title: Screening for occult cancer in patients with acute deep vein thrombosis or pulmonary embolism.
abstract: 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 markers for malignancy. Clinical follow-up was conducted to detect screening failures. The routine clinical evaluation was performed in 864 patients and revealed malignancy in 34 (3.9%) of them. Among the remaining 830 patients the limited diagnostic work-up revealed 13 further malignancies. During follow-up, cancer became symptomatic in 14 patients who were negative for cancer at screening (sensitivity of limited diagnostic work-up, 48.1%). Malignancies that were identified by the limited diagnostic work-up were early stage in 61% of cases vs. 14% in cases occurring during follow-up. Most patients with occult cancer had idiopathic venous thromboembolism and were older than 70 years. A limited diagnostic work-up for occult cancer in patients with venous thromboembolism has the capacity to identify approximately one-half of the malignancies. Identified malignancies were predominantly in an early stage.
authors.affiliation: Department of Medicine, Hospital Universitari Germans Trias i Pujol de Badalona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Monreal
authors.forename: A W A
authors.initials: AW
authors.lastname: Lensing
authors.forename: M H
authors.initials: MH
authors.lastname: Prins
authors.forename: M
authors.initials: M
authors.lastname: Bonet
authors.forename: J
authors.initials: J
authors.lastname: Fernández-Llamazares
authors.forename: J
authors.initials: J
authors.lastname: Muchart
authors.forename: P
authors.initials: P
authors.lastname: Prandoni
authors.forename: J Angel
authors.initials: JA
authors.lastname: Jiménez
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis*; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000209:etiology*; D012307:Risk Factors; D020246:Venous Thrombosis / Q000209:etiology*