The relationship between malignancy and thrombosis has been well established for more than a century.
The recent discoveries that certain tumors (or activated monocytes in cancer patients) express procoagulant molecules such as tissue factor, cysteine protease, and annexin II, have helped to elucidate the pathophysiological underpinnings of this relationship.
A far more vexing question, however, has remained largely unanswered until recently: namely, should patients with an idiopathic episode of venous thromboembolism undergo screening for the presence of an occult malignancy?
This question arises because of the data reported from retrospective studies and registry data that have seemingly demonstrated an excess of cancers already present in patients with idiopathic VTE compared to matched control patients.
These data have had an apparent psychological effect on clinicians who feel compel to extrapolate this information and conclude (erroneously) that screening for such cancers should be performed.
Unfortunately this approach ignores one of the basic tenets of clinical medicine: namely, that screening large populations of patients should only be performed after methodical testing of such a practice has determined the validity of its implementation in terms of appropriate utilization of resources, cost, accuracy, acceptability of the screening test and, perhaps most importantly, whether early detection of such cancers ultimately confers any survival benefit to patients.
This presentation will analyze the findings of two large studies, one retrospective that was published in 1996 (Cornuz et al; Ann Int Med), and one prospective, the SOMIT study, whose results were presented in abstract form at the meeting of the International Society of Thrombosis and Hemostasis in 2001.
The results of both these studies provide compelling reasons to engage in only limited screening of patients with idiopathic VTE, ie a thorough history, physical examination, complete blood count, serum chemistries and a chest X ray. Thus, attempts to lure clinicians into the murky waters of extensive screening of VTE patients for cancer, should be rebuffed by enlightened and informed physicians.
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