Screening of infants and mortality due to neuroblastoma.
BACKGROUND
Neuroblastoma, the most common extracranial solid tumor that occurs in early childhood, can be identified in the preclinical stages by the detection of catecholamines in the urine. However, it is unknown whether routine screening for neuroblastoma reduces mortality due to this disease.


METHODS
Through their parents, we offered screening for neuroblastoma at three weeks and six months of age to all 476,654 children born in the province of Quebec, Canada, during a five-year period (May 1, 1989, through April 30, 1994). The participation rate was 92 percent. The rate of death due to neuroblastoma was determined and compared with the rates in several unscreened control populations born during the same period.


RESULTS
Among children younger than eight years of age in the Quebec cohort, there were 22 deaths due to neuroblastoma; the cumulative (+/-SE) mortality rate due to neuroblastoma was 4.78+/-1.14 per 100,000 children over a period of nine years. The standardized incidence ratios for death due to neuroblastoma for the Quebec cohort were 1.11 (95 percent confidence interval, 0.64 to 1.92) as compared with a control group in Ontario, Canada; 0.90 (95 percent confidence interval, 0.48 to 1.70) as compared with a control group in Minnesota; 1.40 (95 percent confidence interval, 0.81 to 2.41) as compared with a control group in Florida; and 0.96 (95 percent confidence interval, 0.56 to 1.66) as compared with a control group in the Greater Delaware Valley. The standardized mortality ratio for the Quebec cohort as compared with the rest of Canada was 1.39 (95 percent confidence interval, 0.85 to 2.30); the odds ratio for the comparison with a cohort born in Quebec before the screening program began was 0.98 (95 percent confidence interval, 0.54 to 1.77).


CONCLUSIONS
Screening infants for neuroblastoma does not appear to reduce mortality due to this disease.
Woods
William G
WG
AFLAC Cancer Center, Emory University and Children's Healthcare of Atlanta, GA 30322, USA. william.woods@choa.org
Gao
Ru-Nie
RN
Shuster
Jonathan J
JJ
Robison
Leslie L
LL
Bernstein
Mark
M
Weitzman
Sheila
S
Bunin
Greta
G
Levy
Isra
I
Brossard
Josee
J
Dougherty
Geoffrey
G
Tuchman
Mendel
M
Lemieux
Bernard
B
D002170:Canada / Q000453:epidemiology; D016022:Case-Control Studies; D002395:Catecholamines / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006719:Homovanillic Acid / Q000652:urine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening; D015997:Neonatal Screening; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D011792:Quebec / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014642:Vanilmandelic Acid / Q000652:urine
D002395:Catecholamines; D014642:Vanilmandelic Acid; D006719:Homovanillic Acid