In Reply.—Dr Klebanoff's objection to using the VMA spot test as a screen for neuroblastoma is based on two points. My answers are as follows.
I agree with Dr Klebanoff's suggestion that in many cases a routine physical examination is as good as the VMA screening test, in that it will detect many neuroblastomas. Neuroblastoma is the most common malignant tumor of children. The prognosis of this tumor is unfavorable, and two-year survival rates are 29% (94 of 327 cases) in Japan1 and 32% (79 of 246 cases) in the United States.2 Most of the surviving patients who were discovered were younger than 1 year of age, and most of the patients who were discovered and older than 1 year of age showed an unfavorable prognosis. However, only a fourth of the patients who were registered were discovered at younger than 1 year of age either in