Occult cancer screening in patients with venous thromboembolism: A systematic review and meta-analysis

Abstract

Background: Unprovoked venous thromboembolism (VTE) can be the first clinical manifestation of an undiagnosed cancer. A cancer diagnosis at an earlier stage could reduce the risk of cancer progression and contribute to improvements in cancer‐related mortality. Aim: This review analyzes whether extensive screening for undiagnosed cancer in patients with a first episode of unprovoked VTE is effective in reducing cancer-related mortality. Methods: Prospective studies in which patients with an unprovoked VTE were allocated to receive specific tests for identifying cancer were eligible for inclusion. To identify studies, PubMed, Web of Science, Cochrane Library, Scopus, EMBASE, Clinical Trials, the International Clinical Trials Registry Platform, and the Cochrane Central Register of Controlled Trials were searched. Results: Four randomized clinical trials (RCTs) and six prospective observational studies were included. Rates of cancer diagnosis at initial screening and during the follow-up in RCTs differed statistically between the two groups (odds ratio [OR]: 2.28 [95% confidence interval (CI): 1.37 ‒ 3.82; p<0.001] vs. OR: 0.35 [95% CI: 0.16 ‒ 0.77; p<0.001], respectively). The analysis of the RTCs indicated early-stage cancer at diagnosis in an extensive screening group, with results statistically significant (OR: 8.5; 95% CI: 2.57 ‒ 28.17; p<0.001). No differences were observed in cancer-related mortality (OR: 1.07; 95% CI: 0.57 ‒ 2.00; p=0.143) and overall mortality (OR: 0.80; 95% CI: 0.44 ‒ 1.45; p=0.567) at the end of follow-up. Conclusion: Extensive testing for undiagnosed cancer in people with a first episode of unprovoked VTE does not reduce cancer-related mortality. Relevance for Patients: This study supports tailored cancer screening in VTE patients, potentially reducing harm from overtesting and improving clinical outcomes.

Keywords

Early detection screening / Occult malignancy / Risk / Systematic review / Venous thromboembolism

Funding

None.

Conflict of interest

The authors declare that they have no competing interests.

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