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Is a Search for Malignant Disease Justified?

Arch Intern Med. 1994;154(12):1310-1312.

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SINCE ARMAND Trousseau¹ in 1865 directed attention to the association between malignant neoplasms and thrombosis, a growing number of case reports and cohort studies have reported that patients with idiopathic venous thrombosis may have an underlying malignant neoplasm.^2-4 Despite these reports, opinions differ about the need to investigate for underlying malignant disease in patients with idiopathic venous thrombosis who are otherwise well. The general issues related to the appropriateness of screening for asymptomatic disease in any patient group are complex.^5,6 In the context of idiopathic venous thrombosis, the decision to screen for occult malignant neoplasm requires answers to the following questions: (1) What is the incidence of occult malignant neoplasm in patients with idiopathic thrombosis? (2) What types of malignant neoplasms are encountered? (3) Can these occult malignant neoplasms be identified by screening methods? (4) Does early identification and treatment of occult malignant neoplasms improve prognosis?

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