FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 346:1047-1053 April 4, 2002 Number 14 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Cunningham, G. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Neuroblastoma is the second most common type of childhood tumor. It is not known whether screening for neuroblastoma at one year of age reduces the incidence of metastatic disease or mortality due to neuroblastoma.

Methods We offered urine screening for neuroblastoma at approximately one year of age to 2,581,188 children in 6 of 16 German states from 1995 to 2000. A total of 2,117,600 eligible children in the remaining states served as controls. We compared the two groups in terms of the incidence of disseminated disease and mortality from neuroblastoma.

Results A total of 1,475,773 children (61.2 percent of those who were born between July 1, 1994, and October 31, 1999) underwent screening. In this group, neuroblastoma was detected by screening in 149 children, of whom 3 have died. Fifty-five children who had negative screening tests were subsequently given a diagnosis of neuroblastoma; 14 of these children have died. The screened group and children in the control area had a similar incidence of stage 4 neuroblastoma (3.7 cases per 100,000 screened children [95 percent confidence interval, 2.7 to 4.7] and 3.8 per 100,000 controls [95 percent confidence interval, 2.9 to 4.6]) and a similar rate of death among children with neuroblastoma (1.3 deaths per 100,000 screened children [95 percent confidence interval, 0.7 to 1.8] and 1.2 per 100,000 controls [95 percent confidence interval, 0.7 to 1.7]). Comparison of the screened group and the children in the control area revealed substantial overdiagnosis in the former group (an estimated rate of 7 cases per 100,000 children [95 percent confidence interval, 4.6 to 9.2]); the overdiagnosis rate represents children who had neuroblastoma that was diagnosed by screening but who would not benefit from earlier diagnosis and treatment.

Conclusions The present findings do not support the usefulness of general screening for neuroblastoma at one year of age.

Source Information

From the Klinikum Stuttgart, Olgahospital, Child and Adolescent Health, Pediatrics 5, Stuttgart (F.H.S., K.S., J.T.); Johannes Gutenberg University, German Childhood Cancer Registry, Mainz (C.S., G.K., J.M.); the University of Cologne, Children's Hospital, Pediatric Oncology and Hematology, Cologne (F.B., B.H.); the University of Hamburg, University Hospitals Eppendorf, Pediatric Hematology and Oncology, Hamburg (R.E., N.F.); and Landesgesundheitsamt Niedersachsen, Hannover (J.S., U.Z.) — all in Germany.

Address reprint requests to Dr. Schilling at the Klinikum Stuttgart, Olgahospital, Pediatrics 5 (Oncology, Hematology, and Immunology), Bismarckstr. 8, D-70176 Stuttgart, Germany, or at f.schilling{at}olgahospital.de.

Full Text of this Article

Related Letters:

Neuroblastoma Screening in Early Life
Suita S., Kerbl R., Urban C. E., Ambros P. F., Collins M. H., Green N. S., Woods W. G., Bernstein M., Robison L. L., Schilling F. H., Spix C., Berthold F.
Extract | Full Text | PDF  
N Engl J Med 2002; 347:852-854, Sep 12, 2002. Correspondence

This article has been cited by other articles:

