Rising Melanoma Incidence in Hispanics: A Developing Health Disparity

The incidence of the potentially deadly skin cancer called melanoma is increasing faster than any other cancer in the United States. Although early detection of melanoma has resulted in improved survival in the white population, Hispanics and Blacks continue to have poorer survival rates. Hispanics diagnosed with melanoma are twice as likely to have late stage diagnosis resulting in greater risk of functional impairment or death. Relatively limited data exists about melanoma awareness and its impact on ethnic minorities. Traditional or web-based community outreach methods may exclude non-English speaking individuals, those of lower socioeconomic status and low literacy levels, or undocumented individuals facing legal barriers. These factors complicate health behavior education in Hispanics. Promotoras de salud (Latina lay health workers) overcome cultural and language barriers to successfully reach underserved Hispanic communities. HIV, breast, colorectal carcinoma outreach programs are some examples of successful promotora based interventions. Currently, there are no specific melanoma detection programs using promotoras to disseminate skin cancer education and perform surveillance screening. The promotora skills training described in this proposal could become a model for a nationwide lay health worker programs whose overall goal is improving melanoma survival rates in Hispanics. The first objective of this pilot study is to develop an effective promotora melanoma education program. Promotoras will be taught visual skin screening during a single didactic session. Promotora melanoma awareness, self-perceived risks, attitudes, and knowledge about performing skin checks will be assessed pre and post intervention utilizing a questionnaire and skills test. A control group will follow a similar didactic format and skills testing on an unrelated skin care topic. Our second objective is to assess whether our education intervention results in an effective and sustainable promotora melanoma detection program in the Hispanic community. Outcome measures for this objective are utilization rates based on two sources: 1) daily promotora skin check reports, 2) number of promotoras’ clients, clients’ family members, and friends persuaded to present for skin examination at scheduled community screenings. Limited treatment options exist for advanced stage melanoma. Mobilizing and educating lay health workers to perform visual screening of high risk sites should assist in increasing Hispanic melanoma survival rates.