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Effects of mass screening on age-specific incidence of neuroblastoma
1Department of Pediatrics, University of Tokyo Hospital, Japan. bessho@ped.h.u-tokyo.ac.jp
Insights
Japan's neuroblastoma screening program significantly increased cancer incidence in infants. This rise suggests screening may detect tumors that would have regressed naturally, necessitating urgent evaluation of its mortality benefit.
Area of Science:
- Pediatric Oncology
- Cancer Epidemiology
- Public Health Screening Programs
Background:
- Neuroblastoma is a common childhood cancer.
- Cancer screening programs aim to detect diseases early for improved outcomes.
- The impact of widespread screening on cancer incidence rates requires careful analysis.
Purpose of the Study:
- To estimate the age-specific incidence rates of neuroblastoma in Japan.
- To evaluate the effect of the national neuroblastoma screening program on incidence trends.
- To investigate potential overdiagnosis due to screening.
Main Methods:
- Utilized data from the Japan Children's Cancer Registry.
- Calculated age-standardized incidence rates before and after screening program implementation.
- Analyzed incidence trends specifically for infants and young children.
Main Results:
- Neuroblastoma incidence in children under 15 increased from 7.5-9.1 x 10(-6) to 19.5 x 10(-6) after screening began in 1985.
- Incidence in infants (<1 year) dramatically rose to 150.60 x 10(-6) (1989-1992) compared to 23.6-34.13 x 10(-6) in prior periods.
- A slight decrease in incidence was observed in 2-3 year olds, but did not fully account for the infant increase.
Conclusions:
- The neuroblastoma screening program in Japan is associated with a substantial rise in diagnosed cases, particularly among infants.
- Findings suggest that screening may lead to the detection of neuroblastoma tumors that would have spontaneously regressed.
- Further research is critical to ascertain the program's impact on mortality rates before its continuation is decided.
Abstract:
Using data from the Japan Children's Cancer Registry, we estimated the age-specific incidence rates of neuroblastoma. Before the neuroblastoma screening program started in 1985, the age-standardized incidence rates of neuroblastoma ranged from 7.5 to 9.1 x 10(-6) for children under 15 years of age. After the introduction of the screening program, the annual incidence rate rose to 19.5 x 10(-6). The annual incidence rate for neuroblastoma in children under 1 year of age was 150.60 x 10(-6) in the years 1989 to 1992, whereas the incidence rates only varied between 23.6 and 34.13 x 10(-6) in the 3 preceding 5-year periods. This increase in incidence for infants was accompanied by a minor decrease in incidence for children 2 to 3 years of age. However, this decrease may only partly explain the large increase in incidence for infants. Therefore, we suggest that screening may result in the detection of otherwise spontaneously regressing tumors. It is urgent to determine the contribution of screening to decreasing mortality before deciding whether this screening program should be continued.