{'fraction_non_alphanumeric': 0.028535193405199746, 'fraction_numerical': 0.0057070386810399495, 'mean_word_length': 5.0926640926640925, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Neuroblastomas that might benefit from mass screening at 6 months of age in Japan—response

To the Editor: I thank Dr. Kaneko for several clarifications of his manuscript, including the actual number of patients in his study who were screened, as well as the interesting socio-economic-status findings, previously published in the Japanese literature. The description of the three infants in the Saitama study’s intermediate risk group, who were diagnosed clinically and subsequently died, is quite helpful. One of these infants was a 10-day oldwith stage 4S diseasewho died of ‘‘cardiovascular dysfunction.’’ Both this infant and the 2-month-old also staged as 4S who died of progressive disease were not screened because they were below the age of routine screening in Japan. Urinary screening for an inborn error of metabolism, or neuroblastoma, is impossible in the first 7– 21 days of life; a neonate’s urine reflects maternal urine, with its high creatinine. Even if plausible, in all likelihood the screening would not have helped either of these two very young infants, further raising the question of whether ‘‘screening would impact on children with intermediate or high risk disease.’’ As a pediatrician and a population scientist, I share Dr. Kaneko’s optimism for the future of neuroblastoma screening utilizing markers more sophisticated than urinary catecholamines. But for any pre-clinical detection to work in any illness, effective therapies must be at hand. This is not the case for many patients with unfavorable biology neuroblastoma, as exemplified above.