Screening for Occult Cancer in Unprovoked Venous Thromboembolism

Published on Aug 19, 2015in The New England Journal of Medicine91.253
· DOI :10.1056/NEJMOA1506623
Marc Carrier60
Estimated H-index: 60
,
Alejandro Lazo-Langner26
Estimated H-index: 26
+ 16 AuthorsMarc A. Rodger80
Estimated H-index: 80
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Abstract
BackgroundVenous 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. MethodsWe 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. ResultsOf the 854 patients who underwent randomization, 33 (3.9%) had a new diagnosis of occult cancer between randomizat...
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References15
Newest
#1F. F. Van Doormaal (AMC: Academic Medical Center)H-Index: 6
#2W. TerpstraH-Index: 1
Last. J. M. M. B. Otten (AMC: Academic Medical Center)H-Index: 2
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Summary. Background: Patients with a first episode of idiopathic venous thromboembolism (IVTE) have an estimated 10% incidence of cancer within 12 months after diagnosis. However, the utility of screening for cancer in this population is controversial. Methods: In this prospective concurrently controlled cohort study, limited and extensive cancer screening strategies were compared. All 630 patients underwent baseline screening consisting of history, physical examination, basic laboratory tests a...
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#1Paolo Prandoni (UNIPD: University of Padua)H-Index: 107
Last. Manuel MonrealH-Index: 76
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Although there is emerging evidence that bleeding is a strong predictor of mortality in patients with acute arterial thrombosis receiving antithrombotic therapy [1–3], whether a similar association between bleeding and mortality also exists in patients with venous thromboembolism (VTE) has not been thoroughly investigated. In a recent systematic review of randomized trials addressing the value of fondaparinux for prevention of VTE in high-risk surgical or medical patients, Eikelboom et al. [4] w...
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#1Paolo PrandoniH-Index: 107
#2Edoardo CasigliaH-Index: 63
Last. James D. Douketis (McMaster University)H-Index: 95
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#1Rebecca Smith-Bindman (UCSF: University of California, San Francisco)H-Index: 51
#2Jafi A. Lipson (UCSF: University of California, San Francisco)H-Index: 17
Last. Diana L. Miglioretti (UW: University of Washington)H-Index: 80
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Background Use of computed tomography (CT) for diagnostic evaluation has increased dramatically over the past 2 decades. Even though CT is associated with substantially higher radiation exposure than conventional radiography, typical doses are not known. We sought to estimate the radiation dose associated with common CT studies in clinical practice and quantify the potential cancer risk associated with these examinations. Methods We conducted a retrospective cross-sectional study describing radi...
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#1Marc Carrier (U of O: University of Ottawa)H-Index: 60
#2Grégoire Le Gal (U of O: University of Ottawa)H-Index: 56
Last. Marc A. Rodger (U of O: University of Ottawa)H-Index: 80
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Background: Identifying previously undiagnosed cancer in patients with newly diagnosed venous thromboembolism (VTE) is important. Screening for malignant conditions can potentially diagnose more cases of cancer and at earlier stages, thereby preventing cancer-associated morbidity and perhaps mortality. Purpose: To summarize the period prevalence of previously undiagnosed cancer at baseline (within 1 month of VTE diagnosis), 6 months, and 12 months after VTE diagnosis and to quantify the addition...
Source
Venous thromboembolism (VTE) is often asymptomatic, mis-diagnosed, and unrecognized at death, and there is a lack of routine postmortem examinations.These factors are thought to result in marked underestimates ofVTE incidence.The objective of our study was to estimate the total burden of VTE within the European Union (EU) per annum. An epidemiological model was constructed to estimate the number of community- and hospital-acquired incidents and recurrent cases (attack rate) of non-fatal VTE and ...
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Background: It is unclear how frequently unprovoked venous thromboembolism (VTE) reflects the presence of an occult cancer. Methods: The California Cancer Registry was used to identify diagnosed cases of 19 common malignancies during a 6-year period. Cases were linked to a hospital discharge database to identify incident VTE events in the year before the cancer diagnosis date. The standardized incidence ratio (SIR) of unprovoked VTE was determined by using the age-, race-, and sex-specific incid...
