title: Systematic screening for occult cancer in elderly patients with venous thromboembolism: a prospective study.
abstract: BACKGROUND
  Cancer is an established risk factor for venous thromboembolism (VTE) and the incidence of cancer increases in the elderly. The benefit of screening for occult cancers in this population is still not clear.
  
  
  OBJECTIVE
  To evaluate a systematic screening programme for cancer in elderly patients with VTE.
  
  
  METHODS
  This was a prospective study with a 12-month follow-up period. It was conducted in a single centre in consecutive patients over the age of 70 years who had a confirmed diagnosis of VTE. Predefined non-invasive screening techniques for cancer with clinical, laboratory (including tumour markers) and radiological investigations (abdominal ultrasound, chest X-ray and a thoraco-abdominopelvic computed tomography scan) were evaluated.
  
  
  RESULTS
  Fifty patients with a median age of 80 years (range: 70 to 94 years) were included. One patient was diagnosed with chronic lymphocytic leukaemia at inclusion and cancers were found in three other patients during the follow-up period (rectosigmoid adenocarcinoma with hepatic metastases, hepatocellular carcinoma and gastric adenocarcinoma). Only one of the four cancers could have been treated at an earlier stage. The mortality rate of the entire cohort after 12 months was 28%. Two patients died as a direct consequence of cancer.
  
  
  CONCLUSIONS
  In this study of elderly patients, a non-invasive screening strategy did not detect several cancers that were subsequently overt clinically. A full history, clinical examination and routine laboratory investigations might be the optimal first-line strategy to detect cancer after the diagnosis of VTE in elderly patients, but regular clinical examinations during follow up are warranted.
authors.affiliation: Department of Internal Medicine, CHU Estaing, Clermont-Ferrand Department of Medicine, Centre Hospitalier, Riom, France. vrieu@chu-clermontferrand.fr
authors.forename: V
authors.initials: V
authors.lastname: Rieu
authors.forename: S
authors.initials: S
authors.lastname: Chanier
authors.forename: P
authors.initials: P
authors.lastname: Philippe
authors.forename: M
authors.initials: M
authors.lastname: Ruivard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D011446:Prospective Studies; D054556:Venous Thromboembolism / Q000453:epidemiology*