http://bmj.com/cgi/content/full/324/7342/867/a
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Oncology Screening
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Two studies from Canada and Germany published last week provide clear evidence that children aged 1 year or younger should not be screened for neuroblastoma, because mortality is not reduced by mass screening (New England Journal of Medicine 2002;346:1041-6 and 1047-53).
On the contrary, screening may have adverse effects, the researchers say, because it detects early cases of the tumour that probably would have remitted spontaneously without treatment. The German study reported three deaths that were due to treatment complications after early detection.
Neuroblastoma is the second most common type of childhood tumour. The
prognosis depends on the age
the
younger, the betterand
the stage of the disease. Therefore, early detection by mass screening
was thought to be a promising strategy.
Screening is easy. The tumour produces catecholamines, which can be detected in urine. "Studies in Japan with 6 month old children and our own pilot studies had suggested that screening might be beneficial," said the lead author of the German study, Dr Freimut Schilling, of the Olgahospital Paediatric Centre in Stuttgart.
In the early 1990s German health insurance companies were willing to pay for
the screening, but expert opinion remained divided. Eventually German
doctors convinced the health insurance companies to fund a large
epidemiological study that would provide clear evidence on the issue.
The German study cost DM30m (£9.4m; $13.4m; 
15.3m).
In the screening of almost 1.5 million children aged 1 year in six German states from July 1994 to October 1999, 149 cases of neuroblastoma were found. With the help of the German childhood cancer registry, the researchers compared the screened group with the unscreened population in the rest of Germany.
The number of children with progressive disease and a poor prognosis was not reduced by screening. The mortality in both groups was almost equal: 1.1 deaths per 100000 children. More early cases were detected in the screened group, who received unnecessary treatment that in some cases was harmful.
The high rate of overdiagnosis indicates that spontaneous regression occurs after the first nine months.
The Canadian study looked at about 450000 children in Quebec who were screened between the ages of 3 weeks and 6 months. Again, the mortality in Quebec was not reduced in the screened population, compared with children in the rest of Canada.
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Collections under
which this article appears:Other
Oncology Screening
Children
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Pediatrics |
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