Incidence of venous thromboembolism in the year before the diagnosis of cancer in 528 693 adults

Richard H White, Helen K Chew, Hong Zhou, Arti Parikh-Patel, David Harris, Danielle J Harvey, Theodore Wun

Research output: Contribution to journalArticle

165 Citations (Scopus)

Abstract

Background: It is unclear how frequently unprovoked venous thromboembolism (VTE) reflects the presence of an occult cancer. Methods: The California Cancer Registry was used to identify diagnosed cases of 19 common malignancies during a 6-year period. Cases were linked to a hospital discharge database to identify incident VTE events in the year before the cancer diagnosis date. The standardized incidence ratio (SIR) of unprovoked VTE was determined by using the age-, race-, and sex-specific incidence rates in California. Results: Among 528 693 cancer cases, 596 (0.11%) were associated with a diagnosis of unprovoked VTE within 1 year of the cancer diagnosis, compared with 443.0 expected cases (SIR, 1.3; 95% confidence interval, 1.2-1.5; P<.001). Among cases with metastatic-stage cancer, the SIR was 2.3 (95% confidence interval, 2.0-2.6; P<.001), whereas for all other stages, the SIR was 1.07 (95% confidence interval, 0.97-1.18; P=.09). The incidence of preceding VTE was increased over that expected only during the 4-month period immediately preceding the cancer diagnosis date (P<.001). Only 7 cancer types were associated with a significantly elevated SIR: acute myelogenous leukemia; non-Hodgkin lymphoma; and renal cell, ovarian, pancreatic, stomach, and lung cancer (SIR range, 1.8-4.2). Conclusions: In the year preceding the diagnosis of cancer, the number of cases with unprovoked VTE was modestly higher than expected, and almost all of the unexpected VTE cases were associated with a diagnosis of metastatic-stage cancer within 4 months. Given the timing and advanced stage of the unexpected cases, it is unlikely that earlier diagnosis of these cancers would have significantly improved long-term survival.

Original languageEnglish (US)
Pages (from-to)1782-1787
Number of pages6
JournalArchives of Internal Medicine
Volume165
Issue number15
DOIs
StatePublished - Aug 22 2005

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Venous Thromboembolism
Incidence
Neoplasms
Confidence Intervals
Pancreatic Neoplasms
Early Detection of Cancer
Renal Cell Carcinoma
Acute Myeloid Leukemia
Ovarian Neoplasms
Non-Hodgkin's Lymphoma
Stomach Neoplasms
Registries
Lung Neoplasms
Databases

ASJC Scopus subject areas

  • Internal Medicine

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Incidence of venous thromboembolism in the year before the diagnosis of cancer in 528 693 adults. / White, Richard H; Chew, Helen K; Zhou, Hong; Parikh-Patel, Arti; Harris, David; Harvey, Danielle J; Wun, Theodore.

In: Archives of Internal Medicine, Vol. 165, No. 15, 22.08.2005, p. 1782-1787.

Research output: Contribution to journalArticle

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title = "Incidence of venous thromboembolism in the year before the diagnosis of cancer in 528 693 adults",
abstract = "Background: It is unclear how frequently unprovoked venous thromboembolism (VTE) reflects the presence of an occult cancer. Methods: The California Cancer Registry was used to identify diagnosed cases of 19 common malignancies during a 6-year period. Cases were linked to a hospital discharge database to identify incident VTE events in the year before the cancer diagnosis date. The standardized incidence ratio (SIR) of unprovoked VTE was determined by using the age-, race-, and sex-specific incidence rates in California. Results: Among 528 693 cancer cases, 596 (0.11{\%}) were associated with a diagnosis of unprovoked VTE within 1 year of the cancer diagnosis, compared with 443.0 expected cases (SIR, 1.3; 95{\%} confidence interval, 1.2-1.5; P<.001). Among cases with metastatic-stage cancer, the SIR was 2.3 (95{\%} confidence interval, 2.0-2.6; P<.001), whereas for all other stages, the SIR was 1.07 (95{\%} confidence interval, 0.97-1.18; P=.09). The incidence of preceding VTE was increased over that expected only during the 4-month period immediately preceding the cancer diagnosis date (P<.001). Only 7 cancer types were associated with a significantly elevated SIR: acute myelogenous leukemia; non-Hodgkin lymphoma; and renal cell, ovarian, pancreatic, stomach, and lung cancer (SIR range, 1.8-4.2). Conclusions: In the year preceding the diagnosis of cancer, the number of cases with unprovoked VTE was modestly higher than expected, and almost all of the unexpected VTE cases were associated with a diagnosis of metastatic-stage cancer within 4 months. Given the timing and advanced stage of the unexpected cases, it is unlikely that earlier diagnosis of these cancers would have significantly improved long-term survival.",
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AB - Background: It is unclear how frequently unprovoked venous thromboembolism (VTE) reflects the presence of an occult cancer. Methods: The California Cancer Registry was used to identify diagnosed cases of 19 common malignancies during a 6-year period. Cases were linked to a hospital discharge database to identify incident VTE events in the year before the cancer diagnosis date. The standardized incidence ratio (SIR) of unprovoked VTE was determined by using the age-, race-, and sex-specific incidence rates in California. Results: Among 528 693 cancer cases, 596 (0.11%) were associated with a diagnosis of unprovoked VTE within 1 year of the cancer diagnosis, compared with 443.0 expected cases (SIR, 1.3; 95% confidence interval, 1.2-1.5; P<.001). Among cases with metastatic-stage cancer, the SIR was 2.3 (95% confidence interval, 2.0-2.6; P<.001), whereas for all other stages, the SIR was 1.07 (95% confidence interval, 0.97-1.18; P=.09). The incidence of preceding VTE was increased over that expected only during the 4-month period immediately preceding the cancer diagnosis date (P<.001). Only 7 cancer types were associated with a significantly elevated SIR: acute myelogenous leukemia; non-Hodgkin lymphoma; and renal cell, ovarian, pancreatic, stomach, and lung cancer (SIR range, 1.8-4.2). Conclusions: In the year preceding the diagnosis of cancer, the number of cases with unprovoked VTE was modestly higher than expected, and almost all of the unexpected VTE cases were associated with a diagnosis of metastatic-stage cancer within 4 months. Given the timing and advanced stage of the unexpected cases, it is unlikely that earlier diagnosis of these cancers would have significantly improved long-term survival.

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