Journal of Cancer Research and Clinical Oncology

, Volume 145, Issue 4, pp 1013–1020 | Cite as

Cancer risk in stroke survivors followed for up to 10 years in general practices in Germany

  • Louis Jacob
  • Karel KostevEmail author
Original Article – Clinical Oncology



The goal of this study was to analyze cancer risk in stroke survivors followed for up to 10 years in general practices in Germany.


The current study sample included patients who received an initial stroke diagnosis in one of 1262 general practices in Germany between 2006 and 2015 (index date). Patients without stroke were matched (1:1) to patients with stroke by age, gender, index year, and 16 comorbidities diagnosed in the 12 months prior to the index date using a propensity score method. The main outcome of the study was the risk of cancer as a function of stroke within 10 years of the index date.


The stroke and non-stroke groups included 9579 men and 9089 women. After 10 years of follow-up, 29.3% of men with stroke and 23.8% of those without stroke developed any of the included types of cancer (log-rank p value < 0.001). During the same time, the prevalence of cancer was 25.0% in women with stroke and 20.5% in women without stroke (log-rank p value < 0.001). There was a positive association between stroke and any cancer in men (hazard ratio [HR] = 1.18, 95% confidence interval [CI] 1.09–1.28) and in women (HR = 1.22, 95% CI 1.12–1.34). This association was significant for cancers of respiratory and intrathoracic organs in men and women and for cancers of digestive organs in men.


This study, including more than 37,000 patients from Germany, found that stroke was associated with an increased cancer risk.


Cancer risk Stroke survivors General practices Retrospective study 



Professional English language editing services were provided by Claudia Jones, MA, Radford, Virginia, United States.


The authors have received no financial support for the research, authorship, and/or publication of this article.

Compliance with ethical standards

Conflict of interest

Both authors declare that they have no conflicts of interest.

Ethical approval

German law allows the use of anonymous electronic medical records for research purposes under certain conditions. According to this legislation, it is not necessary to obtain informed consent from patients or approval from a medical ethics committee for this type of observational study that contains no directly identifiable data. Because patients were only queried as aggregates and no protected health information was available for queries, no IRB approval was required for the use of this database or the completion of this study.


