22, 23 Therefore, it is possible that syncope may be associated with an underlying undiagnosed cancer. 4, 18, 19, 20 Additionally, a recent multicentre study showed that pulmonary embolism was identified in nearly one of every six patients hospitalised for a first episode of syncope, 21 and pulmonary embolism, in turn, is established as a marker for occult cancer. 7, 9, 10, 11, 12, 13, 14, 15, 16 Syncope also can be the first sign of intracranial tumours due to involvement of autonomic cardiovascular control areas. Syncope can occur due to stimulation of the parasympathetic nervous system or carotid sinus by direct neoplastic infiltration. 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 Thus, firm epidemiological evidence on the association between syncope and cancer is lacking. 1 Whether syncope may be the presenting sign of an occult cancer is largely unknown. reflex-mediated, orthostatic hypotension or cardiac syncope. 3 Clinically, the condition is categorised on the basis of underlying pathophysiology, i.e. 1 The lifetime cumulative risk of syncope is approximately 35%. 1, 2 Episodes occur frequently, accounting for ~1% of all referrals to emergency departments. Syncope is defined as a sudden loss of consciousness of short duration, with an inability to maintain postural tone, and spontaneous complete recovery. An aggressive search for occult cancer in a patient with syncope is probably not warranted. In short-term the highest cumulative risks were observed for lung, colorectal, prostate and brain cancers. Syncope was a weak marker of an occult cancer. The highest cumulative risks after 6 months of follow-up were lung cancer (0.2%), colorectal cancer (0.2%), prostate cancer (0.1%) and brain cancer (0.1%). The 6-month cumulative risk of any cancer was 1.2%, increasing to 17.9 % for 1–20 years of follow-up. ResultsĪmong 208,361 patients with syncope, 20,278 subsequent cancers were observed. We computed cumulative risks and standardised incidence ratios (SIR) with 95% confidence intervals (CI). Using Danish population-based medical registries, we identified all patients diagnosed with syncope during 1994–2013 and followed them until a cancer diagnosis, emigration, death or end of follow-up, whichever came first. We examined if syncope was a marker of an occult cancer by comparing the risk in patients with a syncope episode with that of the general population.
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