Cardiovascular

Elevated risk of ischemic stroke after invasive cancer diagnosis: A nationwide population-based study.

TL;DR

The early period after cancer diagnosis represents a critical window of increased ischemic stroke risk, with an overall standardized incidence ratio of 1.8 within one year and peaking at 2.5 during the first 3 months.

Key Findings

Cancer patients faced an 80% elevated risk of ischemic stroke within one year of invasive cancer diagnosis compared to the general population.

  • Overall SIR for IS within 1 year after cancer diagnosis was 1.8 (95% CI, 1.7–1.9)
  • Study included 182,221 patients aged ≥40 years diagnosed with first invasive cancer during 2014–2021
  • Data were obtained by linking the Israel National Cancer and Stroke Registries in a retrospective cohort design
  • One-year cumulative incidence of IS was 0.62% across all cancer patients, with death treated as a competing event

The risk of ischemic stroke peaked during the first 3 months after cancer diagnosis.

  • SIR during the first 3 months was 2.5 (95% CI, 2.2–2.7)
  • This early post-diagnosis period was described as 'a critical window of increased IS risk'
  • Risk was assessed across multiple time windows since cancer diagnosis

Pancreatic and lung cancers were associated with the highest ischemic stroke risk among all cancer sites studied.

  • Pancreatic cancer had the highest SIR at 5.9 (95% CI, 4.8–7.3)
  • Lung cancer had the second highest SIR at 3.9 (95% CI, 3.4–4.4)
  • One-year cumulative incidence of IS ranged from 0.30% in breast cancer to 1.62% in pancreatic cancer
  • Risk was analyzed across multiple cancer sites

Ischemic stroke risk after cancer diagnosis decreased with increasing patient age.

  • SIR was 3.6 (95% CI, 2.8–4.6) among adults aged 40–54 years
  • SIR was 1.4 (95% CI, 1.3–1.6) among those aged ≥75 years
  • The inverse relationship between age and SIR was observed across demographic subgroups

Ischemic stroke risk after cancer diagnosis increased with advancing cancer stage.

  • SIR was 1.2 (95% CI, 1.0–1.4) for localized disease
  • SIR was 2.8 (95% CI, 2.5–3.2) for metastatic disease
  • Risk was analyzed across cancer stage categories from localized to metastatic

What This Means

This research suggests that people diagnosed with invasive cancer face a substantially higher chance of having an ischemic stroke (a stroke caused by a blood clot blocking blood flow to the brain) in the year following their diagnosis compared to the general population. Using data from over 182,000 Israeli adults linked across national cancer and stroke registries, the study found that the overall stroke risk was 1.8 times higher than expected, and that this risk was especially concentrated in the first three months after cancer diagnosis, when it reached 2.5 times the expected rate. The elevated stroke risk varied considerably depending on the type of cancer, the patient's age, and how advanced the cancer was. Pancreatic cancer carried nearly six times the expected stroke risk, and lung cancer carried nearly four times the expected risk, while breast cancer was associated with lower stroke risk. Younger cancer patients (ages 40–54) showed a greater relative increase in stroke risk compared to older patients, and those with metastatic (widely spread) cancer had more than twice the stroke risk of those with localized disease. In absolute terms, about 0.62% of cancer patients had a stroke within one year, translating to roughly 1 in 160 patients. This research suggests that the period immediately following a cancer diagnosis may be an important time to assess and monitor patients for cerebrovascular risk. The findings point to specific high-risk groups — particularly those with pancreatic or lung cancer, younger patients, and those with advanced-stage disease — who might benefit most from closer monitoring. Incorporating cerebrovascular risk assessment into standard oncologic care could help identify patients who might benefit from preventive strategies, though the study does not test any specific interventions.

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Citation

Libruder C, Tanne D, Silverman B, Binyaminy B, Dichtiar R, Keinan-Boker L. (2026). Elevated risk of ischemic stroke after invasive cancer diagnosis: A nationwide population-based study.. Cancer. https://doi.org/10.1002/cncr.70536