Mass screening for neuroblastoma and mortality in birth cohorts

Abstract

Mortality resulting from neuroblastoma in birth cohorts in both Sapporo City and the whole of Japan was investigated to evaluate the effects of a high-performance liquid chromatography (HPLC) mass screening program, targeting on 6 monthold infants. In Sapporo City, the non-HPLC screened cohort showed no reduction in mortality at 4 years of age compared with the pre-screening cohort. However, the HPLC screened cohort showed a reduction of 69% in mortality compared with the pre-screening cohort. On a nation-wide scale, there was a significant decline in mortality for the non-HPLC screened cohort compared with the pre-screening cohort; for the HPLC screened cohort for 1989-1991, there was also a reduction in mortality for children younger than 2 years of age. The incidence of neuroblastoma at 1-4 years of age in the HPLC cohort in Sapporo City was about half that in the pre-screening cohort, along with and probably because of an increasing incidence among infants in the same cohort. Our findings suggest that HPLC screening may detect some poor-prognosis neuroblastoma cases at early stages, thus providing for more favorable therapy. Int.

Neuroblastoma Screening at One Year of Age

“…37 However, there is no populationbased registry of childhood cancers in Japan, 9 and lead-time bias may result in overestimation of the benefit of screening. 22,23,38,39 In addition, the detection of neuroblastomas that would otherwise spontaneously regress contributes to an overestimation of the benefits of screening.…”

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.…”

“…[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. Among whites, age-standardized annual incidence in children younger than 15 years was 7 to 12 per 1 million, 13 whereas the corresponding figure was 8.2 per 1 million in Japan.…”

“…The rate in all Japan was reported to be 4.42 (360 deaths) for children born approximately between 1974 and 1984. 9 The rates for the cohort born in 1987 were reported to be 3.0 in France and 2.7 in Germany. 18 The neuroblastoma mortality rate in Japan was slightly higher than that in France or in Germany, and it was assumed that a decline of mortality occurred by improvement of therapy and by screening.…”

A Halt to Neuroblastoma Screening in Japan

“…1,3 The findings of the two trials disagreed with those of descriptive and observational studies in Japan that had suggested a reduction in the rate of death due to neuroblastoma in association with the screening of six-month-old infants by high-performance liquid chromatography. 4 Because of these discrepancies, on May 28, 2003, the Japanese Ministry of Health, Labor, and Welfare organized a special committee to reconsider the rationale for the current policy, with one of us serving as the chairman and the other as a member of the committee. After four meetings, the committee published a report on August 14, 2003.…”