AccScience Publishing / JCTR / Online First / DOI: 10.36922/jctr.24.00069
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REVIEW ARTICLE

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

Anabel Franco-Moreno1,2* ,  José Manuel Ruiz-Giardin3 ,  Ana Martínez-Casa-Muñoz4 ,  Cristina Lucía de Ancos-Aracil3,5
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1 Department of Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain
2 Venous Thromboembolism Unit, Hospital Universitario Infanta Leonor, Madrid, Spain
3 Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain
4 Department of Geriatric, Hospital Universitario Gregorio Marañón, Madrid, Spain
5 Venous Thromboembolism Unit, Hospital Universitario de Fuenlabrada, Madrid, Spain
JCTR, 00069 https://doi.org/10.36922/jctr.24.00069
Received: 17 October 2024 | Revised: 12 February 2025 | Accepted: 19 May 2025 | Published online: 16 June 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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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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