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Neuroblastoma screening in the United States: results of the Texas Outreach Program for neuroblastoma screening
J L Ater1, K L Gardner, L E Foxhall
1Division of Pediatrics, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Insights
Early detection of neuroblastoma in infants was achieved using ELISA screening. However, overall compliance rates were low, highlighting the need for improved outreach strategies in healthcare systems.
Area of Science:
- Pediatric Oncology
- Diagnostic Screening
- Public Health
Background:
- Neuroblastoma mass screening in infants was initiated in Japan to improve survival rates through early detection.
- This study assessed the methodology and feasibility of neuroblastoma screening within the U.S. healthcare system.
Purpose of the Study:
- To evaluate the effectiveness of mass screening for neuroblastoma in infants aged 5-10 months in the U.S.
- To determine the feasibility and compliance rates of different screening kit distribution methods.
Main Methods:
- Infants born in Texas were screened using an enzyme-linked immunosorbent assay (ELISA) for homovanillic acid (HVA) and vanillylmandelic acid (VMA) in dried urine specimens.
- Recruitment utilized various methods, with compliance rates calculated to assess effectiveness.
Main Results:
- Between 1991 and 1994, 14,046 infants were screened, detecting 2 cases of neuroblastoma (1 in 7023 incidence).
- Overall compliance rate was low at 4.8% (291,158 kits distributed).
- Compliance varied significantly by distribution method: WIC clinics (53%), volunteers (31%), private physicians (9.9%), and mail (4.7%).
Conclusions:
- ELISA enabled early detection of neuroblastoma in the target infant population.
- Preventive health-focused clinics, like WIC, demonstrated higher compliance rates compared to private physician distribution.
- Low overall compliance underscores challenges in implementing large-scale infant screening programs.
Background:
Mass screening of infants for neuroblastoma began in Japan after studies suggested that survival rates could be improved by early detection. This study was initiated in 1991 to test the methodology and feasibility of screening for neuroblastoma within the U. S. health care system.
Methods:
Infants ages 5-10 months (mean age, 9 months, 25 days) who were born in Texas were screened for neuroblastoma. An enzyme-linked immunoadsorbent assay (ELISA) for homovanillic acid (HVA) and vanillylmandelic acid (VMA) used to quantify the HVA and VMA was performed on urine extracted from specimens dried on filter paper. Infants were recruited to participate in the study by several methods, and the effectiveness of each method was determined by calculating compliance rates.
Results:
Between February 1991 and June 1994 a total of 14,046 infants were recruited to participate in neuroblastoma screening. Neuroblastoma was detected in 2 children for an incidence rate of 1 in 7023. A total of 291,158 screening kits were distributed to the parents of these infants, resulting in an overall compliance rate of only 4.8%. Compliance rates varied by method of distribution of the test kits: Houston Women, Infants, and Children (WIC) clinic (53%), volunteers (31%), Rio Grande Valley WIC clinics (14.5%), the patient's private physician (9.9%), and by mail (4.7%).
Conclusions:
Early detection of neuroblastoma in infants ages 5-10 months was achieved using ELISA. Compliance rates were poor, but clinics with a preventive health focus, such as the WIC clinics, achieved higher compliance rates than did private physicians.
