Newly developed anaemia predicts incident cancer and death within 18 months: Findings from 1.1 million patients in the Stockholm Early Detection of Cancer Study (STEADY-CAN) cohort

Elinor Nemlander, Eliya Abedi, Jan Hasselström, Per Ljungman, Andreas Rosenblad, Axel Carlsson

Keywords: EarlyCancerDetection Anaemia STEADY-CAN

Background:

Anaemia is a common condition in primary healthcare (PHC) and is frequently associated with existing cancer. Detecting newly developed anaemia may provide an opportunity for earlier cancer diagnosis.

Research questions:

This study aimed to examine the association between newly developed anaemia and incident cancer and mortality in women and men, adjusting for age and comorbidities.

Method:

We conducted a population-based cohort study using data from the Stockholm Early Detection of Cancer Study (STEADY-CAN) in Sweden. Adults aged ≥ 18 years with at least two haemoglobin (Hb) measurements on separate days between January 2011 and June 2020 were included. Newly developed anaemia was defined as Hb < 130 g/L for men and < 120 g/L for women between January 2012 and June 2020, following a prior normal Hb level between January 2011 and June 2020. The primary outcomes were incident cancer and death within 18 months, assessed using competing risks Cox regression models.

Results:

Out of 1,068,622 eligible individuals, 259,019 (24.2%) developed anaemia. Incident cancer within 18 months was diagnosed in 9,726 (3.8%) individuals with anaemia, compared to 5,318 (0.7%) non-anaemic individuals. After adjusting for age and comorbidities, the hazard ratio (HR) for incident cancer was highest in men aged 40–49 years (HR 7.8, 95% confidence interval [CI] 6.47–9.38) and women aged 50–59 years (HR 6.2, 95% CI 5.36–7.06). Moreover, anaemia implied a significantly increased mortality risk, with the highest adjusted HR observed in men aged 50–59 years (HR 8.0, 95% CI 6.71–9.42) and women in the same age group (HR 7.3, 95% CI 5.49–9.67).

Conclusions:

Newly developed anaemia is strongly associated with a higher risk of incident cancer and mortality in both women and men. Clinicians should consider anaemia a potential early marker for cancer, warranting further investigations. Future studies should explore anaemia characteristics and follow-up durations to improve early cancer detection and patient outcomes.

Points for discussion:

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