Screening for Occult Cancer in Unprovoked Venous Thromboembolism
Marc Carrier, Alejandro Lazo-Langner, Sudeep Shivakumar, Vicky Tagalakis, Ryan Zarychanski, Susan Solymoss, Nathalie Routhier, James Douketis, Kim Danovitch, Agnes Y Lee, Gregoire Le Gal, Philip S Wells, Daniel J Corsi, Timothy Ramsay, Doug Coyle, Isabelle Chagnon, Zahra Kassam, Hardy Tao, Marc A Rodger, SOME Investigators, M Carrier, L Castellucci, C Code, D J Corsi, D Coyle, K Danovitch, G Le Gal, M Forgie, E Gandara, C Gonsalves, A Karovitch, A Pecarskie, T Ramsay, M A Rodger, D Scarvelis, H Tao, P S Wells, R Corpuz, Z Kassam, A Lazo-Langner, D Taves, D R Anderson, S Couban, W Hasegawa, M Keating, A Kew, D Macdonald, K S Robinson, D White, S Shivakumar, R Zarychanski, T Wong, M Blostein, I Chagnon, A Hirsch, S Kahn, N Routhier, S Solymoss, V Tagalakis, J Douketis, A Y Lee, Marc Carrier, Alejandro Lazo-Langner, Sudeep Shivakumar, Vicky Tagalakis, Ryan Zarychanski, Susan Solymoss, Nathalie Routhier, James Douketis, Kim Danovitch, Agnes Y Lee, Gregoire Le Gal, Philip S Wells, Daniel J Corsi, Timothy Ramsay, Doug Coyle, Isabelle Chagnon, Zahra Kassam, Hardy Tao, Marc A Rodger, SOME Investigators, M Carrier, L Castellucci, C Code, D J Corsi, D Coyle, K Danovitch, G Le Gal, M Forgie, E Gandara, C Gonsalves, A Karovitch, A Pecarskie, T Ramsay, M A Rodger, D Scarvelis, H Tao, P S Wells, R Corpuz, Z Kassam, A Lazo-Langner, D Taves, D R Anderson, S Couban, W Hasegawa, M Keating, A Kew, D Macdonald, K S Robinson, D White, S Shivakumar, R Zarychanski, T Wong, M Blostein, I Chagnon, A Hirsch, S Kahn, N Routhier, S Solymoss, V Tagalakis, J Douketis, A Y Lee
Abstract
Background: Venous thromboembolism may be the earliest sign of cancer. Currently, there is a great diversity in practices regarding screening for occult cancer in a person who has an unprovoked venous thromboembolism. We sought to assess the efficacy of a screening strategy for occult cancer that included comprehensive computed tomography (CT) of the abdomen and pelvis in patients who had a first unprovoked venous thromboembolism.
Methods: We conducted a multicenter, open-label, randomized, controlled trial in Canada. Patients were randomly assigned to undergo limited occult-cancer screening (basic blood testing, chest radiography, and screening for breast, cervical, and prostate cancer) or limited occult-cancer screening in combination with CT. The primary outcome measure was confirmed cancer that was missed by the screening strategy and detected by the end of the 1-year follow-up period.
Results: Of the 854 patients who underwent randomization, 33 (3.9%) had a new diagnosis of occult cancer between randomization and the 1-year follow-up: 14 of the 431 patients (3.2%) in the limited-screening group and 19 of the 423 patients (4.5%) in the limited-screening-plus-CT group (P=0.28). In the primary outcome analysis, 4 occult cancers (29%) were missed by the limited screening strategy, whereas 5 (26%) were missed by the strategy of limited screening plus CT (P=1.0). There was no significant difference between the two study groups in the mean time to a cancer diagnosis (4.2 months in the limited-screening group and 4.0 months in the limited-screening-plus-CT group, P=0.88) or in cancer-related mortality (1.4% and 0.9%, P=0.75).
Conclusions: The prevalence of occult cancer was low among patients with a first unprovoked venous thromboembolism. Routine screening with CT of the abdomen and pelvis did not provide a clinically significant benefit. (Funded by the Heart and Stroke Foundation of Canada; SOME ClinicalTrials.gov number, NCT00773448.).
Source: PubMed