Do we need a cancer screening in patients with idiopathic deep vein thrombosis?

AIM: To review the literature concerning the need for a cancer screening battery to diagnose a hidden cancer in patients presenting with idiopathic venous thromboembolism (VTE).
MATERIALS AND METHODS: Data from computerized database programs (Medline, Ovid) was retrieved. A review of the literature regarding studies on cancer screening in patients with idiopathic VTE was performed and our own policy included.
RESULTS: Patients with VTE have a higher rate of malignancy which may still be undiagnosed. During follow-up of patients with idiopathic VTE, the incidence of cancer increases and is more likely associated with a worse prognosis. Limited diagnostic work-up in patients with idiopathic VTE allows the diagnosis of a hidden malignancy in about half of the cases with a sensitivity of 48 %. Extensive screening of cancer with idiopathic VTE allows less of a delay and earlier stage at diagnosis with a 93 % sensitivity. However, reduced cancer-related mortality is not statistically significant. A two-fold fatal PE and more than 3-fold fatal bleeding are registered in VTE patients with hidden cancer compared to patients without cancer. The major risk factors for hidden cancer are old age, anemia, idiopathic and bilateral deep vein thrombosis.
CONCLUSION: There is no consensus regarding the benefit of extensive screening in patients presenting with idiopathic VTE. Clear diagnostic work-up guidelines are not yet available. A cost-effective diagnostic algorithm for cancer screening in patients with idiopathic VTE is needed.