Notification of workers about an excess of malignant melanoma: a case study

In January 1991, NIOSH completed a retrospective cohort mortality study of 3,588 Westinghouse Electric Corporation workers who had been engaged in the manufacture of electrical capacitors. The study evolved from a NIOSH Health Hazard Evaluation, which was conducted at the request of the Indiana State Board of Health because of its concern about PCB exposures among the Westinghouse workers. Life table analysis revealed a fourfold excess of deaths due to malignant melanoma. Though the workers were principally exposed to PCBs, the available exposure data did not lend itself to constructing an exposure-response curve that could relate PCB exposure to development of malignant melanomas. This was further complicated by the lack of substantial corroboration from other studies of PCB-exposed cohorts. Because of the magnitude of the malignant melanoma excess and the fact that malignant melanoma is probably more amenable to treatment and remediation than most other cancers, NIOSH determined that notification of the individual cohort members was a prudent and necessary public health action. This article describes the notification process from the time the decision to notify was made through the postnotification period. It details the interaction between NIOSH, the former and current plant owners, the two labor organizations that represented the workers at the plant, and the recipients of the notification materials. Scientific and other issues surrounding this notification effort are also discussed. A number of lessons were learned about the notification process; these are described for the benefit of others who conduct notifications.