A 5-year (1990–1994) neuroblastoma screening feasibility study in France. Methodology and preliminary observations

Introduction: Following the pioneering Japanese experience, several European and North American groups implemented pilot studies on screening infants for neuroblastoma, considering the possibility of demonstrating a decrease in mortality rate. In France, a 5-year (1990–1994) feasibility study on neuroblastoma screening at the age of 4 months was initiated in the Rhone district (1.5 M inhabitants, 26 000 births per year). Methods: Vanillyknandelic (VMA) and homovanillic (HVA) acids were measured by HPLC, and creatinine (Cr) by the Jaffe's kinetic method on Technicon RA-XT(™). VMA and HVA were expressed as μg/mg of Cr. The method was assessed with both a daily intra-laboratory control and a sample of urine obtained from a national quality control organism. Results and discussion: The overall participation rate for the 5-year period was 82.2%. Out of 105 293 infants tested from 128 126 births, 12 NB cases were discovered with screening (screened cases) and 1 case was discovered with a late performed test (at 13 months of age). Six neuroblastomas were found clinically before the age of 4 m. Two cases were missed because the parents did not perform the test. Three children with normal tests at screening were false-negative cases: two of them were found secreting at diagnosis, while one remained non-secretory at diagnosis and later on. Otherwise, thirty five false-positive tests were found. Biochemical observations are discussed. It is too early to reach clinical conclusions from this screening program on neuroblastoma as it is presently being followed up.