SCREENING FOR NEUROBLASTOMA IS INEFFECTIVE IN REDUCING THE INCIDENCE OF UNFAVORABLE ADVANCED-STAGE DISEASE IN OLDER CHILDREN

Neuroblastoma exhibits many characteristics which would suggest that p reclinical detection may improve outcome. The Quebec Neuroblastoma Scr eening Project was initiated to determine whether mass screening could reduce mortality in a large cohort of infants. All 476 603 children b orn in the province of Quebec during a 5-year period of time (1 May 19 89 to 30 April 1994) were eligible for determinations of urinary catec holamine metabolites at 3 weeks and 6 months of age. Children with pos itive screening were referred to one of four paediatric cancer centres in Quebec for uniform evaluation and treatment. Standardised incidenc e ratios (SIRs) were calculated for neuroblastoma in Quebec and two co mparable population-based controls during the same period of time usin g similar ascertainment procedures. Compliance with screening in Quebe c was 91% at 3 weeks (n = 425 816) and 74% at 6 months (n = 349 706). Up to 31 July 1995 with a follow-up of the birth cohort of 15-75 month s, 118 cases of neuroblastoma were diagnosed, 43 detected preclinicall y by screening, 20 detected clinically prior to screening at 3 weeks o f age and 55 detected clinically after 3 weeks of age having normal sc reens (n = 52) or never screened (n = 3). Based on data from concurren t control populations, 54.5 cases of neuroblastoma would have been exp ected in Quebec during the study period for an SIR of 2.17 (95% CI 1.7 9-2.57, P<0.0001). For the two control groups, the overall SIR was 1.0 0 (NS). SIRs for Quebec by age at diagnosis in yearly intervals show a marked increased incidence under 1 year of age (SIR = 2.85, 95% CI 2. 26-3.50), with no reduction in incidence in subsequent-years. We concl ude that screening for neuroblastoma markedly increases the incidence in infants without decreasing the incidence of unfavourable advanced s tage disease in older children. It is unlikely that screening for neur oblastoma in infants will reduce the mortality of this disease. (C) 19 97 Published by Elsevier Science Ltd.