scholarly journals Screening for Occult Cancer in Patients with Venous Thromboembolism

2020 ◽  
Vol 9 (8) ◽  
pp. 2389
Author(s):  
Julien D’Astous ◽  
Marc Carrier
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Screening ◽  
Cancer Detection ◽  
Complete Blood Count ◽  
Liver Function Tests ◽  
Screening Strategy ◽  
Mortality And Morbidity ◽  
Occult Cancer ◽  
Chest X Ray ◽  
And Gender

Unprovoked venous thromboembolism (VTE) can be the first sign of an occult cancer. The rate of occult cancer detection within 12 months of a newly diagnosed unprovoked VTE is approximately 5%. Therefore, it is appealing for clinicians to screen patients with unprovoked VTE for occult cancer, as it could potentially decrease cancer-related mortality and morbidity and improve quality of life. However, several randomized controlled trials have failed to report that an extensive occult cancer screening strategy (e.g., computed tomography of the abdomen/pelvis) is improving these patient-important outcomes. Therefore, clinical guidance documents suggest that patients should only undergo a limited screening strategy including a thorough medical history, physical examination, basic laboratory investigations (i.e., complete blood count and liver function tests), chest X-ray, as well as age- and gender-specific cancer screening (breast, cervical, colon and prostate). More intensive occult cancer screening including additional investigations is not routinely recommended. This narrative review will focus on the epidemiology, timing, and evidence regarding occult cancer detection in patients with unprovoked VTE.

scholarly journals Risk factors predictive of occult cancer detection in patients with unprovoked venous thromboembolism

Blood ◽  
2016 ◽  
Vol 127 (16) ◽  
pp. 2035-2037 ◽  
Author(s):  
Ryma Ihaddadene ◽  
Daniel J. Corsi ◽  
Alejandro Lazo-Langner ◽  
Sudeep Shivakumar ◽  
Ryan Zarychanski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Cancer Detection ◽  
Smoking Status ◽  
Screening Strategy ◽  
High Risk Patients ◽  
Occult Cancer ◽  
Key Points ◽  
Risk Patients

Key Points It remains unclear whether a subgroup of high-risk patients could potentially benefit from a more extensive screening strategy. Age, prior provoked VTE, and smoking status may be important predictors of occult cancer detection in patients with first unprovoked VTE.

scholarly journals What is the Utility of Routine Complete Blood Count, Liver Function Tests, and Chest X-ray in the Evaluation of Patients with Clinically Node-Negative Breast Cancer?

2019 ◽  
Vol 85 (1) ◽  
pp. 29-33 ◽  
Author(s):  
Ameliay Merrill ◽  
Mary M. Garland ◽  
Marissa Howard-Mcnatt ◽  
Mena Isnassuos ◽  
Kathleen C. Perry ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Blood Count ◽  
Complete Blood Count ◽  
Liver Function Tests ◽  
Screening Tests ◽  
Occult Metastasis ◽  
Preoperative Screening ◽  
Node Negative ◽  
X Ray ◽  
Chest X Ray

National Comprehensive Cancer Network guidelines suggest a selective workup of early-stage breast cancer with complete blood count (CBC) and liver function tests (LFTs) and no longer recommend chest X-ray (CXR) to screen for occult metastasis. We evaluated the utility of routine preoperative screening tests in patients with clinically node-negative (cN0) breast cancer. We identified 1611 patients with cN0 breast cancer treated at our institution between October 1998 and December 2015; 94.4 per cent of the patients underwent at least one preoperative screening test: 90.8 per cent CBC, 89.4 per cent LFTs, and 63.6 per cent CXR. Thirty-six per cent of CBCs, 13.1 per cent of LFTs, and 6.7 per cent of CXRs were abnormal. Abnormalities led to 17 CTscans, and one found an occult metastasis. Eleven patients (0.7%) were diagnosed with metastatic disease post-operatively, but only half had abnormal preoperative screening tests. Positive predictive values of preoperative CBC, LFTs, and CXR for occult metastasis are 1.3 per cent, 1.1 per cent, and 1.5 per cent, respectively. Preoperative screening in cN0 breast cancer is of low yield. Even when abnormalities are found, metastasis is present in less than 1 per cent of patients, and a normal study does not rule out metastasis. Routine preoperative determination is not warranted, and staging studies should be limited to patients with signs or symptoms.

