Increased risk of ischemic stroke in cervical cancer patients: a nationwide population-based study

Tsai, Shiang-Jiun; Huang, Yung-Sung; Tung, Chien-Hsueh; Lee, Ching‐Chih; Lee, Moon‐Sing; Chiou, Wen‐Yen; Lin, Hon‐Yi; Hsu, Feng-Chun; Tsai, Chih-Hsin; Su, Yu‐Chieh; Hung, Shih‐Kai

doi:10.1186/1748-717x-8-41

Cited by 36 publications

(27 citation statements)

References 22 publications

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“…1,2,[15][16][17][18][19] In a recent study of patients with breast, colorectal, lung, or prostate cancer in the United States, the 1-year cumulative incidence of ischemic/hemorrhagic stroke was increased by 1.3/1.6 in those with colorectal cancer and 1.8/3.4 in those with lung cancer but not in those with breast or prostate cancer, 2 as in our study. In a study of patients with cancers at 34 sites in the Swedish Registry of Cancers, the risks for ischemic/hemorrhagic stroke within 6 months of cancer diagnosis were increased by 1.6/2.2 for 18/20 cancer sites.…”

Section: July 2018supporting

confidence: 66%

“…Another Swedish study on manifest breast cancer, with 5.7 years of follow-up, found a slightly increased risk of ischemic stroke (RR, 1.12) but not for hemorrhagic stroke. 17 Focus has been on the interaction between cancer and the clotting cascade in the search for an explanation for cancer patient's increased risk of stroke; the literature contains ample evidence of this interaction. 20,21 Our study was not designed to investigate causes of stroke in cancer, but our findings nevertheless point in the direction of possible causal relationships.…”

Section: July 2018mentioning

confidence: 99%

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Risk of Ischemic and Hemorrhagic Strokes in Occult and Manifest Cancers

Andersen

Olsen

2018

Stroke

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Background and Purpose-Manifest cancer is associated with increased risk of stroke. The risk of stroke in people with occult cancer in comparison to the risk in the background population without cancer has not been investigated. Smoking is a risk factor for both cancer and stroke, but the role of smoking for the risk of stroke in cancer has not been investigated. Methods-We identified all incident cases of cancer in Denmark 2003Denmark to 2012) from the Danish Cancer Registry.Each person with cancer was matched by age, sex, and income with 10 randomly selected persons without cancer at index date (n=2.571.260). Linking data to the Danish Stroke Registry, we studied risk of ischemic/hemorrhagic stroke the year before (occult cancer) and after cancer diagnosis was established in the Danish Stroke Registry (manifest cancer) and stratified into the 15 most common cancer types related (lung, colon, bladder, rectum, pancreas, kidney, stomach, and head and neck cancer) and unrelated (non-Hodgkin lymphoma, breast, prostate, melanoma, central nervous system, ovary and endometrial) to smoking. Results-Risk of ischemic/hemorrhagic stroke was increased for both occult (relative risk, 1.75/2.00) and manifest cancers (relative risk, 1.30/1.41). For occult cancer, risk of ischemic stroke was increased for all of the smoking-related cancers, but among cancers unrelated to smoking, only lymphoma, central nervous system, and endometrial cancer were associated with increased risk of stroke; breast, prostate, melanoma, and ovarian cancers were not. For occult cancer, risk of hemorrhagic stroke was generally increased for smoking-related cancers while not for cancers unrelated to smoking. For manifest cancer, risk of ischemic and hemorrhagic stroke was generally increased for cancers related to smoking while not for cancers unrelated to smoking. Conclusions-Cancer, occult and manifest, is associated with increased risks for stroke. The increased risk is linked mainly to cancers related to smoking.

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Section: July 2018supporting

confidence: 66%

Section: July 2018mentioning

confidence: 99%

Risk of Ischemic and Hemorrhagic Strokes in Occult and Manifest Cancers

Andersen

Olsen

2018

Stroke

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“…Data from the National Health Insurance Research Database of Taiwan showed a >50% increase in the risk of ischemic stroke for women treated with RT involving the neck for cervical cancer 24. In that study, the investigators postulated that the elevated stroke risk was primarily related to systemic injury caused by RT.…”

Section: Discussionmentioning

confidence: 99%

“…23 Although there are no available prior studies investigating the relationship between HPV status and CVEs in RT-treated HNCA patients, multiple investigators have reported parallel findings in other populations that are supportive of the current results. 12,24,25 Data from the National Health Insurance Research Database of Taiwan showed a >50% increase in the risk of ischemic stroke for women treated with RT involving the neck for cervical cancer. 24 In that study, the investigators postulated that the elevated stroke risk was primarily related to systemic injury caused by RT.…”

Section: Discussionmentioning

confidence: 99%

Human Papillomavirus Status and the Risk of Cerebrovascular Events Following Radiation Therapy for Head and Neck Cancer

