Introduction Unprovoked pulmonary embolism (PE) has a well-documented association with occult malignancy, yet the incidence of malignancy and how to screen for it remain a topic of considerable debate. We set out to identify the proportion of patients who developed cancer within one year following unprovoked PE at our institution, and the number of cases identified on screening.
Methods We retrospectively interrogated a prospectively maintained database of patients attending the PE clinic at our institution, in order to identify those diagnosed with unprovoked PE between September 2011 and December 2015.
Results We identified 207 patients (92 women) of mean age 63 years. 54%, 34%, and 12% had a low-, intermediate- and high-risk PE, respectively. 17 (8%) patients were found to have cancer within one year, of which 12 (71%) were discovered on initial screening. The commonest cancers were prostate (six), colon (three) and pancreas (two). Chest radiograph, serum calcium and serum prostate-specific antigen (PSA) were performed in 94%, 46% and 43%, respectively. Of those over 40 years, 44% had an abdominal ultrasound (USS) and 26% had computed tomography (CT) scanning performed (82% of which were full staging scans) within one month. 33%, 33%, 25% and 8% of the 12 cancers found on screening were initially identified via PSA, USS, CT and CTPA, respectively.
Conclusions The incidence of cancer within one year (8%) was within the range reported by previous studies (4%–10%). This study highlights that thorough history, examination and basic screening investigations (including PSA) should be mandatory for all patients following unprovoked PE – yet for a significant proportion of patients this basic workup may be incomplete. Large prospective trials are required to conclusively establish the value of routine further imaging, especially that involving ionising radiation, and the decision to offer more intensive screening should be made on a case-by-case basis.
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