Occult malignancy in patients with venous thromboembolism: risk indicators and a diagnostic screening strategy

2007 ◽  
Vol 22 (2) ◽  
pp. 75-79 ◽  
Author(s):  
G L Oktar ◽  
E G Ergul ◽  
U Kiziltepe
Keyword(s):  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Screening Strategy ◽  
Risk Indicators ◽  
Diagnostic Screening ◽  
X Ray ◽  
Underlying Malignancy ◽  
Occult Malignancy ◽  
Chest X Ray

Background: The study was designed to analyse the risk indicators for a possible underlying malignancy and to evaluate whether extensive cancer screening is necessary in all patients with venous thromboembolism or not. Methods: In total, 126 patients with idiopathic deep venous thrombosis, and 121 patients with secondary deep venous thrombosis of lower extremity and without a known malignancy were studied. A diagnostic screening workup including a clinical history, physical examination, complete blood count, blood sedimentation rate, basic biochemistry panel including hepatic and renal function tests, prostate-specific antigen, a chest X-ray and an abdominopelvic ultrasonography was performed for all patients. Results: Suspicious findings suggesting an underlying cancer, previous history of venous thromboembolism, bilateral venous thrombosis and associated thrombosis in unusual sites were significantly more common in patients with idiopathic venous thrombosis. A malignancy was detected in 10 of the 126 patients (7.9%) without a known risk factor for deep venous thrombosis. During the follow-up period, a diagnosis of malignancy was established in two patients in the same group. Conclusion: The risk of an underlying malignancy in patients with idiopathic venous thromboembolism is significantly higher. A moderate screening strategy has the capacity to identify the majority of the malignancies in such patients. We advocate simple laboratory tests, a chest X-ray and an abdominopelvic ultrasonography in order to search for an occult malignancy. A more extensive screening strategy may be considered for patients with suspicious findings for cancer, recurrent or bilateral venous thromboembolism and associated thrombosis in unusual sites.

Cancer Screening Participation and Gender Stratification in Europe

2020 ◽  
Vol 61 (3) ◽  
pp. 377-395
Author(s):  
Barbara Willems ◽  
Stéphane Cullati ◽  
Vincent De Prez ◽  
Vladimir Jolidon ◽  
Claudine Burton-Jeangros ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Gender Inequality ◽  
Pap Smear ◽  
Screening Strategy ◽  
Gender Stratification ◽  
Logistic Regression Models ◽  
Screening Participation ◽  
European Health ◽  
European Health Interview Survey ◽  
And Gender

The current study examines whether the extent of macrolevel gender inequality affects the association between women’s educational attainment and their participation in cervical and breast cancer screening and how this relationship is moderated by a country’s cancer screening strategy (organized vs. opportunistic). A multilevel design with women (Ncervical = 99,794; Nbreast = 55,021) nested in 30 European countries was used to analyze data from the European Health Interview Survey (2013–2015). Results of multilevel logistic regression models demonstrate that higher macrolevel gender inequality is associated with (a) a lower overall likelihood that women have had a mammography and Pap smear and (b) a larger gap in participation between women with low and high levels of education, regardless of a country’s screening strategy (i.e., no moderation by a country’s screening strategy was found). We conclude that macrolevel gender stratification should not be neglected when designing cancer screening policy.

