No Benefit of Adding CT to Basic Screening for Occult Cancer in Patients With Unprovoked Venous Thromboembolism


Key Points

  • Overall, 3.9% of patients had a new diagnosis of cancer by the end of 1-year follow-up.
  • There was no significant difference in proportions of occult cancers missed by the limited-screening vs CT-plus–limited screening strategies.

In a Canadian study reported in The New England Journal of Medicine, Carrier et al found that adding computed tomography (CT) of the abdomen and pelvis to basic screening did not improve detection of occult cancers in patients with a first episode of unprovoked venous thromboembolism. Venous thromboembolism can be an early sign of cancer.

Study Details

In the open-label study, 854 patients were randomly assigned to limited screening with basic blood testing, chest radiography, and screening for breast, cervical, and prostate cancer (n = 431) or limited screening plus CT (n = 423) and were followed for development of cancer for 1 year. The primary outcome measure was confirmed cancer missed by screening and detected by the end of the 1-year follow-up.

Detection of Occult Cancer

Overall, 33 patients (3.9%) had a new diagnosis of occult cancer at the end of 1-year follow-up, including 14 (3.2%) in the limited-screening group and 19 (4.5%) in the CT group (P = .28). Four (29%) of the occult cancers were missed by screening in the limited-screening group, compared with five (26%) in the CT group (P = 1.0). There were no significant differences between groups in mean time to cancer diagnosis (4.2 vs 4.0 months, P = .88) or cancer-related mortality (1.4% vs 0.9%, P = .75).

The investigators concluded: “The prevalence of occult cancer was low among patients with a first unprovoked venous thromboembolism. Routine screening with CT of the abdomen and pelvis did not provide a clinically significant benefit.”

Marc Carrier, MD, of the Ottawa Hospital Research Institute, University of Ottawa, is the corresponding author for the New England Journal of Medicine article.

The study was funded by the Heart and Stroke Foundation of Canada. For full disclosures of the study authors, visit

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