van Es N, et al. – The intent here was to discern the prevalence of occult cancer in patients with unprovoked venous thromboembolism (VTE), including in subgroups of varied ages or those who underwent different types of screening. The observations made were, occult cancer was detected in 1 in 20 patients within a year of receiving a diagnosis of unprovoked VTE. A link was brought to light between older age and higher cancer prevalence. Regardless of an extensive screening strategy initially detecting more cancer cases than limited screening, whether this translated into improved patient outcomes could not be determined.

Methods

• Data was extracted from the MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials up to 19 January 2016.
• Prospective studies contemplating the cancer screening strategies were selected.
• They included studies with adults presenting unprovoked VTE that began enrolling patients after 1 January 2000 and had at least 12 months of follow-up.
• An appraisal was performed of the abstracts and full-text articles by 2 investigators, along with an independent analysis of the risk of bias.

Results

• 10 studies were selected.
• Individual data were obtained for all 2316 patients.
• Mean age was 60 years; 58% of patients received extensive screening.
• The 12-month period prevalence of cancer after VTE diagnosis was 5.2% (95% CI, 4.1% to 6.5%).
• A higher point prevalence of cancer was reported in patients who had extensive screening than in those who had more limited screening initially (odds ratio [OR], 2.0 [CI, 1.2 to 3.4]) but not at 12 months (OR, 1.4 [CI, 0.89 to 2.1]).
• A linear increase was noted in the cancer prevalence with age.
• It appeared to be 7-fold higher in patients aged 50 years or older than in younger patients (OR, 7.1 [CI, 3.1 to 16]).