• Douglas, P. S., Taylor, A., Bild, D., Bonow, R., Greenland, P., Lauer, M., Peacock, F., Udelson, J. (2009). Outcomes Research in Cardiovascular Imaging: Report of a Workshop Sponsored by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol Img 2: 897-907 [Abstract] [Full Text]  
• Douglas, P. S., Taylor, A., Bild, D., Bonow, R., Greenland, P., Lauer, M., Peacock, F., Udelson, J. (2009). Outcomes Research in Cardiovascular Imaging: Report of a Workshop Sponsored by the National Heart, Lung, and Blood Institute. Circ Cardiovasc Imaging 2: 339-348 [Abstract] [Full Text]  
• Lauer, M. S. (2009). Discarding Logic: 2008 Ancel Keys Memorial Lecture. Circulation 119: 1533-1537 [Full Text]  
• Woods, W. G., LaQuaglia, M. P. (2009). The Drama of the Gifted Disease. JCO 27: 172-173 [Full Text]  
• Zahl, P.-H., Maehlen, J., Welch, H. G. (2008). The Natural History of Invasive Breast Cancers Detected by Screening Mammography. Arch Intern Med 168: 2311-2316 [Abstract] [Full Text]  
• Hero, B., Simon, T., Spitz, R., Ernestus, K., Gnekow, A. K., Scheel-Walter, H.-G., Schwabe, D., Schilling, F. H., Benz-Bohm, G., Berthold, F. (2008). Localized Infant Neuroblastomas Often Show Spontaneous Regression: Results of the Prospective Trials NB95-S and NB97. JCO 26: 1504-1510 [Abstract] [Full Text]  
• Welch, H. G., Woloshin, S., Schwartz, L. M. (2008). The Sea of Uncertainty Surrounding Ductal Carcinoma In Situ--The Price of Screening Mammography. JNCI J Natl Cancer Inst 100: 228-229 [Full Text]  
• Welch, H. G., Woloshin, S., Schwartz, L. M., Gordis, L., Gotzsche, P. C., Harris, R., Kramer, B. S., Ransohoff, D. F. (2007). Overstating the Evidence for Lung Cancer Screening: The International Early Lung Cancer Action Program (I-ELCAP) Study. Arch Intern Med 167: 2289-2295 [Abstract] [Full Text]  
• Singh, R. J., Eisenhofer, G. (2007). High-Throughput, Automated, and Accurate Biochemical Screening for Pheochromocytoma: Are We There Yet?. Clin. Chem. 53: 1565-1567 [Full Text]  
• Bach, P. B., Jett, J. R., Pastorino, U., Tockman, M. S., Swensen, S. J., Begg, C. B. (2007). Computed Tomography Screening and Lung Cancer Outcomes. JAMA 297: 953-961 [Abstract] [Full Text]  
• Barrette, S., Bernstein, M. L., Leclerc, J.-M., Champagne, M. A., Samson, Y., Brossard, J., Woods, W. G. (2006). Treatment Complications in Children Diagnosed With Neuroblastoma During a Screening Program. JCO 24: 1542-1545 [Abstract] [Full Text]  
• Botkin, J. R. (2005). Research for Newborn Screening: Developing a National Framework. Pediatrics 116: 862-871 [Abstract] [Full Text]  
• Welch, H G., Woloshin, S., Schwartz, L. M (2005). Skin biopsy rates and incidence of melanoma: population based ecological study. BMJ 331: 481- [Abstract] [Full Text]  
• Levy, I. G. (2005). Neuroblastoma, Well-Designed Evaluations, and the Optimality of Research Funding: Ask Not What Your Country Can Do for You .... JNCI J Natl Cancer Inst 97: 1105-1106 [Full Text]  
• Soderstrom, L., Woods, W. G., Bernstein, M., Robison, L. L., Tuchman, M., Lemieux, B. (2005). Health and Economic Benefits of Well-Designed Evaluations: Some Lessons From Evaluating Neuroblastoma Screening. JNCI J Natl Cancer Inst 97: 1118-1124 [Abstract] [Full Text]  
• Bach, P. B., Elkin, E. B., Pastorino, U., Kattan, M. W., Mushlin, A. I., Begg, C. B., Parkin, D. M. (2004). Benchmarking Lung Cancer Mortality Rates in Current and Former Smokers. Chest 126: 1742-1749 [Abstract] [Full Text]  
• Moyer, V. A., Butler, M. (2004). Gaps in the Evidence for Well-Child Care: A Challenge to Our Profession. Pediatrics 114: 1511-1521 [Abstract] [Full Text]  
• Alaminos, M., Davalos, V., Cheung, N.-K. V., Gerald, W. L., Esteller, M. (2004). Clustering of Gene Hypermethylation Associated With Clinical Risk Groups in Neuroblastoma. JNCI J Natl Cancer Inst 96: 1208-1219 [Abstract] [Full Text]  
• Kushner, B. H. (2004). Neuroblastoma: A Disease Requiring a Multitude of Imaging Studies. JNM 45: 1172-1188 [Abstract] [Full Text]  
• Fenton, J. J, Elmore, J. G (2004). Balancing mammography's benefits and harms. BMJ 328: E301-E302 [Full Text]  
• Dyer, M A (2004). Mouse models of childhood cancer of the nervous system. J. Clin. Pathol. 57: 561-576 [Abstract] [Full Text]  
• Tsubono, Y., Hisamichi, S. (2004). A Halt to Neuroblastoma Screening in Japan. NEJM 350: 2010-2011 [Full Text]  
• Kerbl, R., Urban, C. E., Ambros, I. M., Dornbusch, H. J., Schwinger, W., Lackner, H., Ladenstein, R., Strenger, V., Gadner, H., Ambros, P. F. (2003). Neuroblastoma Mass Screening in Late Infancy: Insights Into the Biology of Neuroblastic Tumors. JCO 21: 4228-4234 [Abstract] [Full Text]  
• Spitz, R., Hero, B., Ernestus, K., Berthold, F. (2003). Gain of Distal Chromosome Arm 17q Is Not Associated with Poor Prognosis in Neuroblastoma. Clin. Cancer Res. 9: 4835-4840 [Abstract] [Full Text]  
• Weinstein, J. L., Katzenstein, H. M., Cohn, S. L. (2003). Advances in the Diagnosis and Treatment of Neuroblastoma. The Oncologist 8: 278-292 [Abstract] [Full Text]  
• Berlin, L. (2003). Potential Legal Ramifications of Whole-Body CT Screening: Taking a Peek into Pandora's Box. Am. J. Roentgenol. 180: 317-322 [Full Text]  
• Black, W. C., Brant-Zawadzki, M. N. (2002). Invited Commentary * Author's Response. RadioGraphics 22: 1536-1539 [Full Text]  
• Suita, S., Kerbl, R., Urban, C. E., Ambros, P. F., Collins, M. H., Green, N. S., Woods, W. G., Bernstein, M., Robison, L. L., Schilling, F. H., Spix, C., Berthold, F. (2002). Neuroblastoma Screening in Early Life. NEJM 347: 852-854 [Full Text]  
• (2002). Screening for Neuroblastoma: Not Yet. JWatch Pediatrics 2002: 2-2 [Full Text]  
• (2002). Screening for Neuroblastoma: Not Yet. JWatch General 2002: 7-7 [Full Text]  
• Woods, W. G., Gao, R.-N., Shuster, J. J., Robison, L. L., Bernstein, M., Weitzman, S., Bunin, G., Levy, I., Brossard, J., Dougherty, G., Tuchman, M., Lemieux, B. (2002). Screening of Infants and Mortality Due to Neuroblastoma. NEJM 346: 1041-1046 [Abstract] [Full Text]  
• Cunningham, G. (2002). The Science and Politics of Screening Newborns. NEJM 346: 1084-1085 [Full Text]