Screening for Occult Cancer in Unprovoked Venous Thromboembolism Academic Article uri icon

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abstract

  • 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. (Funded by the Heart and Stroke Foundation of Canada; SOME ClinicalTrials.gov number, NCT00773448.).

authors

  • Carrier, Marc
  • Lazo-Langner, Alejandro
  • Shivakumar, Sudeep
  • Tagalakis, Vicky
  • Zarychanski, Ryan
  • Solymoss, Susan
  • Routhier, Nathalie
  • Douketis, James Demetrois
  • Danovitch, Kim
  • Lee, Agnes Y
  • Le Gal, Gregoire
  • Wells, Philip S
  • Corsi, Daniel J
  • Ramsay, Timothy
  • Coyle, Doug
  • Chagnon, Isabelle
  • Kassam, Zahra
  • Tao, Hardy
  • Rodger, Marc A

publication date

  • August 20, 2015

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