BMJ 1994;308:891-894 (2 April)

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Deep venous thrombosis and occult malignancy: an epidemiological study

M Nordstrom, B Lindblad, H Anderson, D Bergqvist, T Kjellstrom 

Department of Medicine and Surgery, Malmo General Hospital, University of Lund, S-214 01 Malmo, Sweden Department of Surgery, Academic Hospital, Uppsala University, Uppsala, Sweden Regional Tumour Registry, University Hospital, Lund, Sweden Department of Medicine, Helsingborg Hospital, Sweden.

Abstract

Objective : To determine the risk of subsequent cancer in patients with deep venous thrombosis confirmed by venography.
Design : Follow up of all patients who had venography for suspected deep venous thrombosis during 1984-88. Patients were traced through a cancer registry up to 1 January 1991.
Subjects : 4399 patients who had phlebography in one hospital. Setting - General hospital in Malmo, Sweden, serving a population of 230 000.
Main outcome measure : Number of cancers recorded.
Results : 4399 patients had venography for suspected deep venous thrombosis; 604 were known to have a malignancy at the time of venography and were excluded from further analysis. 1383 had deep venous thrombosis, 150 of whom subsequently developed cancer. 182 of the 2412 patients without thrombosis developed cancer. During the first six months after venography 66 patients with thrombosis developed malignancy compared with 37 patients without thrombosis (P<0.0001). 38 of the cancers in the deep venous thrombosis group were detected by history, physical examination, and laboratory tests. Three patients had postoperative or post-traumatic deep venous thromboses. Only two of the remaining patients would have benefited from early detection by extensive screening. After six months the incidence of cancer was identical in patients with and without thrombosis.
Conclusion : Deep venous thrombosis is associated with a significantly higher frequency of malignancy during the first six months after diagnosis. Malignancies can be found with simple clinical and diagnostic methods and extensive screening is not required.

Clinical implications

  • Clinical implications

  • Cancer is often seen in patients with deep venous thrombosis

  • This study shows that cancer is five times more commonly diagnosed within six months after deep venous thrombosis than a control group matched for age and sex

  • Most of the cancers were easily detected by routinemethods (history, physical examination, and laboratory tests)

  • Extensive screening of the 1383 patients with deep venous thrombosis would have resulted in beneficial earlier diagnosis in only two patients

  • Extensive screening of patients with deep venous thrombosis does not seem cost effective


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