Lack of association between venous thrombosis and subsequent malignancy in a retrospective cohort study in young patients

Since the publication of Trousseau in 1865, several studies have documented an increased incidence of cancer in patients with deep venous thrombosis (DVT) especially those with idiopathic or recurrent DVT, but in young patients this association is not clear and is therefore a subject of controversy. We performed a retrospective study in a consecutive cohort of 40 young patients (age <40 years) with a DVT and without a known cancer. All patients were diagnosed in our hospital during the period of 1988-1992. At the time of diagnosis, a routine examination to detect the presence of malignant disease was made. For the follow-up, all patients included in the study were asked to return to our unit and were interviewed for symptoms that could suggest a malignant disease. The mean follow-up was five years (from three to eight years). Twenty-four patients had DVT in the lower limbs and three in the upper extremities, nine had pulmonary embolism (six of them with DVT) and four had DVT in other sites. Sixteen patients (40%) had secondary DVT due to nonbiological causes, abnormalities in hemostasis were found in 14 patients (35%), and biological or environmental triggering factors were not identified in 10 patients (25%). Malignancies were not detected at diagnosis and in the follow-up. In our experience, venous-thrombotic patients under the age of 40 have a low incidence of subsequent cancer. Further studies should be performed to confirm this observation and to ascertain whether extensive screening for cancer is a cost-effective approach.