Stroke risk spikes after some cancer diagnoses

Clinical takeaway: Consider focused cerebrovascular risk assessment, management of modifiable vascular risks, and stroke-symptom counseling during the first 3 months after an invasive cancer diagnosis, especially for patients with pancreatic or lung cancer, metastatic disease, or younger adults, whose relative excess risk was greatest.

Cancer-associated thrombosis is well recognized, but the timing and magnitude of ischemic stroke risk across different cancer types have been less clear. This study helps identify when stroke risk is greatest and which patients may warrant closer monitoring.

In this nationwide Israeli registry study, researchers linked cancer and stroke databases to evaluate first-ever ischemic stroke risk among 182,221 adults aged 40 years or older with a first invasive cancer diagnosis. During the year after diagnosis, 1,125 patients experienced an ischemic stroke, translating to an overall incidence of about 62 strokes per 10,000 patients. Overall, patients with cancer had about 80% more ischemic strokes than would be expected in the general population.

Risk was highest in the first 3 months after diagnosis, when stroke rates were roughly 2.5 times higher than expected. The greatest excess risk was seen in pancreatic cancer, with about 162 strokes per 10,000 patients and nearly six times the expected rate, followed by lung cancer, with nearly four times the expected rate. Elevated risks were also observed with esophageal, gallbladder, bladder, stomach, liver, kidney, and several hematologic malignancies. In contrast, breast and prostate cancers were not associated with a significant increase in stroke risk.

Stroke risk rose with advancing cancer stage and was particularly elevated relative to the general population among younger patients. One-year stroke incidence ranged from 0.3% for breast cancer to 1.6% for pancreatic cancer. Although risk declined after the initial months, it remained modestly elevated through the first year after diagnosis.

“Our findings identify the first months after a cancer diagnosis as a critical window of heightened ischemic stroke risk,” said corresponding author Carmit Libruder, MSc. “The marked variation across cancer types, with particularly pronounced risk elevations in pancreatic and lung cancers, highlights the importance of identifying patients who may benefit from closer cerebrovascular risk assessment.”

Source: Libruder C, et al. (2026 Sep 8) Cancer. Elevated risk of ischemic stroke after invasive cancer diagnosis: A nationwide population-based study