Screening program reduced melanoma mortality at the Lawrence Livermore National Laboratory, 1984 to 1996

Abstract

Worldwide incidence of cutaneous malignant melanoma has increased substantially, and no screening program has yet shown reduction in mortality. We evaluated results of an educational campaign designed to promote self-examination and targeted screening at the Lawrence Livermore National Laboratory (LLNL). Thickness and crude incidence of melanomas detected during 3 phases of increasing melanoma surveillance were studied. These periods were: (1) preawareness (1969-1975), (2) early awareness of increased melanoma risk (1976-1984); and (3) screening program (1984-1996). Melanoma mortality was derived from data recorded in the National Death Index search. The expected annual number of deaths from melanoma among LLNL employees was calculated by using California mortality data matched by age, sex, and race/ethnicity and adjusted to exclude deaths from melanoma diagnosed before the program began or before employment at LLNL. Crude incidence of melanomas thicker than 0.75 mm decreased during the 3 periods from 22.1 to 15.13 to 4.62 cases per 100,000 person-years (P = .001 by chi-square for trend) with the larger decrease from the active screening program. The crude incidence of melanoma measuring less than 0.75 mm in thickness increased and then decreased slightly without a significant linear trend, and crude incidence of in situ melanoma increased substantially. No eligible melanoma deaths occurred among LLNL employees during the screening period, whereas the expected number of deaths was calculated to be 3.39 deaths (P = .034). The study design was not randomized or controlled. The methodology for adjusting expected mortality for the exclusion of employees diagnosed with melanoma before the screening period was devised for this study. Increasing community awareness of melanoma was associated with a progressive decreasing incidence of thicker melanoma. The education, self-examination, and selective program generated the larger reduction in incidence of melanoma thicker than 0.75 mm. This campaign decreased the melanoma-related mortality to zero. The statistically significant decrease in mortality persisted for at least 3 years after employees retired or otherwise left the laboratory.