Note: Separate PDQ summaries on Neuroblastoma Treatment and Levels of Evidence for Cancer Screening and Prevention Studies are also available.

Intervention

Screening, usually at age 6 months, for urine vanillylmandelic acid and homovanillic acid, which are metabolites of the hormones norepinephrine and dopamine.

Benefits

Based on solid evidence, screening for neuroblastoma does not lead to decreased mortality.

Description of the Evidence

• STUDY DESIGN: Evidence obtained from nonrandomized controlled trials.
• INTERNAL VALIDITY: Good.
• CONSISTENCY: Good.
• MAGNITUDE OF EFFECTS ON HEALTH OUTCOMES: No effect on mortality.
• EXTERNAL VALIDITY: Fair.

Harms

Based on solid evidence, screening infants for neuroblastoma leads to an increase in incidence of early-stage neuroblastoma. There is no concurrent decrease in incidence in screened children of advanced-stage disease, which typically does poorly, or of incidence in children older than 1 year. The cases identified by screening almost exclusively have biologically favorable properties.

Based on solid evidence, screening infants for neuroblastoma results in overdiagnosis (diagnosis of some neuroblastomas detectable by mass screening that would not have been clinically diagnosed later). This leads to unnecessary diagnostic and therapeutic procedures with consequent physical and psychological morbidity, including death from treatment complications.

Description of the Evidence

• STUDY DESIGN: Evidence obtained from nonrandomized controlled trials.
• INTERNAL VALIDITY: Good.
• CONSISTENCY: Good.
• MAGNITUDE OF EFFECTS ON HEALTH OUTCOMES: No effect on mortality. Screening may overdiagnose as many as 7 cases per 100,000 infants screened.
• EXTERNAL VALIDITY: Fair.