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Newborn screening for neuroblastoma
1University of Newcastle upon Tyne, Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Insights
Mass screening for neuroblastoma in infants has led to significant overdiagnosis. Current evidence suggests infant screening offers little survival advantage and may not reduce advanced disease incidence.
Area of Science:
- Pediatric Oncology
- Public Health
- Screening Programs
Background:
- Mass screening for neuroblastoma was implemented in Japan in 1985 following positive infant screening reports.
- Subsequent data from Japan, North America, and Europe indicate that screening is linked to considerable overdiagnosis of neuroblastoma.
Purpose of the Study:
- To evaluate the impact of neuroblastoma screening on overdiagnosis and survival.
- To assess the effectiveness of current screening strategies and inform future research.
Main Methods:
- Review of existing reports and studies on neuroblastoma screening from Japan, North America, and Europe.
- Analysis of trends in disease incidence, advanced stage disease, and mortality in relation to screening implementation.
- Examination of ongoing screening studies in Europe focusing on older children to mitigate overdiagnosis.
Main Results:
- Neuroblastoma screening is consistently associated with substantial overdiagnosis across multiple regions.
- Screening infants under one year of age has not been shown to reduce the incidence of disease in older children or advanced stage disease.
- The survival advantage conferred by infant screening appears minimal, with mortality trends potentially predating screening effects.
Conclusions:
- Infant screening for neuroblastoma leads to significant overdiagnosis without clear survival benefits.
- Current research is exploring modified screening protocols in older children to reduce overdiagnosis.
- The definitive impact of neuroblastoma screening on mortality remains uncertain and requires longer-term study.
Abstract:
Following favorable reports of infant screening for neuroblastoma, mass screening was introduced throughout Japan in 1985. Since then, reports from Japan, North America, and Europe have all confirmed that screening is associated with substantial overdiagnosis. Recent reports from both Japan and North America suggest that screening at under 1 year of age does not reduce the incidence of disease in older children or of advanced stage disease and is therefore likely to confer little survival advantage. Current screening studies in Europe are investigating the effects of screening in older children (10 to 14 months) in an attempt to reduce overdiagnosis. The effect of screening on mortality remains unknown. Mortality from neuroblastoma in Japan is falling, but most of the fall predates the possible effect of screening. Longer follow-up of the North American study and the recently implemented German study may eventually provide an answer.