Psoriasis and Cancer population based cohort study

[Fred]

The risk of of cancer amongst psoriasis patients has often been spoken about. Here is a population based cohort study that confirms there is an increased risk albeit small.

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Importance:  
The risk of cancer in patients with psoriasis remains a cause of special concern due to the chronic inflammatory nature of the disease, the use of immune-suppressive treatments and UV therapies, and the increased prevalence of comorbid, well-established risk factors for cancer, such as smoking and obesity, all of which may increase the risk of carcinogenesis.

Objective:  
To compare the overall risk of cancer, and specific cancers of interest, in patients with psoriasis compared with patients without psoriasis.

Design, Setting, and Participants:  
Population-based cohort study of patients ages 18 to 89 years with no medical history of human immunodeficiency virus, cancer, organ transplants, or hereditary disease (albinism and xeroderma pigmentosum), prior to the start date, conducted using The Health Improvement Network, a primary care medical records database in the United Kingdom. The data analyzed had been collected prospectively from 2002 through January 2014. The analysis was completed in August 2015.

Exposures of Interest:  
Patients with at least 1 diagnostic code for psoriasis were classified as having moderate-to-severe disease if they had been prescribed psoralen, methotrexate, cyclosporine, acitretin, adalimumab, etanercept, infliximab, or ustekinumab or phototherapy for psoriasis. Patients were classified as having mild disease if they never received treatment with any of these agents.

Main Outcomes and Measures:  
Incident cancer diagnosis.

Results:
A total of 937 716 control group patients without psoriasis, matched on date and practice visit, and 198 366 patients with psoriasis (186 076 with mild psoriasis and 12 290 with moderate-to-severe disease) were included in the analysis. The adjusted hazards ratios (aHRs) with 95% CIs for any incident cancer excluding nonmelanoma skin cancer (NMSC) were 1.06 (95% CI, 1.02-1.09), 1.06 (95% CI, 1.02-1.09), and 1.08 (95% CI, 0.96-1.22) in the overall, mild, and severe psoriasis group. The aHRs for incident lymphoma were 1.34 (95% CI, 1.18-1.51), 1.31 (95% CI, 1.15-1.49), and 1.89 (95% CI, 1.25-2.86); for NMSC, 1.12 (95% CI, 1.07-1.16), 1.09 (95% CI, 1.05-1.13), and 1.61 (95% CI, 1.42-1.84); and for lung cancer, 1.15 (95% CI, 1.03-1.27), 1.12 (95% CI, 1.01-1.25), and 1.62 (95% CI, 1.16-2.28) in the overall, mild, and severe psoriasis groups, respectively. No significant association was seen with cancer of the breast, colon, prostate, or leukemia.

Conclusions and Relevance:  
The association between psoriasis and cancer, albeit small, was present in our cohort of patients with psoriasis. This association was primarily driven by NMSC, lymphoma, and lung cancer.

Source: jamanetwork.com

*Funding not known.

[Caroline]

The risk of of cancer amongst psoriasis patients has often been spoken about. Here is a population based cohort study that confirms there is an increased risk albeit small.

Quote:

---

Importance:  
The risk of cancer in patients with psoriasis remains a cause of special concern due to the chronic inflammatory nature of the disease, the use of immune-suppressive treatments and UV therapies, and the increased prevalence of comorbid, well-established risk factors for cancer, such as smoking and obesity, all of which may increase the risk of carcinogenesis.

Objective:  
To compare the overall risk of cancer, and specific cancers of interest, in patients with psoriasis compared with patients without psoriasis.

Design, Setting, and Participants:  
Population-based cohort study of patients ages 18 to 89 years with no medical history of human immunodeficiency virus, cancer, organ transplants, or hereditary disease (albinism and xeroderma pigmentosum), prior to the start date, conducted using The Health Improvement Network, a primary care medical records database in the United Kingdom. The data analyzed had been collected prospectively from 2002 through January 2014. The analysis was completed in August 2015.

Exposures of Interest:  
Patients with at least 1 diagnostic code for psoriasis were classified as having moderate-to-severe disease if they had been prescribed psoralen, methotrexate, cyclosporine, acitretin, adalimumab, etanercept, infliximab, or ustekinumab or phototherapy for psoriasis. Patients were classified as having mild disease if they never received treatment with any of these agents.

Main Outcomes and Measures:  
Incident cancer diagnosis.

