Home > Uncategorized > Screening for Occult Cancer in Unprovoked Venous Thromboembolism

Screening for Occult Cancer in Unprovoked Venous Thromboembolism

A useful paper to guide assessment of patients with unprovoked venous thromboembolism.

Summary

BACKGROUND

Venous thromboembolism may be the earliest sign of cancer. Currently, there is a
great diversity in practices regarding screening for occult cancer in a person who
has an unprovoked venous thromboembolism. We sought to assess the efficacy of
a screening strategy for occult cancer that included comprehensive computed tomography
(CT) of the abdomen and pelvis in patients who had a first unprovoked
venous thromboembolism.

METHODS

We conducted a multicenter, open-label, randomized, controlled trial in Canada.
Patients were randomly assigned to undergo limited occult-cancer screening (basic
blood testing, chest radiography, and screening for breast, cervical, and prostate
cancer) or limited occult-cancer screening in combination with CT. The primary
outcome measure was confirmed cancer that was missed by the screening strategy
and detected by the end of the 1-year follow-up period.

RESULTS

Of the 854 patients who underwent randomization, 33 (3.9%) had a new diagnosis
of occult cancer between randomization and the 1-year follow-up: 14 of the 431
patients (3.2%) in the limited-screening group and 19 of the 423 patients (4.5%)
in the limited-screening-plus-CT group (P = 0.28). In the primary outcome analysis,
4 occult cancers (29%) were missed by the limited screening strategy, whereas 5 (26%)
were missed by the strategy of limited screening plus CT (P = 1.0). There was no
significant difference between the two study groups in the mean time to a cancer
diagnosis (4.2 months in the limited-screening group and 4.0 months in the
limited-screening-plus-CT group, P = 0.88) or in cancer-related mortality (1.4% and
0.9%, P = 0.75).

CONCLUSIONS

The prevalence of occult cancer was low among patients with a first unprovoked
venous thromboembolism. Routine screening with CT of the abdomen and pelvis
did not provide a clinically significant benefit.

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