Venous Thromboembolism in Women with Breast and Gynaecological Cancers: What Do We Know and What Should We Do?

Cancer-associated thrombosis (CAT) is a major cause of morbidity and mortality in oncology. Female-specific cancers—including breast, ovarian, endometrial, and cervical malignancies—demonstrate distinct thrombotic profiles influenced by hormonal mechanisms, anatomical features, and treatment strategies. This narrative review synthesizes epidemiological evidence, mechanistic pathways, and clinical trial data to characterize CAT risk across these cancer types. Key modulators of thrombosis include hormonal exposures, tumor histology, inflammatory signaling, tissue factor expression, and therapeutic interventions such as surgery, chemotherapy, endocrine therapy, targeted agents, and immunotherapy. Despite growing understanding, current CAT risk prediction models insufficiently reflect the heterogeneity of female cancers and fail to integrate bleeding risks specific to gynecologic disease and treatment. Optimizing CAT prevention and management will require improved risk stratification tools, individualized thromboprophylaxis strategies, and incorporation of survivorship considerations, including fertility and contraception counseling. A multidisciplinary approach involving oncology, gynecology, and thrombosis specialists is essential to reduce the burden of CAT and improve outcomes for women with cancer.