5 YEARS OF NEUROBLASTOMA SCREENING IN AUS TRIA - COMPLIANCE, RESULTS AND A COMPARISON WITH OTHER SCREENING REGIONS

In late 1990 a screening program for the early detection of neuroblast oma in infants was introduced in Austria. The program is performed on a voluntary basis in collaboration with general pediatricians and prac titioners. Filter strips for urine collection are distributed to paren ts of infants aged seven to nine months on the occasion of a routine c heck up. The samples are sent to the laboratory by parents and analyse d for vanillylmandelic acid (VMA) and homovanillic acid (HVA). Between January 1991 and December 1995 125,201 infants were screened. The com pliance rate was 26.8% for Austria, but great differences were seen fo r different regions (65% in Carinthia, 10% in Vorarlberg). 30 children were admitted to hospital for investigation of repeatedly elevated ur ine catecholamines. A neuroblastoma was identified in 16 cases, In 12 of these cases at least one unfavorable prognostic factor was present (stage greater than or equal to 3, elevated LDH, unfavorable histology . N-myc amplification, di- or tetraploidy). Neuroblastoma screening of infants aged more than six months seems to detect predominantly those tumors which are unlikely to regress spontaneously. The observation o f one false negative case, however, demonstrates that neuroblastomas w hich become clinically manifest at a later dare may remain undetected by early screening. Possible advantages of shifting screening to a lat er age and repeated screening are discussed.