Screening for cancer in venous thromboembolic disease

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7315.704 (Published 29 September 2001) Cite this as: BMJ 2001;323:704

The incidence is higher but intensive screening isn't warranted

  1. Tony Fennerty (Anthony.Fennerty@hhc-tr.northy.nhs.uk), consultant in general and respiratory medicine
  1. Harrogate District Hospital, Harrogate HG2 7SX

    The association between cancer and venous thrombosis has long been recognised. 1 2 Though venous thrombosis is a well known complication of established cancer, it might also be a marker of an otherwise occult cancer. If so, this raises the issue of whether otherwise healthy patients presenting with a venous thromboembolic event should be investigated for a possible underlying cancer on the grounds that a cancer diagnosed early may be more amenable to cure.

    Whether screening for an underlying cancer is a good use of resources will depend on how common such cancers are; the cost, accuracy, and acceptability of the screening tests; and, most important, whether early detection of such cancers would improve patient outcome.

    Large prospective studies of patients presenting with venous thromboembolic disease, linking hospital records with national cancer registers, find an incidence of previously undiagnosed cancer of 4-6.5%, giving standardised incidence ratios of 1.3-3.2.3-5 Smaller retrospective and prospective studies looking particularly at patients with no obvious risk factors for their thrombosis find higher incidences of cancer, of 7.3-12% compared with 1.9-2.9% for patients with risk factors.6-8 In these studies patients were not specifically investigated for an …

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