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open access + Commentary
Venous thromboembolism, which comprises
deep-vein thrombosis and pulmonary embolism, is the third most common
cardiovascular disorder.1-3
It is classified as provoked when it is associated with a transient
risk factor (e.g., trauma, surgery, prolonged immobility, or pregnancy
or the puerperium) and as unprovoked when it is associated with neither a
strong transient risk factor nor overt cancer.
Unprovoked venous thromboembolism may be the earliest sign of cancer4,5; up to 10% of patients with unprovoked venous thromboembolism receive a diagnosis of cancer in the year after their diagnosis of venous thromboembolism.6 More than 60% of occult cancers are diagnosed shortly after the diagnosis of unprovoked venous thromboembolism.6 Thereafter, the incidence rate of cancer diagnosis gradually declines and returns to the rate in the general population after 1 year.5-7
Faced with these troubling statistics, clinicians, patients, and policymakers struggle with how aggressive to be in screening for occult cancers in patients who present with unprovoked venous thromboembolism.
The rationale for screening is to allow early detection and intervention and ultimately reduce cancer-related mortality. However, owing to the paucity of data in this context, there is great variation in practice. Whereas some studies have suggested that a limited screening strategy for occult cancer — including history taking, physical examination, routine blood testing, and chest radiography — is adequate to detect most occult cancers, other studies have suggested that a more extensive screening strategy (e.g., incorporating ultrasonography or computed tomography [CT] of the abdomen and pelvis, measurement of tumor markers, or a combination of these) can substantially increase the rate of detection of occult cancer.8-11 We conducted a randomized clinical trial to assess the efficacy and safety of adding CT of the abdomen and pelvis to a limited screening strategy for occult cancer.
Unprovoked venous thromboembolism may be the earliest sign of cancer4,5; up to 10% of patients with unprovoked venous thromboembolism receive a diagnosis of cancer in the year after their diagnosis of venous thromboembolism.6 More than 60% of occult cancers are diagnosed shortly after the diagnosis of unprovoked venous thromboembolism.6 Thereafter, the incidence rate of cancer diagnosis gradually declines and returns to the rate in the general population after 1 year.5-7
Faced with these troubling statistics, clinicians, patients, and policymakers struggle with how aggressive to be in screening for occult cancers in patients who present with unprovoked venous thromboembolism.
The rationale for screening is to allow early detection and intervention and ultimately reduce cancer-related mortality. However, owing to the paucity of data in this context, there is great variation in practice. Whereas some studies have suggested that a limited screening strategy for occult cancer — including history taking, physical examination, routine blood testing, and chest radiography — is adequate to detect most occult cancers, other studies have suggested that a more extensive screening strategy (e.g., incorporating ultrasonography or computed tomography [CT] of the abdomen and pelvis, measurement of tumor markers, or a combination of these) can substantially increase the rate of detection of occult cancer.8-11 We conducted a randomized clinical trial to assess the efficacy and safety of adding CT of the abdomen and pelvis to a limited screening strategy for occult cancer.
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