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January 2005

Screening School-aged Children for Neurofibromatosis 1: Dermatology or Economics and Public Policy?

Arch Dermatol. 2005;141(1):78-79. doi:10.1001/archderm.141.1.78

In this issue of the ARCHIVES, Lammert et al1 document that screening for neurofibromatosis 1 (NF1) among children entering school can be accomplished efficiently and inexpensively in Germany. Can we conclude from this article that an NF1 screening program should be established in the United States? I believe the answer to this question is yes. However, there are at least 2 additional considerations. The first has to do with potential resistance by persons with NF1, particularly those who are active in various NF1 support groups. The second concern has to do with how readily the German model can be translated to the United States. In Germany, the marginal cost of adding NF1 to the screening system was minimal: simply sensitize a relatively small number of physicians to the presence of several readily detectable features of NF1. In the United States, a huge number of clinicians, only some of whom are physicians, evaluate the health status of only some children enrolling in school for the first time. These considerations notwithstanding, I would like to encourage us to consider such widespread screening for NF1.

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