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Stroke Survivors May Have Increased Risk of Cancer


 

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NASHVILLE—The annual rate of age-adjusted cancer incidence is higher among patients who have had ischemic stroke, compared with the general population, according to data presented at the 2015 International Stroke Conference. Furthermore, the risk of mortality is threefold greater among stroke survivors who develop incident cancer, compared with stroke survivors who do not develop cancer.

“We already knew that cancer patients are at increased risk of stroke. But what happens when you turn it around and look at cancer risks for ischemic stroke survivors? That was our question,” said Malik Adil, MD, at the Zeenat Qureshi Stroke Institute in St. Cloud, Minnesota, and the Department of Neurology at Ochsner Clinic Foundation. Subclinical cancer can manifest itself as a thromboembolic event and may be detected at a later time in patients who have survived ischemic stroke.

Analyzing Data From a Stroke Prevention Trial
Dr. Adil and his colleagues conducted an analysis of 3,680 adults older than 35 with nondisabling cerebral infarction who were followed for two years within the randomized, double-blinded Vitamin Intervention for Stroke Prevention trial between 1997 and 2001. The investigators calculated age-adjusted rates of the incidence of cancer among ischemic stroke survivors. They calculated standardized incidence ratios (SIR) based on comparison with age-adjusted rates in the general population, which were obtained using data from the National Cancer Institute. A logistic regression analysis enabled the researchers to evaluate the association between incident cancer and various end points, including stroke, coronary heart disease, myocardial infarction, and death, after adjusting for age, gender, and race or ethnicity.

The study population included 3,247 patients without cancer at the time of enrollment. Mean age was 66, and 2,013 participants were men. Patients developed various types of cancer, including skin, prostate, breast, lung, and bladder cancer.

Early Cancer Screening May Be Advisable
The incidence of new cancer was 0.15, 0.80, 1.2, and 2.0 per 100 patients at one month, six months, one year, and two years, respectively. The age-adjusted annual rate of cancer in patients with ischemic stroke over one year after recruitment was 581.8 per 100,000 persons, which was higher than the age-adjusted cancer rate of 486.5 per 100,000 persons in the general population (SIR 1.2).

The age-adjusted annual rate continued to be higher in patients with ischemic stroke more than two years after recruitment (1,301.7 per 100,000 people vs 911.5 per 100,000 people, SIR 1.4). There was a higher risk of death (odds ratio [OR] 3.1), fatal or disabling stroke or death (OR 2.3), and a composite end point of stroke, coronary heart disease, or death (OR 1.4) among participants who developed incident cancer, compared with those who were cancer-free, after adjusting for potential confounders.

The investigators found that age was another risk factor for developing cancer. Stroke survivors older than 50 were 1.4 times more likely to develop cancer within two years than their peers who were age 50 or younger.

Having cancer is linked to higher ischemic stroke risks mainly because cancer patients’ blood tends to clot more often, said Dr. Adil. “In addition, when tissues get less oxygen due to blocked blood vessels, it destroys tissue cells and sets off a series of events to alter the normal physiology and may lead to cancer.

“If you’ve had a stroke before, especially with another high-risk factor, it’s important that you talk to your doctor and discuss earlier cancer screening,” said Dr. Adil.

Erik Greb

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