Seidelmann

Janjua

Emami

et al. 2017

JAHA

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BackgroundRadiation therapy (RT) is a standard treatment for head and neck cancer; however, it is associated with inflammation, accelerated atherosclerosis, and cerebrovascular events (CVEs; stroke or transient ischemic attack). Human papillomavirus (HPV) is found in nearly half of head and neck cancers and is associated with inflammation and atherosclerosis. Whether HPV confers an increased risk of CVEs after RT is unknown.Methods and ResultsUsing an institutional database, we identified all consecutive patients treated with RT from 2002 to 2012 for head and neck cancer who were tested for HPV. The outcome of interest was the composite of ischemic stroke and transient ischemic attack, and the association between HPV and CVEs was assessed using Cox proportional hazard models, competing risk analysis, and inverse probability weighting. Overall, 326 participants who underwent RT for head and neck cancer were tested for HPV (age 59±12 years, 75% were male, 9% had diabetes mellitus, 45% had hypertension, and 61% were smokers), of which 191 (59%) were tumor HPV positive. Traditional risk factors for CVEs were similar between HPV‐positive and ‐negative patients. Over a median follow‐up of 3.4 years, there were 18 ischemic strokes and 5 transient ischemic attacks (event rate of 1.8% per year). The annual event rate was higher in the HPV‐positive patients compared with the HPV‐negative patients (2.6% versus 0.9%, P=0.002). In a multivariable model, HPV‐positive status was associated with a >4 times increased risk of CVEs (hazard ratio: 4.4; 95% confidence interval, 1.5–13.2; P=0.008).ConclusionsIn this study, HPV‐positive status is associated with an increased risk of stroke or transient ischemic attack following RT for head and neck cancer.

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“…[1] Although cervical cancer of females has declined in Taiwan since beginning in 1995 because National Health Insurance (NHI) has provided free mass screening of cervical neoplasia since 1995. The national Pap smear screening program significantly reduced cervical cancer risk explaining the dramatic decline in invasive cancer incidence after 1996.…”

Section: Introductionmentioning

confidence: 99%

Pelvic inflammatory disease increases the risk of a second primary malignancy in patients with cervical cancer treated by surgery alone

Chiou

Chen²,

Lee

et al. 2016

Medicine

Self Cite

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As the number of long-term cervical cancer survivors continues to increase because of improvements in treatment, concerns about second primary malignancy have grown. The high-risk area of second primary cancers in cervical cancer survivors is the pelvis. Pelvic inflammatory disease (PID) could be a useful marker for gynecological cancers. Thus, we designed a large-scale, nationwide, controlled cohort study to investigate whether PID or other risk factors increased the risk of second primary cancers in patients with cervical cancer treated by surgery alone.Between 2000 and 2010, a total of 24,444 cervical cancer patients were identified using the Registry Data for Catastrophic Illness and the National Health Insurance Research Database (NHIRD) of Taiwan. Patients who received definite surgery were selected. To exclude the effect on second primary malignancy by treatment modalities, all cervical patients who ever having received adjuvant or definite radiotherapy or chemotherapy for primary cervical cancer were excluded. Finally, 3860 cervical cancer patients treated by surgery alone without adjuvant treatments were analyzed.Cox proportional hazards model was used for multivariate analysis and the Kaplan–Meier method was used to assess the cumulative risks. Regarding the incidence of second primary cancers, the standardized incidence ratio (SIR) was used.The median follow-up time was 56.6 months. The 6-year cumulative risk of second primary cancers is 0.16% and 0.12% for PID and without PID, respectively. After adjustment for confounders, age of less than 50 years, the presence of diabetes mellitus, and PID were significantly positivity associated with the risk of second primary cancers. The hazard ratios (HRs) of age less than 50 years, diabetes mellitus, and PID were 1.38 (95% CI = 1.11–2.04), 1.40 (95% CI = 1.06–1.85), and 1.35 (95% CI = 1.00–1.81), respectively. A higher incidence of second primary cancers was observed in the genitals, bladder, and colon.In conclusion, the incidence of second primary cancers was higher in the genitals, bladder, and colon in patients with cervical cancer treated with surgery alone. The patients with PID had a higher risk of second primary cancers.

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Increased risk of ischemic stroke in cervical cancer patients: a nationwide population-based study

Cited by 36 publications

References 22 publications

Risk of Ischemic and Hemorrhagic Strokes in Occult and Manifest Cancers

Risk of Ischemic and Hemorrhagic Strokes in Occult and Manifest Cancers

Human Papillomavirus Status and the Risk of Cerebrovascular Events Following Radiation Therapy for Head and Neck Cancer

Pelvic inflammatory disease increases the risk of a second primary malignancy in patients with cervical cancer treated by surgery alone

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