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Stephen L. Gans overseas lecture. Mass screening for neuroblastoma in Japan: lessons learned and future directions
1Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Insights
Japan's mass screening for neuroblastoma in infants has detected many cases with excellent survival rates. However, it has not reduced advanced-stage neuroblastoma cases or overall mortality in the Kyushu region.
Area of Science:
- Pediatric Oncology
- Epidemiology
- Cancer Screening
Background:
- A nationwide mass screening (MS) program for neuroblastoma in 6-month-old infants has been active in Japan since 1985.
- Over 1,900 neuroblastoma cases have been detected, with a survival rate exceeding 97% for these patients.
- Despite screening success, reports indicate no substantial change in advanced-stage neuroblastoma cases over one year of age.
Discussion:
- This study analyzed 15 years of MS data from the Kyushu Pediatric Oncology Study Group.
- Clinical and biological features of neuroblastomas detected by MS (n=320) were compared to those not detected (n=245).
- Regional and national neuroblastoma statistics before and after 1985 were examined using standard epidemiologic measures.
Key Insights:
- MS-detected neuroblastomas were predominantly biologically favorable with excellent outcomes.
- Neuroblastomas in non-MS patients were often advanced-stage with unfavorable prognoses.
- Overall neuroblastoma mortality in the Kyushu area showed no improvement attributable to the MS program.
Outlook:
- Optimal screening timing is crucial to detect regressing tumors while identifying aggressive disease.
- A birth cohort study is proposed to determine the ideal timing for a second screening.
- Further research into novel prognostic factors for neuroblastoma may be necessary.
Background/Purpose:
Since 1985, a nationwide mass screening program (MS) for neuroblastoma has been conducted for 6-month-old infants throughout Japan, resulting in the detection of more than 1,900 cases of neuroblastoma. The outcome of these patients has been excellent: more than 97% of them are alive. Yet, several reports suggest that the number of advanced-stage neuroblastoma patients over 1 year of age has not changed substantially. The current report focuses on the 15-year experience with MS of the Kyushu Pediatric Oncology Study Group.
Methods:
The clinical and biological features of neuroblastoms detected (n = 320) and not detected by MS (n = 245) were compared. Regional and national statistics for neuroblastoma before and after 1985 were analyzed using standard epidemiologic measures for the occurrence of disease.
Results:
The majority of the MS-positive cases were biologically favorable and had an excellent outcome. In contrast, the majority of non-MS patients in whom neuroblastoma later developed had advanced-stage, unfavorable-prognosis tumors. The overall mortality rate of neuroblastoma in the Kyushu area was not improved by MS.
Conclusions:
The optimal time for screening is the point at which neuroblastomas regressing spontaneously can no longer be detected, but more aggressive disease can be found. A birth cohort study could determine the optimal timing for a second screening. Identification of other new prognostic factors may be required.
