Highlights
- •Venous thromboembolism can be the first manifestation of cancer.
- •Randomized trials suggest systematic extended cancer screening should not be performed.
- •The one-year incidence of unknown cancer is 5.06% in the general population.
- •Due to this low incidence, results from trials can be applied to the general population.
Abstract
Background
Venous thromboembolism (VTE) can be the first manifestation of cancer; however, the
current incidence of malignancy in unselected patients with first unprovoked VTE needs
to be confirmed.
Material and methods
Between March 1st, 2013 and February 28th, 2015 we included and followed-up all patients
living in the Brest district, France, who were seen in hospitals or the community
for a first symptomatic unprovoked VTE event. The primary study outcome was the one-year
incidence of cancer.
Results
526 patients, mean age 66.6 ± 18.1 years, 246 (46.8%) men, were included in the study.
In the year following VTE, 26 patients were diagnosed with cancer, corresponding to
a one-year cumulative incidence of cancer of 5.06% (95% CI 3.47–7.35). Age ≥60, smoking
and pulmonary embolism were significantly associated with cancer diagnosis in multivariate
analysis. Fifty percent of cancers were patent at the time of VTE diagnosis, mostly
detected on CTPA (Computed Tomographic Pulmonary Angiography) performed for pulmonary
embolism assessment. After excluding patients with patent cancer at VTE diagnosis,
the one-year incidence of cancer was 2.65% (95% CI: 1.55–4.52); in multivariate analysis,
only current smoking was independently associated with a significant 5.4-fold increased
risk for cancer diagnosis (HR 5.40; 95% CI 1.31–22.27). No cancer was diagnosed in
patients aged 50 years or younger.
Conclusion
The one-year incidence of cancer after a first unprovoked VTE was 5.06%. Half of the
cancers were diagnosed during the diagnosis procedure for pulmonary embolism using
CTPA.
Keywords
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Article info
Publication history
Published online: March 01, 2018
Accepted:
February 28,
2018
Received in revised form:
February 27,
2018
Received:
November 20,
2017
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
