Likelihood of Occult Cancer Causing Unprovoked Deep Venous Thrombosis
SOURCE: Carrier M, et al. Screening for occult cancer in unprovoked venous thromboembolism. N Engl J Med 2015;373:697-704.
Recognized provocateurs of deep venous thrombosis (DVT) include prothrombotic disorders (e.g., antiphospholipid antibody syndrome), oral contraceptives, immobilization, trauma, long-haul air flight, and cancer. When DVT occurs absent recognized risk factors — so-called “unprovoked DVT” — should the clinician consider screening for occult cancer? Expert opinion ranges from “not useful” to “consider extended evaluation.”
Carrier et al report on their randomized controlled trial in Canadian adults who experienced new unprovoked DVT (n = 854) who were randomized to undergo either “limited screening” (complete history and physical, complete blood count, comprehensive metabolic panel, chest X-ray, and sex-specific screening such as mammography, if not previously performed) or “limited screening + CT.” A CT scan of the abdomen and pelvis included virtual colonoscopy/gastroscopy and enhanced CT of the liver, pancreas, and bladder.
At the end of a 1-year follow-up period, 3.9% of the total study group were newly diagnosed with cancer: 3.2% of the limited screen group and 4.5% of the limited screen + CT group (P = 0.28, not statistically significant).
The likelihood of identifying occult cancer in patients with new unprovoked DVT is not meaningfully enhanced by performing extended screening.
The likelihood of identifying occult cancer in patients with new unprovoked deep venous thrombosis is not meaningfully enhanced by performing extended screening.
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