Risk Factors Predictive of Occult Cancer Detection in Patients with Unprovoked Venous Thromboembolism

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 625-625
Author(s):  
Ryma Ihaddadene ◽  
Daniel J Corsi ◽  
Alejandro Lazo-Langner ◽  
Sudeep Shivakumar ◽  
Vicky Tagalakis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Cancer Screening ◽  
Research Funding ◽  
Multivariable Analysis ◽  
Hazard Ratio ◽  
Vein Thrombosis ◽  
Occult Cancer ◽  
Occult Malignancy ◽  
Cox Proportional Hazard Models

Abstract Background: Venous thromboembolism (VTE) may be the earliest sign of cancer. Risk factors associated with the presence of an occult cancer in patients with a first acute unprovoked VTE are unknown. We sought to assess the risk factors predictive of occult cancer detection in patients with a first unprovoked symptomatic VTE. Methods: Post-hoc, pre-defined analyses of the multicenter open-label randomized controlled trial - Screening for Occult Malignancy in Patients with Idiopathic Venous Thromboembolism (SOME) trial (Carrier M et al. N Engl J Med 2015). The trial compared comprehensive computed tomography (cCT) of the abdomen and pelvis in addition to limited occult-cancer screening (complete history and examination, basic laboratory testing, chest radiography, and breast, cervical and prostate cancer screening) with limited occult-cancer screening alone in patients with a first unprovoked episode of VTE. Cox proportional hazard models were used to analyze the effect of specific risk factors on the outcome of occult cancer within 12 months of a diagnosis of unprovoked VTE. Multivariable analysis was performed using Cox proportional hazard models that included all variables that achieved a p value of < 0.20 in univariate analyses. Results: A total of 854 patients were randomized to limited occult cancer screening only, or limited occult cancer screening in combination with a cCT. The mean age was 54 years and 67.4% were males. A total of 33 (3.9%; 95% C.I. 2.8-5.4) patients received a new diagnosis of cancer at 12 months follow-up. Age ≥ 60 years, compared to age < 60 years, was a predictor of cancer with a corresponding hazard ratio (HR) of 2.90 (95% C.I. 1.44-5.83, p=0.003). A previous provoked VTE in patients was also associated with a higher risk of developing cancer (HR=3.57, 95% C.I. 1.38-9.25, p=0.009). Patients with an unprovoked deep vein thrombosis (DVT), compared to either those with a pulmonary embolism (PE) only or both DVT and PE, seemed more likely to have a diagnosis of cancer. However, this trend was not statistically significant. (Table 1) These results were confirmed on multivariable analysis. Patients exhibiting one of these characteristics had a three-fold higher risk of occult cancer compared with patients without these characteristics. (Table 1) Conclusion: Age at unprovoked VTE diagnosis (≥ 60 years) and prior provoked VTE are predictors of occult cancer, and could potentially be used to identify a group of patients with unprovoked VTE at high risk of underlying cancer. Table 1.Risk factors of occult malignancy among patients with a first unprovoked symptomatic VTE.Patients without cancer (%) (n = 821)Patients with cancer (%) (n = 33)Univariate analysis Hazard Ratio (95% C.I.)P valueMultivariable analysis Hazard Ratio (95% C.I.)P valueAge at diagnosis ≥ 60 years288 (35.1)20 (60.6)2.90 (1.44-5.83)0.0033.0 (1.47-5.99)0.002Male sex555 (67.6)21 (63.6)0.72 (0.35-1.46)0.358--Prior provoked VTE42 (5.1)5 (15.2)3.57 (1.38-9.25)0.0093.8 (1.46-10.03)0.006Type of current VTEDVT only444 (54.3)24 (72.7)1.91 (0.89-4.12)0.0972.1 (0.97-4.51)0.061PE only271 (33.1)7 (21.2)0.60 (0.26-1.38)0.229--DVT + PE103 (12.6)2 (6.1)0.54 (0.13-2.24)0.392--Baseline medicationsOral contraceptive pill48 (5.8)0 (0.0)----Exogenous estrogen18 (2.2)1 (3.0)1.51 (0.21-11.07)0.685--Antiplatelet agent39 (4.8)1 (3.0)0.62 (0.09-4.56)0.641--Oral anticoagulant688 (83.8)26 (78.8)0.66 (0.29-1.53)0.337--LMWH391 (47.7)15 (45.5)0.68 (0.34-1.36)0.275--VTE, venous thromboembolism; DVT, deep vein thrombosis; PE, pulmonary embolism; LMWH, low molecular weight heparin Disclosures Lazo-Langner: Pfizer: Honoraria, Other: Participated in studies funded by this organization, Speakers Bureau; LEO Pharma: Honoraria, Other: Participated in studies funded by this organization; Boehringer Ingelheim: Honoraria, Other: Participated in studies funded by this organization; Bayer: Honoraria, Other: Participated in studies funded by this organization; Daiichi-Sankyo: Other: Participated in studies funded by this organization; Novartis: Other: Participated in studies funded by this organization; Celgene: Other: Participated in studies funded by this organization; Alexion: Research Funding. Shivakumar:Bayer: Honoraria. Routhier:Sanofi-Aventis: Research Funding. Douketis:Janssen: Consultancy; Bristol-Myers Squibb: Consultancy, Honoraria; Pfizer: Honoraria; Sanofi-Aventis: Honoraria; Daiichi-Sankyo: Consultancy; Actelion: Consultancy; Biotie: Other: Advisory board; The Medicines Company: Other: Advisory board; Bayer: Consultancy; Boehringer Ingelheim: Consultancy, Honoraria. Carrier:LEO Pharma: Consultancy, Research Funding; BMS: Research Funding; Bayer: Consultancy; Pfizer: Consultancy.

