Review: In patients with a first VTE, extended testing for undiagnosed cancer does not reduce mortality

    Research output: Contribution to journalComment/debate


    In patients with a first venous thromboembolism (VTE), does testing for undiagnosed cancer reduce cancer- and VTE-related mortality and morbidity compared with clinically indicated testing?
    Review scope
    Included studies compared the use of specific tests for cancer detection with those done at the physician's discretion or standard testing in patients who had a first unprovoked VTE (deep venous thrombosis [DVT] of the lower limb or pulmonary embolism [PE]) and no previous or clinically apparent cancer. Primary outcomes were all-cause, cancer-related, and VTE-related mortality. Other outcomes included VTE recurrence, frequency of underlying cancer diagnosis, and stage of diagnosed cancer.
    Review methods
    Cochrane Vascular Specialized Register to Feb 2017, Cochrane Register of Studies, CENTRAL (Issue 1, 2017), trial registries, relevant conference proceedings, and reference lists were searched for randomized controlled trials (RCTs) and quasi-RCTs. 4 RCTs (n = 1644, mean age 53 to 69 y, 50% to 67% men) met inclusion criteria: 2 compared extensive testing with testing at the discretion of the physician (n = 396), and 2 compared standard testing plus imaging (computed tomography [CT] of the abdomen and pelvis or 18-fluorodeoxyglucose positron emission tomography [PET]-CT of the chest, abdomen, and pelvis) with standard testing alone (n = 1248). All 4 RCTs had adequate allocation concealment and completeness of data, and 3 RCTs blinded outcome assessors. Blinding of patients and study staff was not considered feasible.
    Main results
    The main results are in the Table.
    In patients with a first venous thromboembolism, testing for undiagnosed cancer beyond standard testing does not reduce all-cause mortality or cancer-related mortality.
    Original languageEnglish
    Pages (from-to)JC64
    Number of pages1
    JournalAnnals of Internal Medicine
    Issue number12
    Publication statusPublished - 19 Dec 2017


    • Randomized controlled trials
    • Cancer treatment
    • Thorax
    • cancer screening
    • tomography
    • pulmonary embolism
    • deep vein thrombosis
    • hematologic tests
    • Positron Emission Tomography (PET)
    • venous thromboembolism
    • computed axial tomography
    • prospective studies
    • lung and intrathoracic tumors


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