Screening for neuroblastoma in infants: investigate or implement?

Neuroblastoma is a type of cancer involving a bleeding tumor; it is one of the most common malignancies occurring in young children in the United States. The outcome of treatment for this cancer depends on the stage of the disease and the age of the patient at the time of diagnosis. Early detection of neuroblastoma has improved the survival rate of afflicted patients. In Japan, infants are required to undergo routine screening for neuroblastoma. The Quebec Neuroblastoma Screening Study was established to assess the effects of screening infants for neuroblastoma on the rate of death due to this cancer. The neuroblastoma tumor secretes large amounts of metabolic products that can easily be measured in urine samples. However, screening may only be useful if the cancer follows a typical pattern of development, consisting of restricted tumor growth followed by metastases, or spreading of the tumor to other sites. But tumors in neuroblastoma appear to develop in a heterogeneous manner, and may regress spontaneously. Screening for neuroblastoma would detect mainly patients with benign, slow-growing or regressing tumors rather than rapidly growing, malignant tumors. Hence, survival rates based on screening may appear better than those determined from clinically detected tumors. Neuroblastoma tumors are classified into different forms, which vary in genetic characteristics, prognosis, and the specific metabolites they produce. Tumors detected by screening tend to have a better prognosis than tumors detected clinically. Results available so far suggest that screening infants for neuroblastoma would be premature and possibly inefficient from an economic standpoint. (Consumer Summary produced by Reliance Medical Information, Inc.)