Results:
A total of 937 716 control group patients without psoriasis, matched on date and practice visit, and 198 366 patients with psoriasis (186 076 with mild psoriasis and 12 290 with moderate-to-severe disease) were included in the analysis. The adjusted hazards ratios (aHRs) with 95% CIs for any incident cancer excluding nonmelanoma skin cancer (NMSC) were 1.06 (95% CI, 1.02-1.09), 1.06 (95% CI, 1.02-1.09), and 1.08 (95% CI, 0.96-1.22) in the overall, mild, and severe psoriasis group. The aHRs for incident lymphoma were 1.34 (95% CI, 1.18-1.51), 1.31 (95% CI, 1.15-1.49), and 1.89 (95% CI, 1.25-2.86); for NMSC, 1.12 (95% CI, 1.07-1.16), 1.09 (95% CI, 1.05-1.13), and 1.61 (95% CI, 1.42-1.84); and for lung cancer, 1.15 (95% CI, 1.03-1.27), 1.12 (95% CI, 1.01-1.25), and 1.62 (95% CI, 1.16-2.28) in the overall, mild, and severe psoriasis groups, respectively. No significant association was seen with cancer of the breast, colon, prostate, or leukemia.

Conclusions and Relevance:  
The association between psoriasis and cancer, albeit small, was present in our cohort of patients with psoriasis. This association was primarily driven by NMSC, lymphoma, and lung cancer.

Source: jamanetwork.com

*Funding not known.

NMSC I can imagine, that is due to the light treatment.
Lymphoma also, because a lot of the medication we take, reduces the lymphocytes or reduces the immune system of us.

Lung cancer? I cannot specifically place that. Might there be a relation between smokers in the research group? Should be good to know.

[Fred]

Lung cancer? I cannot specifically place that. Might there be a relation between smokers in the research group? Should be good to know.

Yes I thought lung cancer was a bit odd. I would put it down to a lot of people with psoriasis have/or do smoke a lot.

It's a well known fact that people with psoriasis tend to look for a crutch. Alcohol, Tobacco, Drugs, Food, even Exercise. We can tend to do some things in excess to help us get through living with it. So it's no big surprise that we also have other problems and I find these type of studies of little importance.

[jiml]

Well there are no startling revelations there, it is a small association with cancers not really significant in my mind
I agree with Fred many of us with psoriasis, leap outside at the first sign of sunshine and try to rid ourselves of the disease, or turn to the bottle and cigarettes as a crutch.
I think I would have taken more notice if there had been a higher incidence of cancers, which gladly there wasn't

[Fred]

Well there are no startling revelations there, it is a small association with cancers not really significant in my mind
I agree with Fred many of us with psoriasis, leap outside at the first sign of sunshine and try to rid ourselves of the disease, or turn to the bottle and cigarettes as a crutch.
I think I would have taken more notice if there had been a higher incidence of cancers, which gladly there wasn't

That's a point Jim. Maybe we can take good things from this study, it was Small but sometimes the wording can make it sound like the end of the world.

I wonder how many people with psoriasis also get run over by a bus.

[jiml]

Well there are no startling revelations there, it is a small association with cancers not really significant in my mind
I agree with Fred many of us with psoriasis, leap outside at the first sign of sunshine and try to rid ourselves of the disease, or turn to the bottle and cigarettes as a crutch.
I think I would have taken more notice if there had been a higher incidence of cancers, which gladly there wasn't

That's a point Jim. Maybe we can take good things from this study, it was Small but sometimes the wording can make it sound like the end of the world.

I wonder how many people with psoriasis also get run over by a bus.  

Possibly more than the average population, as they are likely to cross roads while brushing the flakes from their shoulders ......and splat

[Fred]

Well there are no startling revelations there, it is a small association with cancers not really significant in my mind
I agree with Fred many of us with psoriasis, leap outside at the first sign of sunshine and try to rid ourselves of the disease, or turn to the bottle and cigarettes as a crutch.
I think I would have taken more notice if there had been a higher incidence of cancers, which gladly there wasn't

That's a point Jim. Maybe we can take good things from this study, it was Small but sometimes the wording can make it sound like the end of the world.

I wonder how many people with psoriasis also get run over by a bus.  

Possibly more than the average population, as they are likely to cross roads while brushing the flakes from their shoulders ......and splat