0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Systematic Review: The Trousseau Syndrome Revisited: Should We Screen Extensively for Cancer in Patients with Venous Thromboembolism?

Marc Carrier, MD; Grégoire Le Gal, MD, PhD; Philip S. Wells, MD, MSc; Dean Fergusson, PhD; Tim Ramsay, PhD; and Marc A. Rodger, MD, MSc
[+] Article and Author Information

From the University of Ottawa and the Ottawa Health Research Institute, Ottawa, Ontario, Canada, and Brest University Hospital, Brest, France.


Grant Support: Dr. Carrier is a recipient of a Canadian Institutes of Health Research Fellowship. Dr. Fergusson is a recipient of a Canadian Institutes of Health Research New Investigator Research Award. Dr. Rodger is the recipient of a Career Scientist Award from the Heart and Stroke Foundation of Ontario. Dr. Wells is a recipient of a Canada Research Chair.

Potential Financial Conflicts of Interest:Honoraria: P.S. Wells (Dade Behring, bioMérieux, Sanofi-Aventis, Leo Pharma, Organon).

Requests for Single Reprints: Marc A. Rodger, MD, MSc, Clinical Epidemiology Program, Ottawa Health Research Institute, 501 Smyth Road, Room W6116, Eye Institute, Ottawa, Ontario K1H 8L6, Canada; e-mail, mrodger@ohri.ca.

Current Author Addresses: Drs. Carrier, Fergusson, and Ramsay: Eye Institute, 501 Smyth Road, Room W6109, Ottawa, Ontario K1H 8L6, Canada.

Dr. Le Gal: Centre Hospitalier Universitaire de la Cavale Blanche, EA 3878, 29609 Brest, France.

Dr. Wells: Ottawa Hospital, Civic Campus, Suite F6-49, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada.


Ann Intern Med. 2008;149(5):323-333. doi:10.7326/0003-4819-149-5-200809020-00007
Text Size: A A A

Background: Identifying previously undiagnosed cancer in patients with newly diagnosed venous thromboembolism (VTE) is important. Screening for malignant conditions can potentially diagnose more cases of cancer and at earlier stages, thereby preventing cancer-associated morbidity and perhaps mortality.

Purpose: To summarize the period prevalence of previously undiagnosed cancer at baseline (within 1 month of VTE diagnosis), 6 months, and 12 months after VTE diagnosis and to quantify the additional value of an extensive cancer screening strategy (limited screening plus imaging techniques or tumor marker measurement) at baseline compared with more limited screening (history, physical examination, and simple widely available tests) at baseline.

Data Sources: MEDLINE, EMBASE, the Cochrane Register of Controlled Trials, and Evidence-Based Medicine Reviews.

Study Selection: A total of 36 studies that reported the prevalence of undiagnosed cancer at baseline, 6 months, and 12 months were selected. Fourteen articles and 1 abstract also met inclusion criteria for the assessment of extensive versus limited cancer screening.

Data Extraction: Two reviewers independently extracted data onto standardized forms.

Data Synthesis: The period prevalence of previously undiagnosed cancer in patients with unprovoked VTE was 6.1% (95% CI, 5.0% to 7.1%) at baseline and 10.0% (CI, 8.6% to 11.3%) from baseline to 12 months. An extensive screening strategy using computed tomography of the abdomen and pelvis statistically significantly increased the proportion of previously undiagnosed cancer detected from 49.4% (CI, 40.2% to 58.5%) (with limited screening alone) to 69.7% (CI, 61.1% to 77.8%) in patients with unprovoked VTE.

Limitation: The investigators could not determine complication rates, cost-effectiveness, and difference in morbidity and mortality associated with extensive screening strategies.

Conclusion: Previously undiagnosed cancer is frequent in patients with unprovoked VTE. Many cases of previously undiagnosed cancer are missed by screening. An extensive cancer screening strategy detects more malignant conditions than does a limited screening strategy.

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)