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Marginal decrease in mortality and marked increase in incidence as a result of neuroblastoma screening at 6 months of
Keiko Yamamoto1, Shigeru Ohta, Etsuro Ito
1Saitama Children's Medical Center, Division of Hematology/Oncology, Iwatsuki, Saitama, Japan. a0126966@pref.saitama.jp
Insights
Six-month screening for neuroblastoma significantly increased incidence in infants but did not decrease mortality rates. The overall usefulness of this screening approach remains questionable due to overdiagnosis concerns.
Area of Science:
- Pediatric Oncology
- Screening and Diagnostics
- Public Health
Background:
- Neuroblastoma is a significant pediatric cancer.
- Early detection through screening aims to improve outcomes.
- The utility of 6-month screening protocols requires evaluation.
Purpose of the Study:
- To assess the effectiveness of 6-month screening for neuroblastoma.
- To analyze incidence and mortality rates associated with different screening methods.
Main Methods:
- Comparative analysis of neuroblastoma incidence and mortality rates.
- Cohorts included control, qualitative screening (Qual Screen), and quantitative screening (Quan Screen).
- Analysis of screened versus unscreened subgroups within screening cohorts.
Main Results:
- Six-month screening markedly increased neuroblastoma incidence in infants (6-11 months).
- Incidence rates in older children (12-59 months) showed no significant change with screening.
- A non-significant decrease in mortality was observed, with no significant difference between screened and unscreened groups.
Conclusions:
- Six-month screening leads to increased incidence without a significant reduction in mortality.
- The benefits of screening must be weighed against overdiagnosis and psychological impact.
- The overall usefulness of 6-month neuroblastoma screening is questionable.
Purpose:
To determine the usefulness of 6-month screening for neuroblastoma.
Patients And Methods:
The cumulative incidence rates (IRs) and cumulative mortality rates (MRs) of neuroblastoma in children younger than 60 months of age were analyzed for control (n = 713,025), qualitative screening (Qual Screen, n = 1,142,519), and quantitative screening (Quan Screen, n = 550,331) cohorts, and for Screened and Unscreened subgroups within screening cohorts.
Results:
IRs (per 100,000) for infants aged 6 to 11 months were 1.12 in Control, 5.69 in Qual Screen (P <.0001), and 17.81 in Quan Screen (P <.0001); IRs for children aged 12 to 59 months were 7.29 in Control, 5.86 in Qual Screen (P =.28), and 6.36 in Quan Screen (P =.60). IRs for children aged 12 to 59 months in Unscreened or Screened subgroups remained at the same level. When patients diagnosed at younger than 6 months of age were excluded, the MR (per 100,000) under 60 months for Control was 4.21; those in Unscreened and Screened subgroups were 3.84 and 2.53 in Qual Screen (P =.30), and 3.20 and 1.97 in Quan Screen (P =.73), respectively; MRs between Control and Unscreened subgroups revealed no significant differences (P =.89 in Qual Screen, P =.85 in Quan Screen).
Conclusion:
Six-month screening resulted in a marked increase in incidence for infants with no significant decrease in incidence for children older than 1 year of age. A decrease in mortality was observed, but it was not significant. The usefulness of screening is questionable, because the decrease of mortality should be balanced against the adverse effect of overdiagnosis and the psychological burden on parents and children.