New population-based research finds ischemic stroke risk is highest soon after a cancer diagnosis and varies substantially by cancer type and stage
Cancer care increasingly extends beyond controlling the tumor itself. Cardiovascular and cerebrovascular health are important parts of comprehensive cancer care, particularly as more people live longer with and after cancer.
A 2026 study published in Cancer, the journal of the American Cancer Society, provides important new evidence that a diagnosis of invasive cancer is associated with an increased risk of ischemic stroke, especially during the first few months after diagnosis.
A Nationwide Study of More Than 182,000 Cancer Patients
Researchers linked Israel’s national cancer and stroke registries and studied 182,221 adults age 40 and older diagnosed with a first invasive cancer between 2014 and 2021. During follow-up, 1,125 patients experienced a first-ever ischemic stroke.
The central finding was striking. During the first year following a cancer diagnosis, patients had an 80% higher relative incidence of ischemic stroke than expected compared with the general population.
But timing mattered even more.
During the first three months after diagnosis, the standardized incidence ratio (SIR) reached 2.5, approximately 2½ times the expected rate. It subsequently declined to 1.6 during months 3–6 and 1.5 during months 6–12.
This identifies the months immediately following a cancer diagnosis as a particularly important period for attention to vascular health.
Not All Cancers Carry the Same Risk
One of the study’s most important findings was the substantial variation among cancer types.
Pancreatic cancer had the greatest relative increase, with nearly six times the expected incidence of ischemic stroke. Lung cancer was associated with nearly four times the expected incidence. Elevated risks were also identified with cancers including esophageal, gallbladder, stomach and bladder cancers, as well as several hematologic malignancies.
In contrast, breast and prostate cancers were not associated with a statistically significant excess ischemic stroke risk in this study.
The absolute risks help put these relative numbers into perspective. Across all cancers, the one-year cumulative incidence of ischemic stroke was 0.62%, compared with an expected 0.40%, roughly 6 versus 4 strokes per 1,000 patients. The incidence ranged from 0.30% for breast cancer to 1.62% for pancreatic cancer.
Advanced Cancer Carries Greater Risk
Cancer stage also mattered. The standardized incidence ratio increased from 1.2 with localized disease to 2.8 with metastatic disease. Among patients with metastatic lung cancer, the SIR reached 7.5, while metastatic pancreatic cancer was associated with an SIR of 10.4. The authors caution, however, that cancer stage was unavailable for nearly half the study population, limiting interpretation of these stage-specific findings.
Interestingly, younger patients demonstrated the greatest relative increase in stroke risk. This does not mean younger patients had the highest absolute stroke risk. Rather, because stroke is normally much less common at younger ages, the increase associated with cancer produced a larger relative difference from the expected background rate.
Why Might Cancer Increase Stroke Risk?
Cancer and ischemic stroke can share traditional risk factors, including smoking. But the authors point to additional cancer-associated mechanisms, particularly hypercoagulability, systemic inflammation, platelet activation and tumor-related prothrombotic pathways. Cancer treatment and interruptions in anticoagulant therapy around procedures may also contribute in some patients, although this study was not designed to determine individual mechanisms or treatment effects.
Importantly, this was an observational study. It demonstrates an association between cancer and stroke risk but cannot establish that cancer itself caused the strokes. The investigators also lacked detailed information on comorbidities, cancer treatments and antithrombotic medications.
What Does This Mean for Cancer Patients?
The message is not that patients should fear stroke after a cancer diagnosis. The absolute risk remains relatively low for most patients. Instead, the study argues for recognizing cerebrovascular health as another component of comprehensive cancer care.
The authors specifically recommend incorporating targeted cerebrovascular risk assessment into routine oncology care, particularly for patients with higher-risk cancers and during the early months after diagnosis. Attention to established modifiable vascular risk factors, including blood pressure, smoking, diabetes, cholesterol, physical inactivity and other appropriate lifestyle factors can be part of a broader survivorship and supportive-care strategy. The study itself, however, did not test exercise or demonstrate that exercise reduces cancer-associated stroke risk.
The CancerFitness.org Perspective
This publication reinforces an increasingly important principle: cancer care should address the whole patient, not simply the tumor.
Exercise Oncology programs can fit within this broader model by helping appropriate patients maintain physical function and supporting established cardiovascular health goals. But exercise programs should complement, not replace medical assessment and management of vascular risk, particularly during the vulnerable period immediately following a cancer diagnosis.
For cancer centers developing comprehensive Exercise Oncology Programs, coordination among oncology, primary care, cardiology/cardio-oncology, rehabilitation and exercise professionals may provide an opportunity to identify cardiovascular and cerebrovascular risk while simultaneously promoting safe physical activity.
Call to Action: Ask About Your Vascular Health
If you have recently been diagnosed with cancer, particularly advanced lung, pancreatic or another cancer associated with increased stroke risk, ask your cancer care team whether your cardiovascular and cerebrovascular risk factors should be reviewed.
And ask another important question:
“What kind of physical activity or exercise is safe and appropriate for me during my cancer treatment?”
CancerFitness.org encourages cancer patients and survivors to make individualized, medically appropriate physical activity part of comprehensive cancer care while recognizing that exercise is one component of a much larger strategy for protecting long-term health.
Cancer treatment should address the cancer. Cancer survivorship should protect the whole person.
Reference: Elevated risk of ischemic stroke after invasive cancer diagnosis: A nationwide population‐based study. Carmit Libruder MSc, David Tanne MD, Barbara G. Silverman MD, MPH, et al. Cancer. 2026;e70536. wileyonlinelibrary.com/journal/cncr https://doi.org/10.1002/cncr.70536.
