Re: Neuroblastoma Screening Test May Do More Harm Than Good

Extract

Mass screening of infants for the early detection of neuroblastoma was started in Japan in the early 1970s, and more than 1 million Japanese children are tested every year ( 1 ). The results show that neuroblastoma can be diagnosed early by detecting urinary catecholamine metabolites. The main questions remain, however: 1) Does screening influence mortality? 2) What is the optimal procedure? Fundamental to these questions is to what extent favorable neuroblastoma progresses to unfavorable disease.

The Journal commented recently on a study ( 2 ) carried out in the province of Quebec in Canada and published in The Lancet ( 3 ). The two-step test procedure was scheduled for infants at 3 weeks and 6 months of age. There was no stopping rule on overdiagnosis. The authors reported a 2.4-fold increase in neuroblastoma incidence in the screened population compared with the nonscreened population controls and no reduction of advanced stage disease in older children in the screened cohort. Data were not given on relevant biologic prognostic factors, MYCN copy number ( 4 ), aberrations of chromosome 1p ( 5 ), and DNA ploidy ( 4 ). The authors concluded that the implementation of screening is not to be recommended. Whether screening in general, especially after 6 months of life, is an approach to lower the mortality from neuroblastoma cannot be concluded from these results.