Screening of infants and mortality due to neuroblastoma

N Engl J Med. 2002 Apr 4;346(14):1041-6. doi: 10.1056/NEJMoa012387.


Background: Neuroblastoma, the most common extracranial solid tumor that occurs in early childhood, can be identified in the preclinical stages by the detection of catecholamines in the urine. However, it is unknown whether routine screening for neuroblastoma reduces mortality due to this disease.

Methods: Through their parents, we offered screening for neuroblastoma at three weeks and six months of age to all 476,654 children born in the province of Quebec, Canada, during a five-year period (May 1, 1989, through April 30, 1994). The participation rate was 92 percent. The rate of death due to neuroblastoma was determined and compared with the rates in several unscreened control populations born during the same period.

Results: Among children younger than eight years of age in the Quebec cohort, there were 22 deaths due to neuroblastoma; the cumulative (+/-SE) mortality rate due to neuroblastoma was 4.78+/-1.14 per 100,000 children over a period of nine years. The standardized incidence ratios for death due to neuroblastoma for the Quebec cohort were 1.11 (95 percent confidence interval, 0.64 to 1.92) as compared with a control group in Ontario, Canada; 0.90 (95 percent confidence interval, 0.48 to 1.70) as compared with a control group in Minnesota; 1.40 (95 percent confidence interval, 0.81 to 2.41) as compared with a control group in Florida; and 0.96 (95 percent confidence interval, 0.56 to 1.66) as compared with a control group in the Greater Delaware Valley. The standardized mortality ratio for the Quebec cohort as compared with the rest of Canada was 1.39 (95 percent confidence interval, 0.85 to 2.30); the odds ratio for the comparison with a cohort born in Quebec before the screening program began was 0.98 (95 percent confidence interval, 0.54 to 1.77).

Conclusions: Screening infants for neuroblastoma does not appear to reduce mortality due to this disease.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Canada / epidemiology
  • Case-Control Studies
  • Catecholamines / metabolism
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Homovanillic Acid / urine
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Mass Screening*
  • Neonatal Screening
  • Neoplasm Staging
  • Neuroblastoma / diagnosis
  • Neuroblastoma / mortality*
  • Neuroblastoma / prevention & control
  • Quebec / epidemiology
  • United States / epidemiology
  • Vanilmandelic Acid / urine


  • Catecholamines
  • Vanilmandelic Acid
  • Homovanillic Acid