Division of Epidemiology, Department of Family Medicine & Population Health, Virginia Commonwealth University, Richmond, Virginia.
School of Medicine, Wayne State University, Detroit, Michigan; Karmanos Cancer Institute, Detroit, Michigan.
Womens Health Issues. 2018 Jan-Feb;28(1):29-34. doi: 10.1016/j.whi.2017.10.012. Epub 2017 Dec 2.
Associations between a history of cancer and higher subsequent stroke risk have been established. However, whether a history of stroke is associated with higher subsequent cancer risk, especially for cancers with overlapping risk factors for stroke, is unknown. Therefore, we examined whether a history of stroke was associated with subsequent cancer risk and tumor site, by race/ethnicity, among postmenopausal women.
Using data from 145,075 participants in the Women's Health Initiative observational study and clinical trials (1993-2014), we used Cox proportional hazards models to predict cancer risk, comparing women with and without a history of stroke. Bivariate and multivariate models were estimated, accounting for potential confounders and death as a competing risk.
Women with a history of stroke survived roughly 3 fewer years than women without such history. The average time between incident stroke and incident cancer was 4.8 years. In adjusted competing risk models, women with a history of stroke had a lower cancer risk compared with women without such a history (adjusted hazard ratio, 0.81; 95% CI, 0.75-0.88). The magnitude of the association between a history of stroke and time to incident cancer was similar across racial/ethnic groups.
Postmenopausal women with a history of stroke had a significantly lower risk of subsequent cancer compared with women with no history of stroke. Although the risk of certain cancers were greater for African American compared with White women, the association between a stroke history and cancer risk did not vary by race/ethnicity.
Postmenopausal women with a history of stroke, who survive long enough to develop cancer, have a lower risk of cancer than women without such a history. Future studies should examine whether behavioral or clinical characteristics explain and/or mediate this association.
癌症病史与较高的后续中风风险之间存在关联已得到证实。然而，中风病史是否与较高的后续癌症风险相关，特别是对于具有中风重叠危险因素的癌症，尚不清楚。因此，我们研究了在绝经后妇女中，按种族/族裔划分，中风病史是否与随后的癌症风险和肿瘤部位相关。
利用妇女健康倡议观察性研究和临床试验（1993-2014 年）的 145075 名参与者的数据，我们使用 Cox 比例风险模型来预测癌症风险，比较了有和没有中风病史的女性。估计了双变量和多变量模型，考虑了潜在的混杂因素和死亡作为竞争风险。
患有中风病史的女性比没有此类病史的女性平均少活 3 年左右。中风发病与癌症发病之间的平均时间为 4.8 年。在调整后的竞争风险模型中，与没有中风病史的女性相比，患有中风病史的女性癌症风险较低（调整后的危险比为 0.81；95%CI，0.75-0.88）。中风病史与癌症发病时间之间的关联程度在不同种族/族裔群体中相似。
与没有中风病史的女性相比，患有中风病史的绝经后女性随后发生癌症的风险显著降低。尽管某些癌症的风险在非裔美国女性中比白人女性更高，但中风病史与癌症风险之间的关联不受种族/族裔的影响。
患有中风病史并存活足够长的时间以发展为癌症的绝经后女性患癌症的风险低于没有此类病史的女性。未来的研究应研究行为或临床特征是否解释和/或调节这种关联。
