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Original Investigation |

The Risk of Cancer in Patients With Psoriasis A Population-Based Cohort Study in the Health Improvement Network

Zelma C. Chiesa Fuxench, MD1,2; Daniel B. Shin, MS1; Alexis Ogdie Beatty, MD, MSCE2,3; Joel M. Gelfand, MD, MSCE1,2
[+] Author Affiliations
1Departments of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
2Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia
3Department of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
JAMA Dermatol. 2016;152(3):282-290. doi:10.1001/jamadermatol.2015.4847.
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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 hazard 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.

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Adjusted Hazard Ratio (aHR) for Cancer by Study Group

This Figure provides information on the adjusted hazard ratio (aHR) (95% CI) for any cancer except nonmelanoma skin cancer (NMSC) as well as individual cancers of interest in the overall, mild, and moderate-to-severe psoriasis groups. a Adjusted for age, BMI, drinking and smoking status, b adjusted for age and sex, c adjusted for age, sex, and smoking status, d adjusted for age only, e includes only men, f includes only women. CTCL indicates cutaneous T-cell lymphoma.

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