Phlebotomy decreased cancer risk in patients with PAD

Clinical Question

Is phlebotomy associated with reduced cancer risk in patients with peripheral artery disease?

Bottom Line

In this secondary analysis, patients with stable peripheral artery disease undergoing phlebotomy were less likely to develop cancer than control patients. But, remember: Although results of secondary analyses are great for generating hypotheses for additional studies, they are generally not ready for prime time. (LOE = 2c)


Zacharski LR, Chow BK, Howes PS, et al. Decreased cancer risk after iron reduction in patients with peripheral arterial disease: results from a randomized trial. J Natl Cancer Inst 2008;100(14):996-1002.  [PMID:18612130]

Study Design

Randomized controlled trial (single-blinded)






Outpatient (any)


This study was originally designed to study whether phlebotomy would improve cardiovascular outcomes in patients with stable peripheral artery disease. Patients were randomized to receive phlebotomy every 6 months (n = 636) or no phlebotomy (n = 641). The investigators assessed ferritin as a marker of whether phlebotomy was effective in reducing iron stores. The outcome of interest in this secondary analysis was the development of solid visceral cancers, assessed by a researcher unaware of treatment. After an average of 4.5 years of follow up, 38 (6%) patients undergoing phlebotomy developed cancers compared with 60 (9%) patients in the control. The authors report that the mean ferritin levels were lower in patients who did not develop cancer than in those who did.