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Screening for neuroblastoma in North America. 2-year results from the Quebec Project
W G Woods1, M Tuchman, M L Bernstein
1Department of Pediatrics, University of Minnesota Hospital, Minneapolis.
Insights
The Quebec Neuroblastoma Screening Project screened over 157,000 infants for neuroblastoma using urinary catecholamine metabolites. This infant screening program identified neuroblastoma in 0.02% of participants, demonstrating its potential for early detection.
Area of Science:
- Pediatric Oncology
- Screening Programs
- Biomarker Detection
Background:
- Neuroblastoma is a common childhood cancer.
- Early detection of neuroblastoma can improve patient outcomes.
- Screening programs are essential for identifying at-risk populations.
Purpose of the Study:
- To evaluate the effectiveness of mass screening for neuroblastoma in newborns.
- To assess the clinical and biological aspects of infant neuroblastoma screening.
- To determine the yield of a two-stage screening protocol using urinary catecholamine metabolites.
Main Methods:
- Infants born in Quebec were screened for neuroblastoma.
- Urine-saturated filter paper was used to measure vanillylmandelic acid (VMA) and homovanillic acid (HVA).
- A two-stage screening process involved initial testing at 3 weeks and 6 months of age.
Main Results:
- Over 157,000 infants were screened at 3 weeks and over 98,000 at 6 months.
- 340 infants (0.13%) required further laboratory examination due to elevated VMA/HVA levels.
- Neuroblastoma was diagnosed in 9 children (0.02%) through the screening program.
Conclusions:
- Infant screening for neuroblastoma using urinary VMA and HVA is feasible and identifies cases.
- The screening program demonstrated a low but significant detection rate for neuroblastoma.
- Further evaluation is needed to optimize screening protocols and assess long-term benefits.
Abstract:
The Quebec Neuroblastoma Screening Project was initiated to assess the clinical and biological aspects of screening infants for the presence of neuroblastoma in North America. All children born in the province of Quebec from May 1, 1989 to April 30, 1994 are eligible for participation. This report provides results from 22 months' accrual of infants who were screened using urine-saturated filter paper for determination of the catecholamine metabolites vanillylmandelic acid (VMA) and homovanillic acid (HVA). More than 157,000 infants have been screened to date at 3 weeks of age, representing 92% of the entire birth population of Quebec. Over 98,000 infants have been screened a second time at 6 months of age, which made up 76% of the Quebec birth cohort. After a two-stage initial screening, 340 (0.13%) infants (182 at 3 weeks and 158 at 6 months) required second laboratory examinations because of elevated levels of urinary VMA, HVA, or both. Twenty infants from the 3-week screening (0.01%) and nine from the 6-month screening (0.01%) were subsequently referred to one of four Quebec pediatric oncology centers for neuroblastoma evaluation. Seven of 20 children from the 3-week screening and two of nine children from the 6-month screening have been identified as having neuroblastoma. During the same period, 14 additional children in the birth cohort were diagnosed clinically with neuroblastoma; eight were diagnosed prior to screening at 3 weeks of age, three children had negative results at 3 weeks of age, two had negative results at 3 weeks and at 6 months of age, and one had never been screened.(ABSTRACT TRUNCATED AT 250 WORDS)