A nationwide Israeli cohort study found the risk of first ischemic stroke nearly doubled in the year after an invasive cancer diagnosis, with the greatest elevation in the first three months and large differences by cancer type.
Risk varied sharply by cancer type: pancreatic (SIR 5.9) and lung (SIR 3.9) showed the highest relative increases.
Absolute 1-year cumulative incidence was 0.62% overall, highest for pancreatic cancer (1.62%) and lowest for breast cancer (0.3%).
# What the study measured Researchers linked national cancer and stroke registries in Israel to estimate first-ever ischemic stroke risk after a first invasive cancer diagnosis. The cohort included 182,221 adults aged 40 or older diagnosed between 2014 and 2021 with no prior stroke. Follow-up covered 162,593 person-years, during which investigators recorded 1,125 ischemic strokes.
# Main findings
The study reported a 1-year cumulative incidence of ischemic stroke of 0.62% overall (62 per 10,000 adults). Cumulative incidence varied by cancer site: pancreatic cancer had the highest 1-year incidence at 1.62%, while breast cancer had the lowest at 0.3%.
# Variation by cancer type and age
# Clinical interpretation and implications The pattern of sharply increased risk in the first few months after diagnosis is described by the investigators as a critical window for targeted assessment and intervention. The authors advise a multidisciplinary approach: while cancer treatment remains central, vascular health should be considered alongside the patient's cancer type, stage, age, planned treatments and overall clinical situation.
Practically, this means clinicians may need to incorporate stroke risk assessment and management into early cancer care planning, especially for high-risk cancer types such as pancreatic and lung cancer. The study aimed to make relative risk more clinically interpretable by also presenting cumulative incidence at 1 year while accounting for competing risks of death.
# How the data were produced Investigators used population-based registries within Israel's universal health care system to calculate SIRs for first ischemic stroke among people with cancer relative to the general population. They stratified results by cancer site, demographics, stage at diagnosis and time since diagnosis.
# Bottom line Adults diagnosed with an invasive cancer face elevated risk of first ischemic stroke, most sharply in the first 3 months after diagnosis and varying markedly by cancer site. Absolute stroke incidence in the first year is modest overall (0.62%), but clinicians should consider early vascular assessment and tailored risk management, particularly for patients with pancreatic or lung cancer.
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