Secular Trends in Neuroblastoma Mortality Before and After the Cessation of National Mass Screening in Japan

Background: In 2003, the Japanese government halted the national mass screening program for neuroblastoma (NB), which had been running since the mid-1980s. It is not known whether the NB mortality rate subsequently increased or decreased. Methods: Utilizing vital statistics data from 1980 through 2006, we analyzed the secular trends in NB mortality by using cancer of the adrenal gland as a surrogate. We examined the validity of this substitution by comparing the results with data from death certificates. Using a joinpoint regression model, we examined the trends in age-specific mortality rates by calendar year and cumulative mortality rates by birth year. The cumulative mortality rate was analyzed for age under I or 2 years for infants born after the cessation of the mass screening program. Results: The number of deaths from cancer of the adrenal gland was closely correlated with the number of deaths from NB. Significant decreases in the mortality rate were observed from 1980 through 2006 by calendar year for those aged under I year, I to 4 years, and 5 to 9 years. The cumulative mortality rates by birth year also significantly decreased from the 1980 birth cohort. Although the cumulative mortality rates under the age of 2 appear to have increased after the 2003 birth cohort, the change was not statistically significant. Conclusions: No significant increase in the NB mortality rate was detected after the cessation of the mass screening program in Japan. However, continuous monitoring is still needed to fully evaluate this health policy decision.