Risk Scores for Occult Cancer in Patients with Venous Thromboembolism: A Post Hoc Analysis of the Hokusai-VTE Study

2018 ◽  
Vol 118 (07) ◽  
pp. 1270-1278 ◽  
Author(s):  
Noémie Kraaijpoel ◽  
Nick van Es ◽  
Gary Raskob ◽  
Harry Büller ◽  
Marc Carrier ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Screening Strategy ◽  
Risk Scores ◽  
Post Hoc Analysis ◽  
Occult Cancer ◽  
Occult Malignancy ◽  
Optimal Screening ◽  
Post Hoc

AbstractVenous thromboembolism (VTE) may be the first sign of an undiagnosed cancer. In patients with unprovoked VTE, the risk is approximately 5% in the year following VTE diagnosis. Cancer-specific screening is therefore often considered in these patients, but the optimal screening strategy remains controversial. Recently, two risk classification scores have been proposed that may help in identifying patients at high risk of occult cancer in whom extensive screening may be warranted. In the present post hoc analysis of the Hokusai-VTE study, we evaluated the performance of the Registro Informatizado de Pacientes con Enfermedad TromboEmbólica (RIETE) and Screening for Occult Malignancy in Patients with Idiopathic Venous Thromboembolism (SOME) scores for occult cancer in patients with acute VTE. A total of 8,032 patients were included in the analysis of whom 218 (2.7%; 95% confidence interval [CI], 2.4–3.1) developed cancer between 30-day and 12-month follow-up. The c-statistics of the RIETE and SOME scores were 0.62 (95% CI, 0.57–0.66) and 0.59 (95% CI, 0.55–0.62), respectively. In patients classified as ‘high risk’, the cumulative incidence of cancer diagnosis during follow-up was 2.9% (95% CI, 2.1–3.9) for the RIETE score and 2.7% (95% CI, 1.9–3.7) for the SOME score, corresponding to hazard ratios of 1.8 (95% CI, 1.3–2.5) and 1.5 (95% CI, 1.04–2.2), respectively. In conclusion, the performance of both scores was poor. When used dichotomously, the scores were able to identify a group of patients with a significantly higher risk of occult cancer, although it remains unknown whether this translates into improved clinical important outcomes.

