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Editor,—Papanicolaou et al 1 reported their experience of using abdominal ultrasound for the preclinical diagnosis of neuroblastoma in seven infants. The authors suggest that this may be a useful screening technique and urge paediatricians to perform this examination as it is “non-invasive, painless, and safe”.
Unfortunately, the authors are clearly unaware of the controversy which surrounds infant screening for neuroblastoma. It has been used throughout Japan since 1985 and has been studied in Europe and North America.2 Screening infants for neuroblastoma greatly increases the observed cumulative incidence of the disease, and up to 75% of all infants detected by biochemical screening have tumours which would otherwise have undergone spontaneous regression and would have been of no clinical consequence.3 Papanicolaouet al detected seven cases in a population of 7500 babies1; at least six of these children must have had regressing disease and were not in need of any intervention. In contrast to the technique used for primary screening, surgical removal of an abdominal tumour is neither non-invasive, painless, nor safe—it is associated with significant mortality and morbidity.
Despite more than 20 years of infant screening for neuroblastoma there is no convincing data to suggest that preclinical detection of neuroblastoma reduces the death rate from this disease.
In 1991, the International Paediatric Oncology Society (SIOP) issued a statement that there was no case for the universal implementation of infant screening for neuroblastoma. The claim by Papanicolaou et al that their preliminary results may justify the use of abdominal ultrasound as a screening method for the general population is unwarranted. No screening programme should be introduced until its efficacy has been shown in a controlled trial. The only controlled trial of infant screening published so far began in Quebec in 1990 and to date has shown no advantage of screening.4 In Germany, a controlled trial of over a million children screened at the age of 1 year is underway and should report early in the next century.
Screening infants under the age of 1 year for neuroblastoma is a potentially hazardous procedure and is not recommended.
Editor,—Papanicolaou et al present early data on their population based study to evaluate the use of abdominal ultrasound as a screening method to detect early abdominal tumours and conclude that ultrasound is useful in the early diagnosis of neuroblastoma.1-1 However, all of the tumours so identified were localised. Two required no interventional treatment and five—although the details of other staging methods is not described—are presumed to have been stage I neuroblastomas. It is now conventional wisdom that these types of tumour also do not require intervention, especially major invasive surgery, with its resultant morbidity. If it were not for this current study we believe that they would have remained asymptomatic and never diagnosed.
Many population based studies have looked at the usefulness of urinary screening for neuroblastoma.1-2 1-3 In general, they conclude that screening for neuroblastoma increases the incidence in infants without decreasing the incidence of unfavourable advanced stage disease in older children. It does not appear that screening for neuroblastoma in infants will reduce the mortality of this disease by enabling early intervention. In our opinion this preliminary report does not justify abdominal ultrasound as a screening method for abdominal tumours, even if performed for other reasons. Moreover, it may encourage unnecessary intervention at a cost to both the child and the health service.