  1. Andrykowski MA, Lykins E, Floyd A (2008) Psychological health in cancer survivors. Semin Oncol Nurs 24:193–201. CrossRefGoogle Scholar
  2. Boffetta P, Hashibe M (2006) Alcohol and cancer. Lancet Oncol 7:149–156. CrossRefGoogle Scholar
  3. Caine GJ, Stonelake PS, Lip GYH, Kehoe ST (2002) The hypercoagulable state of malignancy: pathogenesis and current debate. Neoplasia N Y N 4:465–473. CrossRefGoogle Scholar
  4. Chen C-W, Cheng T-J, Ho C-H, Wang J-J, Weng S-F, Hou Y-C, Cheng H-C, Chio C-C, Shan Y-S, Chang W-T (2017) Increased risk of brain cancer incidence in stroke patients: a clinical case series, population-based and longitudinal follow-up study. Oncotarget 8:108989–108999. Google Scholar
  5. Cocho D, Gendre J, Boltes A, Espinosa J, Ricciardi AC, Pons J, Jimenez M, Otermin P (2015) Predictors of occult cancer in acute ischemic stroke patients. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc 24:1324–1328. CrossRefGoogle Scholar
  6. Cornfield J, Haenszel W, Hammond EC, Lilienfeld AM, Shimkin MB, Wynder EL (2009) Smoking and lung cancer: recent evidence and a discussion of some questions. Int J Epidemiol 38:1175–1191. CrossRefGoogle Scholar
  7. Dearborn JL, Urrutia VC, Zeiler SR (2014) Stroke and cancer—a complicated relationship. J Neurol Transl Neurosci 2:1039Google Scholar
  8. Guo L, Liu S, Zhang S, Chen Q, Zhang M, Quan P, Lu J, Sun X (2015) C-reactive protein and risk of breast cancer: a systematic review and meta-analysis. Sci Rep 5:10508. CrossRefGoogle Scholar
  9. Jacob L, Kostev K (2017) Conflicts at work are associated with a higher risk of cardiovascular disease. Ger Med Sci GMS E J 15:Doc08. Google Scholar
  10. Kakourou A, Koutsioumpa C, Lopez DS, Hoffman-Bolton J, Bradwin G, Rifai N, Helzlsouer KJ, Platz EA, Tsilidis KK (2015) Interleukin-6 and risk of colorectal cancer: results from the CLUE II cohort and a meta-analysis of prospective studies. Cancer Causes Control CCC 26:1449–1460. CrossRefGoogle Scholar
  11. Kostev K, Meister U, Kalder M, Jacob L (2017) Suspected cancer diagnoses made by general practitioners in a population with subsequently confirmed cancer diagnoses in Germany: a retrospective study of 31,628 patients. Oncotarget 8:84540–84545. CrossRefGoogle Scholar
  12. Kostev K, Lasrich M, Schüller L, Diogo I, Sesterhenn A, Jacob L (2018) Diagnoses of suspected cancer in otolaryngology practices in Germany. Mol Clin Oncol 9:459–463. Google Scholar
  13. Mao JJ, Armstrong K, Bowman MA, Xie SX, Kadakia R, Farrar JT (2007) Symptom burden among cancer survivors: impact of age and comorbidity. J Am Board Fam Med 20:434–443. CrossRefGoogle Scholar
  14. Medeiros EA, Castañeda SF, Gonzalez P, Rodríguez B, Buelna C, West D, Talavera GA (2015) Health-related quality of life among cancer survivors attending support groups. J Cancer Educ Off J Am Assoc Cancer Educ 30:421–427. CrossRefGoogle Scholar
  15. Munir F, Yarker J, McDermott H (2009) Employment and the common cancers: correlates of work ability during or following cancer treatment. Occup Med 59:381–389. CrossRefGoogle Scholar
  16. Quintas S, Rogado J, Gullón P, Pacheco-Barcia V, Dotor García-Soto J, Reig-Roselló G, Mondéjar R, Colomer R, Vivancos J (2018) Predictors of unknown cancer in patients with ischemic stroke. J Neurooncol 137:551–557. CrossRefGoogle Scholar
  17. Qureshi AI, Malik AA, Saeed O, Adil MM, Rodriguez GJ, Suri MFK (2015) Incident cancer in a cohort of 3,247 cancer diagnosis free ischemic stroke patients. Cerebrovasc Dis Basel Switz 39:262–268. CrossRefGoogle Scholar
  18. Rathmann W, Bongaerts B, Carius H-J, Kruppert S, Kostev K (2018) Basic characteristics and representativeness of the German Disease Analyzer database. Int J Clin Pharmacol Ther 56:459–466. CrossRefGoogle Scholar
  19. Reynolds K, Lewis B, Nolen JDL, Kinney GL, Sathya B, He J (2003) Alcohol consumption and risk of stroke: a meta-analysis. JAMA 289:579–588. CrossRefGoogle Scholar
  20. Selvik HA, Thomassen L, Bjerkreim AT, Næss H (2015) Cancer-associated stroke: the Bergen NORSTROKE study. Cerebrovasc Dis Extra 5:107–113. CrossRefGoogle Scholar
  21. Shah RS, Cole JW (2010) Smoking and stroke: the more you smoke the more you stroke. Expert Rev Cardiovasc Ther 8:917–932. CrossRefGoogle Scholar
  22. Wiefarn S, Heumann C, Rettelbach A, Kostev K (2017) Risk of nonfatal stroke in type 2 diabetes mellitus patients: a retrospective comparison between disease management programs and standard care. J Diabetes Sci Technol 11:808–813. CrossRefGoogle Scholar
  23. World Health Organization (2018) Cancer—key facts. Accessed 14 Dec 2018
  24. Yabroff KR, Lund J, Kepka D, Mariotto A (2011) Economic burden of cancer in the US: estimates, projections, and future research. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol 20:2006–2014. CrossRefGoogle Scholar
  25. Zöller B, Ji J, Sundquist J, Sundquist K (2012) Risk of haemorrhagic and ischaemic stroke in patients with cancer: a nationwide follow-up study from Sweden. Eur J Cancer 48:1875–1883. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of MedicineUniversity of Versailles Saint-Quentin-en-YvelinesMontigny-le-BretonneuxFrance
  2. 2.EpidemiologyIQVIAFrankfurt am MainGermany

Personalised recommendations