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

Arch Intern Med. 2005 Aug 8-22;165(15):1782-7. doi: 10.1001/archinte.165.15.1782.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / epidemiology
  • California / epidemiology
  • Carcinoma, Renal Cell / epidemiology
  • Cohort Studies
  • Colonic Neoplasms / epidemiology
  • Comorbidity
  • Female
  • Humans
  • Incidence
  • Kidney Neoplasms / epidemiology
  • Leukemia, Myeloid / epidemiology
  • Lung Neoplasms / epidemiology
  • Lymphoma, Non-Hodgkin / epidemiology
  • Male
  • Middle Aged
  • Neoplasms / epidemiology*
  • Ovarian Neoplasms / epidemiology
  • Pancreatic Neoplasms / epidemiology
  • Prostatic Neoplasms / epidemiology
  • Stomach Neoplasms / epidemiology
  • Time Factors
  • Venous Thrombosis / epidemiology*