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Cancer diagnosis may be preceded by heart attack, stroke
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Older adults had a 69% higher risk for myocardial infarction and ischemic stroke in the year prior to cancer diagnosis, according to research published in Blood.
This significantly elevated risk for arterial thromboembolic events began 5 months before the pathologic diagnosis of cancer, and reached a peak 1 month before diagnosis, when it increased 5-fold.
“Since cancers take months to years to develop, the cancer was probably there all along and, at least in some of those patients, caused their stroke or heart attack,” Babak Navi, MD, associate professor of neurology in the department of neurology and of neuroscience in the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine and a neurologist at New York-Presbyterian/Weill Cornell Medical Center, said in a press release. “If we can identify the highest-risk patients, we can determine the utility of screening them to help diagnose their cancers earlier, which may lead to better outcomes.”
Navi and colleagues reviewed the SEER-Medicare linked data set to identify 374,331 patients aged 67 years and older (mean age, 76 years) with a primary diagnosis of one of the following cancers between 2005 and 2013: breast, lung, prostate, colorectal, bladder, uterine, pancreatic, gastric and non-Hodgkin lymphoma.
Researchers individually matched the patients with cancer based on demographics and comorbidities to control Medicare beneficiaries without cancer. Researchers identified arterial thromboembolic events — defined as a composite of myocardial infarction or ischemic stroke — using validated diagnosis codes.
Between 360 and 151 days prior to cancer diagnosis, Medicare beneficiaries with and without cancer had comparable risk of arterial thromboembolic events.
However, between 150 days and 1 day before diagnosis, estimates at 30-day intervals showed higher risk for arterial thromboembolic events among patients who eventually would be diagnosed with cancer compared with matched controls. Moreover, this risk progressively increased during the time leading up to diagnosis, reaching a peak during the 30 days preceding the cancer diagnosis.
During this peak period, 2,313 (0.62%) patients who eventually would be diagnosed with cancer had an arterial thromboembolic event, compared with 413 (0.11%) controls (OR = 5.63; 95% CI, 5.07-6.25).
In an analysis of all 360 days prior to study entry, researchers found 6,567 (1.75%) of the patients with cancer had an arterial thromboembolic event vs. 3,916 (1.05%) of the matched controls (OR = 1.69; 95% CI, 1.63-1.76), indicating those eventually diagnosed with cancer had a 69% increased risk for an event.
Among the patients who experienced an arterial thromboembolic event during the 360 days preceding their cancer diagnosis, primary underlying cancer sites included lung (n = 1,908; 29%), colorectal (n = 1,561; 24%), prostate (n = 752; 11%), breast (n = 663; 10%), bladder (n = 533; 8%) non-Hodgkin lymphoma (n =384; 6%), pancreatic (n =333; 5%), gastric (n=250; 4%) and uterine (n = 183; 3%).
According to Navi, these results underscore a need for clinicians to be watchful for signs of cancer in patients who recently experienced heart attack or stroke.
“Your suspicion should be higher for cancer than for someone who hasn’t experienced a heart attack or stroke,” Navi said. “Clinicians have a barometer in their minds they use to determine whether to perform a procedure, and we’re always juggling risks and benefits. I think this study moves the ball over a little when it comes to screening, since the risk for cancer is higher than it might be otherwise.” – by Jennifer Byrne
Disclosures: The researchers report no relevant disclosures.
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