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From:  AiA <aia@i...> Date: Wed Apr 3, 2002 7:17 pm Subject: Infant Screening for Cancer Not Effective | ||||
Wed Apr 3, 6:26 PM ET By Amy Norton NEW YORK (Reuters Health) - Screening infants for a type of childhood cancer does not appear to cut death rates and could actually cause harm by leading to unnecessary treatment, according to the results of two studies released Wednesday. The studies looked at the effectiveness of screening babies for neuroblastoma, a cancer of the nervous system that primarily affects young children and frequently arises by age 1. Because neuroblastomas produce chemicals that are detectable in urine, it is possible to catch the disease early by testing babies' urine samples. In Japan, neuroblastoma screening programs have been in place since the early 1970s. However, the evidence used to support this mass screening has been in doubt, Dr. Freimut H. Schilling, lead author of one of the new studies, explained in an interview with Reuters Health. For one, research has already suggested that screening before age 1 does not reduce death rates from neuroblastoma. What's more, neuroblastomas are known to sometimes spontaneously regress, and in other cases the immature cancer cells mature, stop dividing and become a benign tumor. So there is the possibility that screening infants could lead to unnecessary, and potentially harmful, treatment. The two new studies, both published in the April 4th issue of The New England Journal of Medicine (news - web sites), should answer the question of whether infant neuroblastoma screening is worthwhile, according to Schilling, a pediatric oncologist at Klinikum Stuttgart, Olgahospital in Germany. "We hope so," he said. Schilling's team looked at the effectiveness of neuroblastoma screening at age 1, as past research had suggested screening earlier was not useful. The investigators found that the measure did not cut neuroblastoma death rates among the more than 2.5 million children offered screening over 5 years. In the other study, Canadian and US researchers found that screening at the ages of 3 weeks and 6 months did not reduce death rates among nearly 477,000 children. There was, however, evidence of possible harm. One of the 43 children diagnosed with neuroblastoma through screening is in a vegetative state due to complications from gastrointestinal surgery--performed due to problems that developed after surgery to remove the neuroblastoma 7 years earlier. According to the researchers, this child--like the others diagnosed through screening--had had a tumor with "favorable biologic features," meaning the odds were good that it would not be deadly. Similarly, in the German study, the three deaths among children who screened positive for neuroblastoma were related to treatment, not the disease. "There is a possibility of causing harm by treating cases detected by screening that would otherwise have a benign course," write the authors of the North American study, led by Dr. William G. Woods of Emory University and Children's Healthcare of Atlanta, Georgia. On the other hand, the researchers found, children with a poor prognosis were not caught early. Of 19 screened children who eventually died from neuroblastoma during the study period, 18 had screened negative for the cancer, according to the report. Woods and colleagues suggest that the findings add further evidence to the idea that neuroblastoma represents at least two distinct diseases--one that is readily detectable during infant screening but often self-limiting, and one that is more lethal but rarely caught through screening. However, Schilling pointed out, since children's cancer is uncommon, large studies were needed to reach such conclusions. SOURCE: The New England Journal of Medicine 2002;346:1041-1046, 1047- |
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