Screening for occult cancer in patients with acute venous thromboembolism

Abstract

Although usually developing in advanced stages of the disease, venous thromboembolism may also appear before the cancer has become symptomatic and may lead to an earlier diagnosis of cancer. One clinical implication of a high risk of occult cancer in patients with acute venous thromboembolism could be an extensive diagnostic workup at the time of presentation. The prevalence of occult cancer is between 2.2% and 12% within the first 2 years after the venous thromboembolism. This variation in reported incidence likely reflects the variation in the intensity of cancer surveillance in each study. Although extensive screening in venous thromboembolism patients may result in early identification of hidden cancer, it is unknown whether the prognosis of the clinical course of the malignancy can be favourably influenced. Early discovery of occult cancer should improve the potential for cure, not merely advance the date of diagnosis. The absence of demonstrated benefit, as well as the potential for actual harm caused by the use of hazardous invasive diagnostic tests, has led to the recommendation not to use extensive screening procedures, unless indicated by clinical circumstances.