title: A nationwide population-based retrospective cohort study: decreased risk of stroke in cervical cancer patients after receiving treatment.
abstract: OBJECTIVE
  To evaluate risk of stroke in patients with cervical cancer using population-based data.
  
  
  METHODS
  Claims collected in the Taiwan National Health Insurance database were used to identify 20,286 cervical cancer patients receiving diagnosis and treatment during 2000-2008. A reference group of 81,144 non-cancer participants, matched for age, cervical cancer-month and cervical cancer-year, was used for comparison. Risk of stroke was further assessed at follow-up until the end of 2009.
  
  
  RESULTS
  Patients with cervical cancer had a 42 % lower risk of developing stroke compared with the cancer-free reference population. Increased risk of stroke was observed in patients receiving radiotherapy compared with the surgery treatment group (HR = 1.88, 95 % CI = 1.52-2.32).
  
  
  CONCLUSIONS
  Results from this large retrospective cohort study indicate a lower risk of developing stroke in cervical cancer patients after receiving treatment compared with a reference population free of cancer after adjusted for age, sex, urbanization level, and stroke risk factors including hypertension and diabetes. Supplementation of estrogen after cancer treatment could explain this finding. Further prospective randomized controlled analysis is needed to confirm these findings and to elucidate the underlying biological mechanisms.
authors.affiliation: Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan, China.
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Chang
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
authors.forename: Shih-Ni
authors.initials: SN
authors.lastname: Chang
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
authors.forename: Yen-Jung
authors.initials: YJ
authors.lastname: Chang
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000628:therapy