Key result
Prior VTE linked to increased risk of multiple cancers including lung and colon.
Why the study?
Is prior venous thromboembolism associated with an increased risk of cancer in elderly adults?
Case-Control (n=1,400,000)
Yes
Is prior venous thromboembolism associated with an increased risk of cancer in elderly adults?
Absolute Event Rate: 2.5% vs 2.2%
Prior venous thromboembolism is associated with an elevated risk of subsequent cancer diagnosis in elderly adults, with some risks persisting beyond 6 years.
May support heightened cancer vigilance after VTE in elderly adults; leaves open whether screening improves outcomes.
BACKGROUND: Few studies have evaluated cancer risk following venous thromboembolism (VTE). Both VTE and cancer disproportionately affect older adults. METHODS: Using linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we evaluated 1.2 million cancer cases and 200,000 controls (66-99 years old, 1992-2005). VTEs occurring before selection were identified using Medicare claims. Logistic regression was used to estimate ORs. RESULTS: VTE was present in 2.5% of cases and 2.2% of controls. VTE was associated with risk of cancers of the lung [OR = 1.18; 95% confidence interval (CI), 1.12-1.23], stomach (OR = 1.19; 95% CI, 1.09-1.30), small intestine (OR = 1.42; 95% CI, 1.17-1.71), colon (OR = 1.25; 95% CI, 1.18-1.31), gallbladder (OR = 1.39; 95% CI, 1.16-1.67), pancreas (OR = 1.53; 95% CI, 1.43-1.64), soft tissue (OR = 1.43; 95% CI, 1.21-1.68), ovary (OR = 1.35; 95% CI, 1.22-1.50), and kidney/renal pelvis (OR = 1.34; 95% CI, 1.23-1.46), and melanoma (OR = 1.17; 95% CI, 1.08-1.27), non-Hodgkin lymphoma (OR = 1.27; 95% CI, 1.20- 1.35), myeloma (OR = 1.48; 95% CI, 1.35-1.63), and acute myeloid leukemia (OR = 1.35; 95% CI, 1.19-1.54). Strongest risks were observed within 1 year of VTE diagnosis, but risks were elevated more than 6 years after VTE for colon cancer (OR = 1.24; 95% CI, 1.12-1.37), pancreatic cancer (OR = 1.33; 95% CI, 1.15-1.54), and myeloma (OR = 1.35; 95% CI, 1.10-1.66). Few differences in risk were observed by VTE subtype. Cancers of the lung, stomach, and pancreas were more likely to have distant metastases within one year after VTE. CONCLUSION: Among elderly adults, cancer risk is elevated following VTE diagnosis. IMPACT: Short-term associations with cancer are likely driven by enhanced screening following VTE and reverse causation. While obesity, other comorbidities, and smoking cannot be excluded as explanations, longer-term elevations for select cancers suggest that some VTEs may be caused by cancer precursors.
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Marks et al. (2014) conducted a case-control in Cancer and Venous Thromboembolism (n=1,400,000). Venous thromboembolism vs. No venous thromboembolism was evaluated on Cancer (overall). Among elderly adults, prior venous thromboembolism was present in 2.5% of cancer cases versus 2.2% of controls and was associated with an increased risk of multiple cancers, including lung and colon.
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