title: Screening for neuroblastoma in the north of England.
abstract: OBJECTIVE
  To determine the feasibility of establishing a system of screening for neuroblastoma.
  
  
  METHODS
  Prospective study of mass screening in four clearly defined geographical areas.
  
  
  METHODS
  Four health districts of the Northern region of England.
  
  
  METHODS
  20,829 babies aged 6 months, 92% of target population.
  
  
  METHODS
  Collection of urine on filter paper for analysis of content of homovanillic and vanillylmandelic acid in relation to urinary creatinine concentrations.
  
  
  METHODS
  Derivation of reference range. Identification of babies with homovanillic or vanillylmandelic acid > 3 SD above the mean (positive cases). Investigation of positive cases for evidence of neuroblastoma.
  
  
  RESULTS
  The upper limit of normal (3 SD above the mean) for vanillylmandelic acid was 15 mumol/mmol creatinine and for homovanillic acid 24 mumol/mmol creatinine. Of the 20,829 babies screened, 2537 (12.2%) required a second sample to be taken because the first sample was inadequate. Of these, 527 (2.5%) provided a liquid urine specimen and 10 (0.04%) had positive results for neuroblastoma. Two of them had neuroblastoma (true positives) and eight did not (false positives). A further three children from the cohort were subsequently found to have neuroblastoma; they had raised homovanillic acid or vanillylmandelic acid values, or both, but screened negative at 6 months.
  
  
  CONCLUSIONS
  Screening for neuroblastoma is possible in the health care system of the United Kingdom. Evaluation of the efficacy of screening in reducing the mortality from neuroblastoma requires a controlled trial.
authors.affiliation: Department of Child Health, Medical School, Newcastle upon Tyne.
authors.forename: L
authors.initials: L
authors.lastname: Parker
authors.forename: A W
authors.initials: AW
authors.lastname: Craft
authors.forename: G
authors.initials: G
authors.lastname: Dale
authors.forename: S
authors.initials: S
authors.lastname: Bell
authors.forename: M
authors.initials: M
authors.lastname: Cole
authors.forename: A C
authors.initials: AC
authors.lastname: McGill
authors.forename: J A
authors.initials: JA
authors.lastname: Seviour
authors.forename: J
authors.initials: J
authors.lastname: Smith
mesh_terms: D003404:Creatinine / Q000652:urine; D004739:England / Q000453:epidemiology; D005188:False Negative Reactions; D005189:False Positive Reactions; D005240:Feasibility Studies; D005260:Female; D006719:Homovanillic Acid / Q000652:urine; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009447:Neuroblastoma / Q000453:epidemiology / Q000517:prevention & control* / Q000652:urine; D011446:Prospective Studies; D012016:Reference Values; D014642:Vanilmandelic Acid / Q000652:urine
chemical_list: D014642:Vanilmandelic Acid; D003404:Creatinine; D006719:Homovanillic Acid