Screening for Neuroblastoma Using Urinary Catecholamines: The End of the Story

• Authors: William Woods, Emory University
• Journal Title: JNCI Cancer Spectrum
• Volume: Volume 5, Number 4
• Publisher: Oxford University Press. | 2021-08-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1093/jncics/pkab042
• Subjects: Health Sciences, Oncology
• Keywords: Catecholamines; Humans; Mass Screening; Neuroblastoma; Vanilmandelic Acid

Abstract

Neuroblastoma (NB) is the most common extracranial solid tumor of childhood, with a peak incidence at birth. About 40% of children are diagnosed in the first year of life, and by 6 years of age, more than 90% of children will have presented with the disease. Unlike cancers in adults, where many common malignancies can be preclinically detected, including the 4 most prevalent cancers—lung, colon, prostate, and breast—no pediatric cancer was deemed easily detectable by screening. The 1 exception was NB because it has been known for decades that 90% of patients presenting clinically excrete elevated catecholamine metabolites in their urine. Furthermore, if children present with NB at a young age—specifically, under 18 months of age—the prognosis is outstanding, with about 90% of cases cured. Based on these facts, Sawada and Japanese colleagues pioneered NB screening programs in the 1970s (1), with early results suggesting that overall survival in the children screened improved. Unfortunately, survival can look artificially increased if screening programs diagnose patients whose tumors would have spontaneously regressed, a known phenomenon in NB. One must determine population-based mortality to determine true efficacy of any such intervention.