This story was originally published by ProPublica.

After learning from a ProPublica analysis that his Missouri city is a hot spot of toxic air pollution, Verona Mayor Joseph Heck demanded that government officials look into the local cancer rate.

Three months later, the state health department confirmed his fears: The rate of Non-Hodgkin lymphoma in the Verona zip code is more than twice as high as that of the surrounding county and state, officials told him. Non-Hodgkin lymphoma, a cancer that begins in the lymphatic system, can be caused by exposure to ethylene oxide, a potent carcinogen released by the BCP Ingredients plant in Verona. ProPublica’s unique analysis of air pollution data from the Environmental Protection Agency found the facility’s ethylene oxide emissions substantially increased local cancer risk; in some areas, the estimated industrial cancer risk was 27 times what the EPA considers acceptable.

This month, state regulators sent Heck a letter about the “statistically significantly higher” Non-Hodgkin lymphoma cancer rate for the 65769 zip code, saying that a committee of health and environmental experts had opened an inquiry. The department asked Heck to distribute a health survey to local cancer patients, which could prompt additional study.

Heck said he was encouraged by the cancer inquiry and the surveys. “If we get these filled out and it does show a high number, maybe this will prompt the EPA to take the next step, or there could be funding available for more health studies,” he said.

Pamela Dorton, a former schoolteacher who volunteers for Verona’s city government, was also heartened. “This is kind of the first light we’ve seen as far as anyone who’s willing to listen,” she said. “I welcome any kind of investigation, any kind of realization that there may be health issues.”

Following ProPublica’s investigation last fall and a segment on Verona’s cancer risk by TV station KY3, the EPA held a community meeting where residents including Heck called for regulators to protect them. The following day, Heck asked the state health department to investigate broader health effects in Verona. “While cancer is of the highest concern, we understand that there may be other ailments that are triggered or caused by exposure” to ethylene oxide, he wrote to officials.

A spokesperson for BCP Ingredients said in an email this week that the company would not comment on the health survey. “We would like to bring your attention to the language that is listed on the form that states, ‘Confirmation of a cancer excess in a community does not necessarily mean that there is any single, external cause or hazard that can be identified,’” the spokesperson wrote. The statement said the facility “is in full compliance with both federal and state regulations” and has “strict protocols in place to ensure that we’re safely manufacturing, storing and transporting ethylene oxide which is used to sterilize medical and surgical equipment for life-saving surgeries and medical procedures.”

Verona is also the site of an old toxic waste site that contains dioxin, a contaminant that’s linked to Non-Hodgkin lymphoma and other cancers.

Lisa Cox, a state health department spokesperson, said the agency would focus on responses involving Non-Hodgkin lymphoma for its study.

Cox provided data showing 17 counts of Non-Hodgkin lymphoma diagnosed between 1999 and 2018 in the zip code of roughly 2,900 people. That’s more than twice the rate expected based on diagnoses from the rest of the county and state, the data showed. (Verona itself has a population of 620.)

“This type of study is an opportunity to provide useful community-level health information,” Cox wrote. It is “unlikely” to “provide a link to a common identifiable risk factor and cannot provide information about individual health causes or concerns.”

Heck said the surveys are available at Verona City Hall. He publicized the survey on Verona’s Facebook page and asked a local newspaper to write about it. Heck urged current and former residents of the 65769 zip code, BCP Ingredients employees and the families of those who’ve died from cancer to fill one out. The survey asks people to explain the type of cancer they have, when they were diagnosed and where they lived at the time of diagnosis. Each respondent should mail their completed survey to the state health department to maintain medical privacy.

Since December, Verona has also repeatedly requested air monitoring from the EPA to track ethylene oxide emissions. Heck said the initial conversations were so promising that the city decided not to apply for an EPA air monitoring grant, since it believed the agency would provide monitoring services. But on March 3, the regional EPA office told Heck that it “does not have the equipment to deploy immediately to conduct ethylene oxide monitoring.”

“We recognize the concerns in Verona,” said EPA Region 7 spokesperson Ben Washburn in an email to ProPublica. “On January 27, EPA Region 7 committed to evaluating what an air monitoring campaign in Verona would look like. Region 7 staff have been working since the December 2021 public meeting to seek access to the air quality monitors necessary for such a study, as we do not house such equipment in our regional office in Kansas City.”

Heck expressed “disgust” in a reply to the EPA. “I do not understand how you say that you don’t have air monitoring systems or the technology, because we have paperwork that shows that in other cities, EPA does have this equipment and technology,” he wrote. “There is no trust, respect, or even hope that you and the agency will ever be honest and keep to your word.”