The identification of WT susceptibility syndromes led to the proposition that asymptomatic children 'at-risk' of WT would benefit from cancer surveillance. Over the past few decades screening for WT has become routine in many countries although its efficacy has not been formally demonstrated. The efficacy of a surveillance procedure can be evaluated in a number of ways the most simple of which is crude survival. For conditions such as Wilms tumour where survival rates are very high, it is unlikely that screening will lead to a substantial decrease in mortality. An alternative, or additional, basis on which to evaluate screening could be a more favourable stage distribution among screened patients resulting in lower treatment-related morbidity.
Overall, there is currently no definitive evidence that screening results in a significant decrease in either overall mortality or tumour stage.
In evaluating any screening test it is important to consider the potential negative sequelae, for example a false positive result. Published false positive cases highlight the potential difficulties in interpretation of screening ultrasounds in individuals with conditions that are associated with cystic and/or nodular changes in the kidney. Additionally, although difficult to quantify, the anxiety and practical difficulties associated with regular surveillance should not be underestimated.