Multiple firm nodules in a young woman: an unusual presentation of sarcoidosis

2021 ◽  
Vol 14 (1) ◽  
pp. e237264
Author(s):  
Leila Izadi Firouzabadi ◽  
Alireza Ghanadan ◽  
Shabnam Fahim ◽  
Ali Sadeghinia
Keyword(s):  
Complete Blood Count ◽  
Subcutaneous Fat ◽  
Liver Function Tests ◽  
Dermatology Department ◽  
Normal Ranges ◽  
Associated Symptoms ◽  
Upper And Lower Extremities ◽  
History Of ◽  
Chest X Ray ◽  
High Index Of Suspicion

A 27-year-old woman presented to the dermatology department with a 1-year history of multiple asymptomatic violaceous lesions on her upper and lower extremities, trunk and abdomen. The lesions were firm on palpation. She had no other associated symptoms and the rest of the examination was unremarkable. An incisional biopsy showed multiple confluent granulomas composed of histiocytes devoid of necrosis surrounded by a rim of lymphocytes extending to the subcutaneous fat consistent with the diagnosis of subcutaneous sarcoidosis. The serum ACE assay was elevated at 134 IU/L. Other blood tests including complete blood count, renal and liver function tests, serum calcium and phosphate were within normal ranges and chest X-ray was unremarkable. Complete remission was achieved with an intralesional triamcinolone injection (10 mg/mL) for a few sessions. Subcutaneous sarcoidosis is a rare variation and its diagnosis requires a high index of suspicion.

scholarly journals Occult cancer screening in patients with venous thromboembolism: guidance from the SSC of the ISTH

2017 ◽  
Vol 15 (10) ◽  
pp. 2076-2079 ◽  
Author(s):  
A. Delluc ◽  
D. Antic ◽  
R. Lecumberri ◽  
C. Ay ◽  
G. Meyer ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Screening ◽  
Occult Cancer

scholarly journals Determinants of Early Cancer Screening Behaviour in Nigeria

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 54s-54s
Author(s):  
R.C.W. Chidebe ◽  
T.C. Orjiako ◽  
D.K. Atakere ◽  
O.O. Arowosegbe ◽  
D. Onu ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Early Detection ◽  
Cancer Detection ◽  
Early Cancer ◽  
Specific Antigen ◽  
Risk Groups ◽  
Early Cancer Detection ◽  
Mortality And Morbidity ◽  
Clinical Breast ◽  
The Impact

Background: Early detection and improvements/advancements in medicine have contributed to an overall decrease in mortality and morbidity rates resulting from cancer diagnoses. Despite this improvement in national and global health status, Nigerians continue to be diagnosed at a later stage, with a more aggressive disease state. This is an important observation given the impact cancer has on the abilities of individuals to function physically, psychologically, and socially within the context of their environment. It is important therefore to identify and target specific groups that may be less willing to present for early cancer screening. Aim: To understand the characteristics of people who are likely or not likely to present for early cancer screening among Nigerians, and to address the use of mechanisms by which to ensure a timely diagnosis of preventable cancers among Nigerians. Methods: Adult Nigerians (N=144), 18-71 years of age who presented for clinical breast exam (CBE), visual inspection with acetic acid (VIA) and prostate specific antigen test (PSA) screenings after an awareness exercise; completed survey forms which included a personality inventory, early cancer detection behavior scale and a demography profile. Multiple regression and ANOVA were used to examine predictive patterns as well as differences between and within groups. Results: Results showed income ( b = 0.18, P < .05) to be a significant determinant of early cancer detection behavior, such that higher income earners were more likely to go for screening. There were also significant gender differences in current cancer detection behavior between males (M = 0.15, SD = 0.51) and females (M= 0.47, SD = 0.80); males are less likely to engage in early detection behavior ( F(1,145) = 4.76, P = .03). Data further show differences between older (≥ 41) and younger (≤ 40) participants in intention to screen for cancer, with older participants reporting more willingness to engage in cancer screening. Conclusion: Our finding enhances our understanding of the profile of the groups who are less likely to screen for cancer. Also, it suggests that awareness campaign and free screening exercises should target these at-risk groups in Nigeria.

Sign in / Sign up

Export Citation Format

Share Document