BACKGROUND: Cardiovascular disease (CVD) and cancer share many common risk factors; patients with CVD also may
be at risk of developing cancer.
OBJECTIVES: The aim of this study was to derive and externally validate prediction models for the estimation of
lifetime and 10-year risk for total, colorectal, and lung cancer in patients with established CVD.
METHODS: Data from patients with established CVD from the UCC-SMART cohort (N ¼ 7,280) were used for model
development, and from the CANTOS trial (N ¼ 9,322) for model validation. Predictors were selected based on previously
published cancer risk scores, clinical availability, and presence in the derivation dataset. Fine and Gray competing
risk-adjusted lifetime models were developed for the outcomes total, colorectal, and lung cancer.
RESULTS: Selected predictors were age, sex, smoking, weight, height, alcohol use, antiplatelet use, diabetes, and
C-reactive protein. External calibration for the 4-year risk of lung, colorectal, and total cancer was reasonable in our
models, as was discrimination with C-statistics of 0.74, 0.64, and 0.63, respectively. Median predicted lifetime and
10-year risks in CANTOS were 26% (range 1% to 52%) and 13% (range 1% to 31%) for total cancer; 4% (range 0% to 13%)
and 2% (range 0% to 6%) for colorectal cancer; and 5% (range 0% to 37%) and 2% (range 0% to 24%) for lung cancer.
CONCLUSIONS: Lifetime and 10-year risk of total, colorectal, and lung cancer can be estimated reasonably well in
patients with established CVD with readily available clinical predictors. With additional study, these tools could be used in
clinical practice to further aid in the emphasis of healthy lifestyle changes and to guide thresholds for targeted diagnostics and screening
