Neuroblastoma Mass Screening—What Can We Learn From It?

In this issue of the Journal of Epidemiology, Ioka et al reported a study on the national mass screening program for neuroblastoma in Japan. 1 The mass screening program for neuroblastoma was started in Kyoto City in 1973 and expanded as a national mass screening program in the mid-1980s.The screening was carried out by collecting urine samples from 6-month-old infants for the measurement of catecholamine metabolites (vanilmandelic acid and homovanillic acid).This method was widely accepted by parents having a new baby: the participation rate in 2001 was approximately 90%, 2 which is much higher than the current participation rates in cancer screening programs for adults.This screening method for neuroblastoma was developed in Japan.3 A study reported in Cancer in 1984 showed that the survival rate of neuroblastoma patients increased from 17.1% to 72.2% after the introduction of the mass screening program in Kyoto City. 3 This must have encouraged many pediatricians, who had encountered many miserable outcomes in children.An epidemiologist might wish that this study could have been done with population-based mortality as the outcome.However, given that the annual number of deaths from this disease was <100 in the entire nation, the sample size might have been insufficient even if the city residents had been followed for decades.4 In the 1990s, descriptive epidemiological studies in Sapporo and Osaka examined the effects of mass screening for neuroblastoma by comparing the mortality rates between the post-and pre-screening periods.The study in Sapporo showed a reduction in mortality after the introduction of mass screening, 5 whereas the study in Osaka reported that the screening program minimally affected mortality.6 There had also been a vigorous debate in clinical settings regarding the spontaneous regression of neuroblastoma detected by mass screening.[7][8][9][10][11] In 2002, two historical reports were published in the same issue of the New England Journal of Medicine.12,13 The two

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