the project is not slated to conclude until 2014, though Rowse said that sometimes researchers share preliminary information if they identify trends.

“I think that it is recognized with the researchers that the sooner that there is any type of data or anything published in the literature, the sooner there is going to be better understanding of the disease in itself and a better understanding of how to clean this stuff up,” Rowse said.