Breast Cancer Survivors: Increased Risk Of Stroke?

Previous studies have shown that patients with breast cancer have a higher risk of sleep disorders, which in turn increases the risk of stroke. In addition, chemotherapy and radiation therapy used to treat breast cancer can also increase the risk of stroke. As a result, patients who have survived breast cancer have a higher risk of death from stroke than those who have never had breast cancer.

Breast cancer patients with sleep disorders have an increased risk of stroke

Sleep disorders are a common occurrence in people with cancer, affecting their ability to fall and stay asleep. A study on breast cancer patients with sleep disorders found that they had a 1.31-fold higher risk of ischemic stroke than those without sleep disorders. The study also found that the time from the breast cancer diagnosis to the occurrence of stroke was approximately 6 years.

Sleep disorders can lead to an increased risk of stroke through several mechanisms. These include sleep fragmentation, which can alter sympathetic activity and lead to endothelial dysfunction and increased arterial stiffness. Sleep disorders can also result in mood disorders, weakness, and immune dysfunction, all of which can contribute to the risk of stroke.

Additionally, chemotherapy, a common treatment for breast cancer, has been linked to an elevated risk of stroke. Certain chemotherapy drugs, such as tamoxifen, increase the risk of blood clot formation and, subsequently, the risk of stroke.

Treating sleep disorders and managing the risk of stroke in breast cancer patients is crucial for their overall health and well-being.

Stroke is the second leading cause of death and is responsible for approximately 11% of all deaths worldwide

Breast cancer patients have a higher risk of stroke than the general population. A study found that patients with breast cancer had a 1.31-fold higher risk of ischemic stroke than those without sleep disorders, after adjustment for comorbidities, cancer clinical stage, and treatment types. Another study found that the risk of stroke was highest between 0.5 years before and after a diagnosis of cancer, with a steep-sided bell curve.

The risk of stroke in breast cancer patients is influenced by several factors, including age, gender, marital status, and time after diagnosis. Patients diagnosed at a younger age had a higher standardised mortality ratio (SMR) for stroke, and the SMRs gradually declined as patients were diagnosed at a later age. The risk of stroke also increased with the stage of cancer, with patients with stage 4 cancer having a higher risk than those with stage 1 cancer.

In addition, certain treatments for breast cancer, such as chemotherapy and radiation therapy, can increase the risk of stroke. Chemotherapy can lead to stroke by causing endothelial toxicity and abnormalities in coagulation and hemostasis factors. Radiation therapy can cause stroke by inducing atherosclerosis and damaging blood vessels.

Overall, the risk of stroke in breast cancer patients is influenced by a combination of factors, including patient characteristics and cancer treatments. It is important for clinicians to be aware of these risk factors and to consider stroke prevention strategies for patients at high risk.

Cancer is a risk factor for stroke because of hypercoagulability, direct tumor compression of blood vessels, radiation therapy and chemotherapy

Cancer is a risk factor for stroke due to a combination of factors, including hypercoagulability, direct tumour compression of blood vessels, radiation therapy, and chemotherapy.

Hypercoagulability

Cancer patients are at an increased risk of developing hypercoagulability, a condition where the blood's ability to clot is heightened. This can lead to the formation of blood clots, which can then cause strokes. This is known as Trousseau's syndrome, and it is often associated with adenocarcinomas—cancers that develop in the mucus-secreting glands. These cancers can directly secrete mucin into the bloodstream, creating a viscous and hypercoagulable state. Additionally, cancer cells can release pro-coagulant molecules, such as tissue factor and cancer pro-coagulant, which activate the coagulation cascade and increase the risk of clotting.

Direct Tumour Compression of Blood Vessels

Direct tumour compression of blood vessels can also lead to stroke. Metastases to the brain or primary brain tumours can physically compress blood vessels or cause vessel obstruction through associated oedema. This can result in cerebral ischemia and subsequent infarction in the affected region.

Radiation Therapy

Radiation therapy, particularly in the head and neck region, is a risk factor for stroke. It can cause a vasculopathy of medium and large-sized vessels, which may present years after radiation exposure. This vasculopathy is often associated with accelerated atherosclerosis, leading to vessel wall irregularities and an increased risk of embolism.

Chemotherapy

While the link between chemotherapy and stroke risk is less clear, some chemotherapeutic agents have been associated with an increased risk. For example, tamoxifen, used in breast cancer treatment, is associated with a higher risk of blood clot formation and, consequently, stroke. Bevacizumab, used in the treatment of various solid tumours, has also been linked to an increased risk of cerebrovascular events, including ischemic and haemorrhagic stroke.

Patients with prostate, breast, and colorectal cancer had a higher risk of dying from fatal stroke than patients with other cancers

Patients with prostate, breast, and colorectal cancer are at a higher risk of dying from a fatal stroke than patients with other cancers.

The risk of stroke in cancer patients is two times that of the general population and rises with longer follow-up time. The relative risk of fatal stroke, vs the general population, is highest in those with cancers of the brain and gastrointestinal tract. The plurality of strokes occurs in patients >40 years of age with cancers of the prostate, breast, and colorectum. Patients of any age diagnosed with brain tumors and lymphomas are at risk for stroke throughout life.

Patients who survived breast cancer had a higher risk of death from stroke than patients who had never had breast cancer

Breast cancer is one of the most common cancers diagnosed in women worldwide. Stroke is the second leading cause of death worldwide. Previous studies have shown that patients with breast cancer had a higher risk of sleep disorders, which in turn increased the risk of stroke. Cancer is a risk factor for stroke due to hypercoagulability, direct tumor compression of blood vessels, and radiation and chemotherapy.

A study showed that patients who survived breast cancer had a higher risk of death from stroke than patients who had never had breast cancer. The risk of stroke among cancer patients is more than twice that of the general population and rises with longer follow-up time. The relative risk of fatal stroke, compared to the general population, is highest in those with brain and gastrointestinal cancers. The plurality of strokes occurs in patients over 40 years of age with cancers of the prostate, breast, and colorectum. Patients of any age diagnosed with brain tumors and lymphomas are at risk for stroke throughout their lives.

Recommendations

The findings suggest that stroke-prevention strategies may be aimed at patients treated for brain tumors and lymphomas and older patients diagnosed with cancers of the prostate, breast, and colorectum. The National Comprehensive Cancer Network, American Heart Association, and American Stroke Association provide guidelines for monitoring distress and stroke prevention.

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