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Risk factors associated with venous thromboembolism in breast cancer: a narrative review

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Abstract

Purpose

To date, there is no universally acceptable risk assessment tool in clinical practice that accurately estimates the risk of venous thromboembolism (VTE) in patients with breast cancer, despite the large number of published studies. Thus, the aim of this narrative review was to summarize the most relevant risk factors for VTE in these patients.

Methods

We searched Ovid Embase and Ovid MEDLINE, from inception to March 26, 2021, to identify all articles that focused on breast cancer and multiple thromboembolic diseases. We also searched the references section of relevant articles to identify studies. We did not include case reports or case series with small sample size, N < 20.

Results

VTE in patients with breast cancer was strongly associated with patient-, tumor-, and non-tumor-related risk factors, such as age, disease stage, central catheter placement, and chemotherapy and tamoxifen use, especially within 2 years of breast cancer diagnosis. CDK inhibitors are emerging factors that may also increase the risk of VTE.

Conclusions

The risk of VTE in patients with breast cancer depends on various patient-, tumor-, and non-tumor-related risk factors. Identifying these risk factors during breast cancer diagnosis and treatment is essential in developing a practical dynamic predictive tool that can help individualize strategies to prevent VTE.

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Acknowledgements

The authors thank Kate Krause in the Research Medical Library at The University of Texas MD Anderson Cancer Center for her assistance with the literature review. The authors also thank Ann Sutton, Scientific Editor, and Ashli Nguyen-Villarreal, Associate Scientific Editor, in the Research Medical Library at The University of Texas MD Anderson Cancer Center, for editing this article.

Author information

Authors and Affiliations

  1. Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Zayd Adnan Razouki, Vinh Q. Nguyen & Carmen P. Escalante

  2. Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan

    Nadeen T. Ali

  3. Department of Pharmacology, Faculty of Pharmacy, Al-Yarmouk College, Khartoum, Sudan

    Nadeen T. Ali

Authors
  1. Zayd Adnan Razouki
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  2. Nadeen T. Ali
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  3. Vinh Q. Nguyen
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  4. Carmen P. Escalante
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Contributions

ZR: design, writing, literature search, and review. NA: writing and review. VN: writing. CE: design, writing, and review.

Corresponding author

Correspondence to Zayd Adnan Razouki.

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Appendices

Appendix

METHODS SECTION

We searched the Ovid Embase and Ovid Medline databases from inception – March 26, 2021.

Search structures, MeSH and Emtree subject headings, and keywords were tailored to each database by a medical research librarian (KJK) specializing in literature searching. Searches were limited to English only but not by study type or any other restriction. The complete Embase search string can be found in appendix. After removing duplicate citations, we had 161 citations to review. Our citation review process included articles that discussed possible causes of and treatment modalities for thromboembolic diseases. Further, we searched the references section of relevant articles to identify additional relevant studies. We excluded case reports and small case series with sample sizes less than 20 participants.

EMBASE Search String

  1. 1.

    exp *Breast Cancer

  2. 2.

    breast cancer.ti.

  3. 3.

    OR/1–2

  4. 4.

    Cerebral Sinus Thrombosis/

  5. 5.

    Deep Vein Thrombosis/

  6. 6.

    Experimental Venous Thrombosis/

  7. 7.

    Jugular Vein Thrombosis/

  8. 8.

    Kidney Vein Thrombosis/

  9. 9.

    Leg Thrombophlebitis/

  10. 10.

    Liver Vein Thrombosis/

  11. 11.

    Lower Extremity Deep Vein Thrombosis/

  12. 12.

    Lung Embolism/

  13. 13.

    Mesenteric Vein Thrombosis/

  14. 14.

    Paradoxical Embolism/

  15. 15.

    Portal Vein Thrombosis/

  16. 16.

    Superficial Thrombophlebitis/

  17. 17.

    Thromboembolism/

  18. 18.

    Thrombophlebitis/

  19. 19.

    Thrombosis Prevention/

  20. 20.

    Upper Extremity Deep Vein Thrombosis/

  21. 21.

    Vein Embolism/

  22. 22.

    Vein Thrombosis/

  23. 23.

    Vein Occlusion/

  24. 24.

    Venous Thromboembolism/

  25. 25.

