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Problems of neuroblastoma screening for 6 month olds and results of second screening for 18 month olds
1Department of Pediatric Surgery, Tohoku University School of Medicine, Sendai, Japan.
Insights
Japan's initial neuroblastoma screening for infants detects most cases, but misses some. A second screening at 18 months helps find these missed neuroblastoma cases, improving survival rates.
Area of Science:
- Pediatric Oncology
- Cancer Screening
- Public Health
Background:
- Nationwide neuroblastoma mass screening for infants was established in Japan in 1985.
- The initial screening identifies approximately 110 cases annually with a 97% survival rate.
- However, the first screening's sensitivity is limited to about 75%, leaving a significant proportion of cases undetected.
Purpose of the Study:
- To evaluate the effectiveness of a second screening for neuroblastoma in infants.
- To identify and improve outcomes for false-negative cases missed by the initial screening.
Main Methods:
- A second screening at 18 months of age was implemented in Miyagi Prefecture starting May 1992.
- Data from 62 neuroblastoma cases treated since 1985 were analyzed, including those detected by first and second screenings.
- Compliance rates and outcomes for infants undergoing the second screening were assessed.
Main Results:
- The second screening identified 2 neuroblastoma cases among 14,282 infants screened (75% compliance rate).
- These cases, initially missed by the first screening, were successfully treated and are disease-free.
- Analysis of false-negative cases revealed a wide age distribution, with many younger than 36 months, and poor survival rates (5 of 18 alive).
Conclusions:
- The first neuroblastoma screening in Japan is effective for early detection but lacks sufficient sensitivity.
- A second screening at 18 months is recommended to identify and treat false-negative cases, thereby improving overall patient outcomes.
Abstract:
Nationwide neuroblastoma mass screening for 6-month-old infants (first screening) was introduced in Japan in 1985. About 110 neuroblastoma cases are detected annually by the first screening and treated, with a survival rate of 97%. Sensitivity of the first screening (positive cases/positive cases+false negative cases) is about 75%, and the prognosis of false-negative cases is unfavorable. A second screening at 18 months of age was started to rescue false-negative cases in Miyagi Prefecture in May 1992. Of 62 neuroblastoma cases treated in our hospital since 1985, 40 cases had received the first screening. Twenty cases were positive at first screening, 18 cases were false negative, and 2 cases were false negative and picked up by the second screening. Age distribution of false-negative cases ranged from 12 to 83 months and included 12 cases younger than 36 months old. Only 5 of 18 false-negative cases are alive without the disease. From May 1992 to November 1993, 14,282 infants had received the second screening (compliance rate: about 75%), and 2 neuroblastoma cases were detected. The first case was stage III with paraortic lymph node metastases, Shimada UH, aneuploidy and negative N-myc amplification. The second case was stage II with Shimada FH, aneuploidy, and negative N-myc amplification. Both cases are alive now without the disease after undergoing radical operation and chemotherapy. The first screening is effective for early detection of neuroblastoma cases, but the sensitivity is insufficient; the authors recommend a second screening to rescue false-negative cases.