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Summary. Patients with acute venous thromboembolism have an increased risk for occult malignancy. Limited screening for these malignancies has become common practice but little is known about its usefulness. This is a prospective cohort follow-up study in consecutive patients with acute venous thromboembolism. All patients underwent a routine clinical evaluation for malignancy, if negative, followed by a limited diagnostic work-up consisting of abdominal and pelvic ultrasound and laboratory mark...
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#1Andrea Piccioli (UNIPD: University of Padua)H-Index: 25
#2A. W. A. Lensing (UvA: University of Amsterdam)H-Index: 22
Last. Paolo Prandoni (UNIPD: University of Padua)H-Index: 107
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Patients with symptomatic idiopathic venous thromboembolism and apparently cancer-free have an approximate 10% incidence of subsequent cancer. Apparently cancer-free patients with acute idiopathic venous thromboembolism were randomized to either the strategy of extensive screening for occult cancer or to no further testing. Patients had a 2-year follow-up period. Of the 201 patients, 99 were allocated to the extensive screening group and 102 to the control group. In 13 (13.1%) patients, the exte...
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#1Richard H. White (UC Davis: University of California, Davis)H-Index: 78
Venous thromboembolism (VTE) is categorized by the U.S. Surgeon General as a major public health problem. VTE is relatively common and associated with reduced survival and substantial health-care costs, and recurs frequently. VTE is a complex (multifactorial) disease, involving interactions between acquired or inherited predispositions to thrombosis and VTE risk factors, including increasing patient age and obesity, hospitalization for surgery or acute illness, nursing-home confinement, active c...
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Venous thromboembolism (VTE), encompassing pulmonary embolism (PE) and deep vein thrombosis (DVT), is encountered commonly. Acute PE may present as a high-risk cardiovascular emergency, and acute DVT can cause acute and chronic vascular complications. The goal of this review is to ensure that cardiologists are comfortable managing VTE-including risk stratification, anticoagulation therapy, and familiarity with primary reperfusion therapy. Clinical assessment and determination of degree of right ...
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#1Salma Adham (University of Paris)H-Index: 6
#2G. ArmengolH-Index: 6
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BACKGROUND Clinical guidelines do not recommend further investigation for occult malignancy in the scenario of unprovoked venous thromboembolism in the absence of additional clinical features suggestive of malignancy. We present the case of a young gentleman with pulmonary embolism who was diagnosed with testicular seminoma despite lack of symptoms or signs suggestive of malignancy. This is a unique case describing a scenario not well documented in existing literature where contravention of clin...
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CASE A 30-year-old man presented with progressive lower right extremity pain and swelling, initially diagnosed as a deep venous thrombosis. He returned 18 months later after 2 episodes of gross hemoptysis, with chest computed tomography angiography findings concerning for tumor thrombus in the left pulmonary artery. Subsequent advanced imaging showed a lesion arising from his right femoral vein, which open biopsy revealed to be a primary intravascular mesenchymal chondrosarcoma. He underwent med...
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Mondor disease is characterized by an acute painful thrombophlebitis occurring at specific anatomical sites. Data on its incidence, characteristics of clinical presentation, and course are unavailable to date. We studied the course of Mondor disease in patients diagnosed and followed at the University Hospital Zurich (Switzerland) between 2004 and 2020. The primary study outcomes were a diagnosis of active cancer either at the time of clinical diagnosis of Mondor disease or within 1 year, as wel...
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#8H. R. BĂĽller (UvA: University of Amsterdam)H-Index: 45
The incidence of venous thromboembolism in cancer patients may have changed in the past decade, possibly due to novel cancer therapies, improved survival, and high-resolution imaging. Danish medical registries were used to identify 499,092 patients with a first-time cancer diagnosis between 1997 and 2017, who were matched to 1,497,276 comparison individuals without cancer from the general population. We computed cumulative incidences of venous thromboembolism 6 and 12 months after the diagnosis/...
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Cerebral venous thrombosis (CVT), although accounting for only 0.5-1% of all strokes, remains a potentially fatal neurological emergency, which must be promptly diagnosed and treated. Consisting of two parts, this review aims to highlight the most important data from recent years regarding diagnosis and treatment of CVT, illustrating both the current modern therapeutic approach and the future research directions in the field. Regarding the clinical diagnosis, the neurologist may sometimes have d...
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