Joel Gelfand, MD, MSCE, and colleagues conducted a population-based cohort study of patients aged 18 to 89 years in the United Kingdom with no medical history of HIV, cancer, organ transplants or hereditary disease, including albinism and xeroderms pigmentosum, prior to the beginning of the study. The data source was the Health Improvement Network, a primary care medical records database in the United Kingdom, with data collected from 2002 through January 2014 and analysis completed in August 2015.
Patients prescribed psoralen, methotrexate, cyclosporine, acitretin, Humira (adalimumab, AbbVie), Enbrel (etanercept, Amgen), Remicade (infliximab, Janssen), Stelara (ustekinumab, Janssen) or phototherapy for psoriasis were classified as having moderate-to-severe psoriasis. Patients not receiving the treatments were classified as having mild psoriasis.
Researchers analyzed 937,716 control group patients without psoriasis and 198,366 patients with psoriasis, including 186,076 with mild psoriasis and 12,290 with moderate-to-severe psoriasis.
Any incident cancer excluding melanoma skin cancer had an adjusted hazard ratio (HR) of 1.06 (95% CI, 1.02-1.09) in the overall psoriasis group, 1.06 (95% CI, 1.02-1.09) in the mild psoriasis group and 1.08 (95% CI, 0.96-1.22) in the severe psoriasis group.
Incident lymphoma had an adjusted HR of 1.34 (95% CI, 1.18-1.51) for the overall psoriasis cohort, 1.31 (95% CI, 1.15-1.49) for the mild psoriasis cohort and 1.89 (95% CI, 1.25-2.86) for the severe psoriasis cohort. Nonmelanoma skin cancer had an adjusted HR of 1.12 (95% CI, 1.07-1.16) overall, and 1.09 (95% CI, 1.05-1.13) and 1.61(95% CI, 1.42-1.84) for the mild and severe psoriasis cohorts, respectively. Lung cancer had an adjusted HR of 1.15 (95% CI, 1.03-1.27) in the overall psoriasis cohort, and 1.12 (95% CI, 1.01-1.25) and 1.62 (95% CI, 1.16-2.28) in the mild and severe psoriasis cohorts, respectively.
Breast, colon and prostate cancer and leukemia did not have significant associations with the psoriasis cohorts.
“Patients with psoriasis who received treatment with systemic medications or phototherapy were shown to be at a higher risk for malignant neoplasms compared with controls,” the researchers concluded. “Dermatologists who care for patients with psoriasis should consider incorporating current cancer screening guidelines and counseling, such as smoking cessation, into their daily practice.” – by Bruce Thiel