IS NEUROBLASTOMA SCREENING EVALUATION NEEDED AND FEASIBLE

Despite the five million children who have been screened for neuroblas toma in Japan through detection of catecholamine metabolites, it is st ill uncertain whether screening for this disease is beneficial. The Ja panese study has clearly indicated that screening at 6 months or earli er leads to heavy overdiagnosis. It is shown in this paper that screen ing at a later age may give the same reduction in mortality with possi bly less overdiagnosis. However, it is estimated that, even with two s creens at 12 and 18 months, the reduction in mortality would not great ly exceed 25%, under realistic hypotheses on the length of the preclin ical phase of the disease. The evaluation of the efficacy of this scre ening strategy would need the recruitment of half a million children p er year over 5-7 years and the follow-up of an equal number of control s. Such a trial would improve our knowledge of the natural history of the disease and might help to answer some questions raised recently re garding its biological heterogeneity.