Risk of cancer in patients with epistaxis and haemoptysis

Abstract

Background: Respiratory tract bleeding may be a marker of cancer. We quantified the risk of specific cancer types among patients with hospital-based diagnoses of epistaxis and haemoptysis relative to risk in the general population. Methods: We used Danish, nationwide databases to conduct a population-based cohort study of 80460 patients diagnosed with epistaxis and 18487 patients presenting with haemoptysis (1995-2013). We followed patients until a cancer diagnosis, emigration, death, or 31 December 2013, whichever came first. As a measure of the relative risk, we computed standardised incidence ratios (SIRs), as the observed to expected number of cancers based on national cancer incidence rates. Results: The 90-day absolute risk of any cancer was 0.59% in the epistaxis cohort and 3.78% in the haemoptysis cohort. The corresponding SIRs were 1.85 (95% confidence interval (CI) 1.69, 2.02) and 14.6 (95% CI 13.5, 15.7), respectively. The 90-day SIRs were highest for haematological cancers following epistaxis (5.78 (95% CI 4.62, 7.14)), and for smoking and alcohol-related cancers following haemoptysis (36.3 (95% CI 33.5, 39.3)). The cancer risk decreased steadily over time, but persisted beyond 5 years of follow-up after both conditions. Conclusions: Epistaxis and particular haemoptysis may be markers of cancer at several sites.