September 09, 2026
5 min read
Key takeaways:
- Stroke risk is elevated for up to a year after cancer diagnosis, with greatest risks in the first few months.
- Risk varied by cancer type and age, potentially informing targeted assessment and intervention.
People with invasive cancer may be more likely to experience ischemic stroke, according to results of a retrospective cohort study.
Risk — which varied considerably by cancer type — appeared particularly elevated in the first few months after diagnosis.
Data derived from Libruder C, et al. Cancer. 2026;doi:10.1002/cncr.70536.
This establishes “a critical window” for targeted assessment and intervention, according to lead author Carmit Libruder, MSc, researcher with University of Haifa and the Israel Ministry of Health.
“Our findings reinforce the importance of a multidisciplinary approach to cancer care,” Libruder told Healio. “Cancer treatment is, of course, central after diagnosis, but vascular health should not be overlooked. Identifying and appropriately managing modifiable vascular risk factors — while taking the patient’s cancer type, stage, age, treatments and overall clinical situation into account — may be particularly important during this period.”
Clarifying the link
Cancer and stroke are among the top contributors to the chronic disease burden worldwide.
About 10% of stroke cases occur among people with cancer, according to study background. That percentage is expected to increase as the population ages and the number of cancer survivors rises.
Meta-analyses and systemic reviews have consistently suggested stroke risk is elevated after a cancer diagnosis. Stroke that occurs in conjunction with cancer frequently is more severe, having been linked to higher risk for recurrence or mortality.
“Yet the magnitude and timing of first-ever ischemic stroke risk across specific cancer types have not been fully characterized,” Libruder said. “We, therefore, examined this question using a large, nationwide population-based cohort to determine how the risk varies by cancer type, time since diagnosis, stage, age and other demographic characteristics.”
Elevated risks
The researchers used linked data from population-based stroke and cancer registries from Israel’s universal health care system to calculate standardized incidence ratios (SIR) for first ischemic stroke among people with cancer relative to the general population.
Investigators evaluated outcomes by cancer site, and they stratified by demographics, cancer stage at diagnosis and time since diagnosis. They aimed to place relative risk “in a more clinically interpretable context” by assessing cumulative incidence of stroke at 1 year while accounting for competing risk for death, Libruder said.
The analysis included 182,221 people aged 40 years or older (median age, 67.1 years; 52% women) with no stroke history who had been diagnosed with their first invasive cancer between 2014 and 2021. The most common cancers in the cohort included breast (18.2%), colorectal (11.5%), prostate (10.5%) and lung (9.8%).
Researchers determined 1,125 ischemic stroke events occurred during a combined 162,593 person-years of follow-up.
Sixty-two of every 10,000 adults experienced a stroke in the first year. This equated to 1-year cumulative incidence of 0.62%, with the highest among adults with pancreatic cancer (1.62%) and the lowest among those with breast cancer (0.3%).Results showed a nearly twofold higher risk for ischemic stroke within the first year of invasive cancer diagnosis than would be expected in the general population (SIR = 1.8; 95% CI, 1.7-1.9).
Stroke risk peaked during the first 3 months after cancer diagnosis (SIR = 2.5; 95% CI, 2.2-2.7). Risk declined but still remained elevated between 3 and 6 months (SIR = 1.6; 95% CI, 1.4-1.8), and between 6 and 12 months (SIR = 1.5; 95% CI, 1.3-1.6).
An exploratory analysis with extended follow-up showed SIRs remained “modestly elevated” — ranging from 1.3 to 1.5 — up to 3 years after cancer diagnosis.
Impact of cancer type, age
The overall increase in ischemic stroke risk after cancer diagnosis did not surprise investigators given prior research, but “the marked variation” across cancer types “stood out,” Libruder said.
Researchers observed the highest risk observed among people with pancreatic cancer (SIR = 5.9; 95% CI, 4.8-7.3) and lung cancer (SIR = 3.9; 95% CI, 3.4-4.4).
Researchers observed what they called “pronounced excess risks” among people with esophageal cancer (SIR = 4.1; 95% CI, 2.2-6.8) and gallbladder cancer (SIR = 3.6; 95% CI, 2-5.9) but noted those estimates had been based on smaller numbers of events. Investigators also reported two- to threefold increases in risk among adults with bladder, stomach or liver cancers, myeloid leukemia, and malignant brain or nervous system tumors.
In contrast, diagnosis of breast or prostate cancers did not appear linked to elevated stroke risk.
There probably is “no single explanation” for the variation between cancer types, Libruder said.
“Cancer can promote hypercoagulability and systemic inflammation, which can increase the tendency to form clots, and these mechanisms may be particularly relevant in cancers with strong prothrombotic features, such as pancreatic and lung cancers,” Libruder said. “Shared vascular risk factors for both cancer and ischemic stroke — including smoking — may also contribute, and cancer treatment-related factors may play a role, as well. Our study did not have the clinical information needed to disentangle these different potential contributions.”
Stroke risk varied by age, peaking among those aged 40 to 54 years (SIR = 3.6; 95% CI, 2.8-4.6) but declining among those aged 75 years or older (SIR = 1.4; 95% CI, 1.3-1.6). Risk also varied by cancer stage, with greater risk among those with metastatic disease (SIR = 2.8; 95% CI, 2.5-3.2) than localized disease (SIR = 1.2; 95% CI, 1-1.4).
Risks appeared similar between men and women, as well as between Jewish and Arab individuals.
Tailored prevention
Researchers acknowledged study limitations.
For example, a limited number of ischemic stroke events for some cancer sites reduced statistical precision, and registries lacked information about potential confounders such as comorbidities, cancer treatments and antithrombotic medication use.
In addition, investigators could not determine cancer stage at diagnosis for approximately half of cases, requiring cautious interpretation of stage-specific estimates.
However, the findings provide valuable insights that could improve early identification of individuals at the greatest risk and allow for personalized interventions, researchers concluded.
“Our study adds a clearer understanding of how substantially stroke risk differs across cancer types and patient subgroups and helps identify which patients may be most vulnerable,” Libruder said. “Our findings [also] highlight how much we still need to learn about cancer-associated ischemic stroke. We can identify cancer types and patient groups in whom the risk is clearly higher, but there is still limited evidence on how best to translate that information into prevention. In that sense, the field now needs to move from describing the risk to understanding how best to act on it.”
Existing guidance on thrombosis among people with cancer focuses on venous thromboembolism, whereas evidence for preventing arterial events — such as ischemic stroke — remains much more limited, Libruder said.
“More detailed studies that take cancer type, stage, treatment, vascular risk factors and biomarkers into account will be important for determining which patients may benefit from closer cerebrovascular assessment and which preventive approaches are effective,” Libruder said. “Ultimately, that evidence could help inform more specific clinical guidance for stroke prevention in patients with cancer.”
Libruder and colleagues are planning a follow-up study in which they will use data from a large healthcare organization. This will allow for examination of factors not available in national registries, such as underlying medical conditions, cancer treatments, medications, and laboratory data.
“One of the main unanswered questions is how much of the increased stroke risk is attributable to the cancer itself and how much is related to the patient’s underlying vascular risk, cancer treatment, medications or other clinical factors,” Libruder said. “We would also like to better understand why the risk differs substantially between cancer types and, ultimately, identify which patients are at sufficiently high risk to benefit from more individualized preventive strategies.”
For more information:
Carmit Libruder, MSc, can be reached at carmit.libruder@moh.gov.il.
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