INCIDENTALLY detected splenomegaly may signal substantially increased risk of hematologic cancer and liver disease in older adults, according to new findings from a large perspective cohort study in Denmark and the UK. The study provides clinicians with evidence-based thresholds for when spleen size warrants further evaluation.
Study Design and Cohort
Researchers analysed data from 47 066 individuals from the general population with computed tomography or magnetic resonance imaging scans performed between 2012 and 2021. Among 8459 Danish participants, 57.0% were female and the median age at scan was 61 years. Among 38 607 UK participants, 51.9% were female and the median age was 65 years. Spleen length was measured in 8440 Danish individuals, while spleen volume was assessed in 8226 Danish and all UK participants. Outcomes included hematologic cancers, cirrhosis, and liver cancer over a median follow-up of 5 years.
Splenomegaly and Cancer Risk
Relative risk of hematologic cancer increased sharply for Danish individuals with spleen lengths above the 99th percentile (greater than 134 mm; hazard ratio: 5.11; 95% CI: 2.00–13.06) and for spleen volumes above the 99th percentile (greater than 433 mL in Danish participants; hazard ratio: 11.08; 95% CI: 5.44–22.59; greater than 386 mL in UK participants; hazard ratio: 11.82; 95% CI: 6.98–20.02). Clinically relevant thresholds indicated that 5-year risk of any hematologic cancer was moderately increased for spleen length of 130–139 mm or volume of 400–499 mL and markedly increased for spleen length of 140 mm or greater or volume of 500 mL or greater. For older adults, absolute 5-year risks reached 46% in Danish men and 27% in Danish women aged 70 years or older with spleen volume of 500 mL or greater.
Implications for Clinical Practice
The study provides actionable guidance for evaluating incidentally detected splenomegaly. Individuals with spleen length of 140 mm or greater or spleen volume of 500 mL or greater may warrant diagnostic workup for hematologic cancer. Smaller spleens—less than 130 mm in length or less than 400 mL in volume—are associated with limited absolute risk, suggesting that routine evaluation may not be necessary. Clinicians should integrate spleen measurements with the patient’s overall clinical context when deciding on further investigation.
Reference
Juhl AR et al. Incidentally detected splenomegaly and risk of hematologic cancer and liver disease. JAMA Oncol. 2026; doi: 10.1001/jamaoncol.2025.5934.
