Screening for neuroblastoma: a 9–year birth cohort–based study in Niigata, Japan

Abstract

Between April 1985 and March 1994 (9 years), 229,346 babies were born in Niigata prefecture, and 201,888 (88.0%) underwent mass screening (MS) for neuroblastoma at 6 months of age. To date, 29 infants have been screen-detected as having neuroblastoma (1:7908). All screen-detected patients survived after removal of the primary tumor. In the same birth cohort, 17 additional children were clinically diagnosed as having neuroblastoma. The cumulative incidence rate of neuroblastoma at 5 years of age was 10.5 per 100,000 live births in the 5-year birth cohort before MS was introduced, and 18.6 per 100,000 in the first 5-year birth cohort after MS was introduced. These values were not statistically different. The birth cohort incidence rate increased significantly to 22.2 per 100,000 (p < 5% compared with before MS) after the method of MS was changed to high-power liquid chromatography (HPLC), even though this latest birth cohort has not been followed for 5 years. The population-based mortality rate from neuroblastoma was 5.9 per 100,000 in the 5-year birth cohort before MS, and 4.5 per 100,000 after MS in the first 5-year birth cohort, using the vanillymandelic acid (VMA) spot test. These values were not statistically significant. In contrast, no death was observed in the next 4-year birth cohort after MS using HPLC; however, this birth cohort has not yet been followed for 5 years.

Marginal Decrease in Mortality and Marked Increase in Incidence as a Result of Neuroblastoma Screening at 6 Months of Age: Cohort Study in Seven Prefectures in Japan

“…Previous reports from Japan have commonly noted an increased incidence in those younger than 1 year of age, but a decrease in incidence in those older than 1 year was controversial. [8][9][10][11][12] Regarding mortality, it was reported that cumulative mortality rates in children younger than 5 years of age in the HPLC cohort was lower than that in the prescreening cohort (.05 Ͻ P Ͻ .10) in Sapporo City. 9 The most dramatic effect of screening was an increase in incidence.…”

Screening for neuroblastoma in infants younger than 1 year of age: review of the first 30 years

“…Bessho [38] has presented data that suggest a possible decline in neuroblastoma incidence in older children associated with screening, which would imply that mortality should fall, but uncertainties in the ascertainment of neuroblastoma cases, reflecting the overall incompleteness of cancer registration in Japan, make the conclusions far from certain. Asami et al [20] have presented data on mortality in screened and unscreened cohorts in Niigata. There have been no deaths in the HPLC-screened cohort of 94,811 births from April 1990-September 1994, compared with a mortality rate of 4.5 per 100,000 in the cohort born 5 years before this period who were screened by spot test.…”

Colloquy on Neuroblastoma Screening: Is there a future for neuroblastoma mass screening?

“…There are other reports that show a reduction in NBL mortality and/or incidence after introduction of screening programs [13,14]. However, the observation period is still short, and meaningful differences may emerge with time; up to now, the differences are not statistically significant.…”