    ((("Budd-Chiari" or postthrombotic or "post-thrombotic") ADJ syndrome) or ((intracranial or "intra-cranial" or lung or paradoxical or postthrombotic or "post-thrombotic" or pulmonary) ADJ embolism*) or "pulmonary infarction*" or "pulmonary occlusion*" or "retinal vein occlusion*" or thromboembolism* or "thrombo-embolism*" or thrombophlebitis or VTE or (("cerebral sinus" or pulmonary) ADJ (thromboembol* or thrombosis)) or ((vein or veinous) ADJ (embolism or obstruction* or occlusion* or thromboembo* or thrombosis))).ti,ab.

  26. 26.

    OR/4–25

  27. 27.

    Clinical Predictors/

  28. 28.

    Cohort Analysis/

  29. 29.

    Epidemiology/

  30. 30.

    Exp Prediction/

  31. 31.

    Follow-Up Studies/

  32. 32.

    Follow-Up/

  33. 33.

    Genetic Predisposition to Disease/

  34. 34.

    Genetic Risk/

  35. 35.

    Genetic screening/

  36. 36.

    Genetic Susceptibility/

  37. 37.

    Proportional Hazards Models/

  38. 38.

    Risk Assessment/

  39. 39.

    Risk Factors/

  40. 40.

    Risk/

  41. 41.

    Survival Analysis/

  42. 42.

    Toremifene/

  43. 43.

    Exp Antiestrogen/

  44. 44.

    Exp "Antineoplastic hormone agonists and antagonists"/

  45. 45.

    Epidermal Growth Factor Receptor 2/

  46. 46.

    Exp Progesterone receptor/

  47. 47.

    Exp Antineoplastic Monoclonal Antibody/

  48. 48.

    Exp Protein Tyrosine Kinase Inhibitor/

  49. 49.

    Exp Cyclin Dependent Kinase Inhibitor/

  50. 50.

    Exp phosphatidylinositol 3 kinase inhibitor/

  51. 51.

    Breast Reconstruction/

  52. 52.

    Exp Chemotherapy/

  53. 53.

    Comorbidity/

  54. 54.

    Demography/

  55. 55.

    Immobility/

  56. 56.

    Biological Marker/

  57. 57.

    D-Dimer/

  58. 58.

    C reactive protein/

  59. 59.

    (Cohort or Epidemiology or Prediction or predictor* or predisposition or follow-up or risk or susceptibl* or screen or screening or screened or stage or "hormonal therap*" or "hormone therap*" or tamoxifen or Toremifene or Fulvestrant or Letrozole or Anastrozole or Exemestane or goserelin or leuprolide or antiestrogen or "antineoplastic hormone" or "Her 2" or "progesterone receptor*" or differentiated or undifferentiated or lobular or ductal or Radiation or radiotherapy or "Targeted Therap*" or "Monoclonal antibod*" or Trastuzmab or Pertuzmab or Margetuximab or bevacizumab or belimumab or basiliximab or adalimuab or abciximab or canakinumab or daclizumab or infliximab or dupilumab or natalizumab or omalizumab or ranibizumab or secukinumab or tocilizumab or "Kinase inhibitor*" or Lapatinib or Tucatinib or Neratinib or palbociclib or ribociclib or abemaciclib or alpelisib or alaparib or talazoparig or "checkpoint inhibitor*" or pembrolizumab or atezolizumab or lumpectomy or mastectomy or "breast reconstructi*" or chemotherap* or paclitaxel or docetaxel or abraxane or Anthracycline* or Doxorubicin or doxorubicin or Epirubicin or cisplatin or carboplatin or Vinorelbine or Navelbine or Capecitabine or Xeloda or Gemcitabine or Gemzar or Ixabepilone or Ixempra or Eribulin or Halaven or Cyclophosphamide or Cytoxan or Carboplatin or Paraplatin or comorbid* or hypertension or diabetes or hypercoagulable or demograph* or race or racial or ethnic or latina* or hispanic* or asian* or "african american*" or leiden or genetic or immobility or biomarker* or "D-dimer" or "D-Dimer" or "C-Reactive protein*" or fibrinogen or platelet* or leukocyte* or hemoglobin or "factor VIII" or "P-selectin" or "endogenous thrombin potential").ti,ab.

  60. 60.

    OR/27–59

  61. 61.

    3 and 26 and 60

  62. 62.

    Limit 61 to English

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Razouki, Z.A., Ali, N.T., Nguyen, V.Q. et al. Risk factors associated with venous thromboembolism in breast cancer: a narrative review. Support Care Cancer 30, 8589–8597 (2022). https://doi.org/10.1007/s00520-022-07045-y

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