Mass Screening for Neuroblastoma

Neuroblastoma is the most common solid tumour in infancy. The introduction of multimodality therapy has improved treatment, but the prognosis of advanced neuroblastoma remains dismal. In 1974, Sawada and colleagues started experimental screening for neuroblastoma at 6 months of age using the vanillylmandelic acid (VMA) spot test1,2. The excellent results of treatment in these patients led to the introduction in 1985 of a nationwide mass screening programme in Japan3,4. The idea of mass screening infants at 6 months is largely based on the following three findings: 1. Over 90% of children with neuroblastoma excrete increased quantities of catecholamine metabolites, which can be measured in random urine samples obtained from diapers: it is therefore possible to screen and detect these tumours before symptoms become manifest. 2. Children who present before 1 year of age have a better outlook than older children. 3. Patients with localized disease fare better than those with advanced disease.