April 23, 1998New England Journal of Medicine625 citationsOpen Access
View Full PaperThe Risk of a Diagnosis of Cancer after Primary Deep Venous Thrombosis or Pulmonary Embolism
Key Result
Deep venous thrombosis and pulmonary embolism were associated with a subsequent diagnosis of cancer (SIR 1.3), with the risk substantially elevated only during the first six months.
Study Design
Type
Cohort (n=26,653)
Multicenter
Yes
Structured PICO
Does a diagnosis of primary deep venous thrombosis or pulmonary embolism increase the risk of a subsequent cancer diagnosis?
P
Population
26,653 patients (15,348 with deep venous thrombosis and 11,305 with pulmonary embolism) drawn from the Danish National Registry of Patients (1977-1992)
I
Intervention
Diagnosis of primary deep venous thrombosis or pulmonary embolism
C
Comparator
Expected number of cancer cases based on national age-, sex-, and site-specific incidence rates
O
Outcome
Subsequent diagnosis of cancerhard clinical
Although DVT and PE are associated with a slightly increased risk of a subsequent cancer diagnosis, the risk is mostly limited to the first six months and often involves advanced cancers, suggesting that aggressive screening for hidden cancer is not warranted.
Main Result
Effect estimate: SIR 1.3 (95% CI 1.21-1.33)
Abstract
BACKGROUND: Several small studies have indicated an association between deep venous thrombosis or pulmonary embolism and a subsequent diagnosis of cancer, but the subject is controversial. METHODS: We conducted a nationwide study of a cohort of patients with deep venous thrombosis or pulmonary embolism that was drawn from the Danish National Registry of Patients for the years 1977 through 1992. The occurrence of cancer in the cohort was determined by linkage to the Danish Cancer Registry. The expected number of cancer cases was estimated on the basis of national age-, sex-, and site-specific incidence rates. RESULTS: A total of 15,348 patients with deep venous thrombosis and 11,305 patients with pulmonary embolism were identified. We observed 1737 cases of cancer in the cohort with deep venous thrombosis, as compared with 1372 expected cases (standardized incidence ratio, 1.3; 95 percent confidence interval, 1.21 to 1.33). Among the patients with pulmonary embolism, the standardized incidence ratio was 1.3, with a 95 percent confidence interval of 1.22 to 1.41. The risk was substantially elevated only during the first six months of follow-up and declined rapidly thereafter to a constant level slightly above 1.0 one year after the thrombotic event. Forty percent of the patients given a diagnosis of cancer within one year after hospitalization for thromboembolism had distant metastases at the time of the diagnosis of cancer. There were strong associations with several cancers, most pronounced for those of the pancreas, ovary, liver (primary hepatic cancer), and brain. CONCLUSIONS: An aggressive search for a hidden cancer in a patient with a primary deep venous thrombosis or pulmonary embolism is not warranted.