Abstract: The recent overview by Paulino describes 94 cases of trilateral retinoblastoma.1 Both he and Singh et al.2 advocate screening for intracranial disease in selected cases. In fact, Singh et al. proposed 6-month magnetic resonance imaging (MRI) scans until age 5 years. We agree that everything should be done to improve the dismal prognosis of children with this disease. However, we would urge caution before advocating screening procedures with far-reaching consequences before a proper analysis of the pros and cons has been performed. In general, screening is useful only when the screened disease is treatable and the rate of incidence is high. Both conditions may not be met in patients with trilateral retinoblastoma. Singh et al. already have suggested that screening may produce a lag time bias similar to that observed in the detection of women with breast carcinoma using mammography (i.e., the detection of disease earlier without true consequences for survival). The meta-analysis by Kivelä3 confirmed that the median survival after trilateral retinoblastoma was significantly longer if screening was performed.4, 5 However, the age at which trilateral retinoblastoma was detected by screening was proportionally earlier, and the age at death did not differ between the two groups, indicating that the longer survival was due largely to lead time bias. Another possibility is the detection of irrelevant abnormalities that may lead to inadvertent “treatment.” As long as cranial spinal radiation is an inevitable part of the treatment, important neuropsychologic sequelae are to be expected with extensive loss of cognitive functions. We currently are following a patient with an intracranial abnormality on MRI whose disease has been stable for years without progression or symptoms. Frequent screening (with questions existing regarding how frequent and how long) could lead to a false sense of security and a disregard of possible symptoms developing between the screening procedures. In young children MRI is not an entirely safe procedure because sedation is necessary. Finally, it remains to be determined whether patients whose disease is detected by screening have a truly better prognosis than patients with current, more symptomatic disease. We believe that the case for screening is not strong in this situation. Ideally, a randomized clinical trial should be performed and, at a minimum, a prospective cohort should be subjected to screening before blanket recommendations such as those by Paulino1 and Singh et al.2 are made. Annette C. Moll M.D., Ph.D.*, Saskia M. Imhof M.D., Ph.D.*, Antoinette Y. N. Schouten-van Meeteren M.D. , Maarten Boers M.D., Ph.D. , * Department of Ophthalmology, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands, Department of Pediatrics, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands, Department of Clinical Epidemioloy and Biostatistics, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands
Publication Year: 2000
Publication Date: 2000-02-15
Language: en
Type: letter
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 30
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