Extensive screening for occult malignant disease in idiopathic venous thromboembolism: a prospective randomized clinical trial.
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 extensive screening identified occult cancer. In the extensive screening group, a single (1.0%) malignancy became apparent during follow-up, whereas in the control group a total of 10 (9.8%) malignancies became symptomatic [relative risk, 9.7 (95% CI, 1.3-36.8; P < 0.01]. Overall, malignancies identified in the extensive screening group were at an earlier stage and the mean delay to diagnosis was reduced from 11.6 to 1.0 months (P < 0.001). Cancer-related mortality during the 2 years follow-up period occurred in two (2.0%) of the 99 patients of the extensive screening group vs. four (3.9%) of the 102 control patients [absolute difference, 1.9% (95% CI, -5.5-10.9)]. Although early detection of occult cancers may be associated with improved treatment possibilities, it is uncertain whether this improves the prognosis.
Piccioli
A
A
Department of Medical and Surgical Sciences, Second Division of Internal Medicine, University of Padua, Italy.
Lensing
A W A
AW
Prins
M H
MH
Falanga
A
A
Scannapieco
G L
GL
Ieran
M
M
Cigolini
M
M
Ambrosio
G B
GB
Monreal
M
M
Girolami
A
A
Prandoni
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D013923:Thromboembolism / Q000209:etiology*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology*