title: Atrial fibrillation as a marker of occult cancer.
abstract: BACKGROUND
  Recent studies suggest that cancer increases risk of atrial fibrillation. Whether atrial fibrillation is a marker for underlying occult cancer is unknown.
  
  
  METHODS
  We conducted a cohort study (1980-2011) of all Danish patients with new-onset atrial fibrillation. To examine cancer risk, we computed absolute risk at 3 months and standardized incidence ratios (SIRs) by comparing observed cancer incidence among patients newly diagnosed with atrial fibrillation with that expected based on national cancer incidence during the period.
  
  
  RESULTS
  Median follow-up time was 3.4 years among 269 742 atrial fibrillation patients. Within 3 months of follow-up, 6656 cancers occurred (absolute risk, 2.5%; 95% confidence intervals [CI], 2.4%-2.5%) versus 1302 expected, yielding a SIR of 5.11; 95% CI, 4.99-5.24. Associations were particularly strong for cancers of the lung, kidney, colon, ovary, and for non-Hodgkin's lymphoma. The SIR within 3 months of follow-up was 7.02; 95% CI, 6.76-7.28 for metastatic and 3.53; 95% CI, 3.38-3.68 for localized cancer. Beyond 3 months of follow-up, overall cancer risk was modestly increased (SIR, 1.13; 95% CI, 1.12-1.15).
  
  
  CONCLUSIONS
  Patients with new-onset atrial fibrillation had a markedly increased relative risk of a cancer diagnosis within the next three months, however, corresponding absolute risk was small.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark; Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Eva B
authors.initials: EB
authors.lastname: Ostenfeld
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Rune
authors.initials: R
authors.lastname: Erichsen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Pedersen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Dóra K
authors.initials: DK
authors.lastname: Farkas
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark; Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.
authors.forename: Noel S
authors.initials: NS
authors.lastname: Weiss
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Henrik T
authors.initials: HT
authors.lastname: Sørensen
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D014408:Biomarkers, Tumor; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D018570:Risk Assessment
chemical_list: D014408:Biomarkers, Tumor