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 17 December 2017

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Screening for occult cancer with unprovoked venous thromboembolism

The latest issue of the Annals of Internal Medicine estimates the prevalence of occult cancer in patients with unprovoked venous thromboembolism, including in subgroups of different ages or those that have had different types of screening.

News image

Screening for cancer in patients with unprovoked venous thromboembolism often is considered, but clinicians need precise data on cancer prevalence, risk factors, and the effect of different types of screening strategies.

Dr Nick van Es and colleagues estimated the prevalence of occult cancer in patients with unprovoked venous thromboembolism, including in subgroups of different ages or those that have had different types of screening.

The team searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials up to 2016.

Prospective studies evaluating cancer screening strategies in adults with unprovoked venous thromboembolism that began enrolling patients after 2000 and had at least 12 months of follow-up.

There were 2 investigators that independently reviewed abstracts and full-text articles and independently assessed risk of bias.

The team identified 10 eligible studies.

The 12-month period prevalence of cancer after venous thromboembolism diagnosis was 5%
Annals of Internal Medicine

Individual data were obtained for all 2316 patients.

The research team found that the mean age was 60 years, of which 58% of patients received extensive screening.

The 12-month period prevalence of cancer after venous thromboembolism diagnosis was 5%.

The researchers found that the point prevalence of cancer was higher in patients who had extensive screening than in those who had more limited screening initially but not at 12 months.

The team noted that cancer prevalence increased linearly with age, and was 7-fold higher in patients aged 50 years or older than in younger patients.

Dr van Es' team commented, "Occult cancer is detected in 1 in 20 patients within a year of receiving a diagnosis of unprovoked venous thromboembolism."

"Older age is associated with a higher cancer prevalence."

"Although an extensive screening strategy initially may detect more cancer cases than limited screening, whether this translates into improved patient outcomes remains unclear."

Ann Intern Med 2017: [Epub ahead of print 22 August 2017] doi: 10.7326/M17-0868
01 September 2017

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