Meta-Analysis Shows Patients With Psoriasis at Significantly Elevated Risk for Cancer

Due to the inflammatory nature of psoriasis and the immunosuppressive nature of some treatments for the disease, the risk of cancer among patients with psoriasis is of special concern, although evidence for the link between this disease and the incidence of cancer has not been fully elucidated.

In a study presented at the British Association of Dermatologists’ 99th Annual Meeting in Liverpool, United Kingdom, July 2-4, 2019, researchers from the University of Manchester and the Salford Royal National Health Service Foundation Trust reported on an effort to assess evidence on the risk of cancer in patients with psoriasis. They found that there are a number of site-specific cancers for which patients with psoriasis are at elevated risk.

The study was a meta-analysis, funded by the Global Psoriasis Atlas, of studies with case-control or cohort designs that provided information on cancer incidence in patients with psoriasis. The 50 included studies were sourced from electronic databases. In total, 43 of the studies were cohort studies involving 919,883 patients in 9 countries.

In the 9 included studies of patients with severe disease, there was a significantly elevated risk ratio (RR) of 1.22 (95% CI, 1.08-1.39) for all cancer types. For patients with all disease severities, 7 cohort studies were analyzed, resulting in a significantly elevated pooled RR of 1.18 (95% CI, 1.06-1.31) for all cancers.

For patients with severe disease, the risk of squamous cell carcinoma, assessed in 4 studies, was elevated, at a RR of 7.70 (95% CI, 1.29-46.0). The RR of lymphoma, also assessed in 4 studies, was 3.39 (95% CI, 1.34-8.60), and the RR of basal cell carcinoma, assessed in 3 studies, was 3.17 (95% CI, 1.32-7.61).

Among patients with all disease severities, the RR for oral cavity cancer, assessed in 2 studies, was 2.80 (95% CI, 1.99-3.93); the RR for squamous cell carcinoma, assessed in 4 studies, was 2.15 (95% CI, 1.32-3.50); and the RR for esophageal cancer, assessed in 3 studies, was 2.05 (95% CI, 1.04-4.06).

Additionally, for patients with all severities of disease, increased risks were also identified for liver, laryngeal, keratinocyte, pancreatic, colorectal, and colon cancers, as well as lymphoma.

Recognizing this increased risk of cancer for people with psoriasis, wrote the investigators, is essential for ensuring appropriate, comprehensive care. The authors called on providers to help patients address potentially modifiable risk factors for cancer, such as smoking, alcohol use, and obesity.

Reference

Trafford A, Parisi R, Kontopantelis E, Griffith CEM, Ashcroft DM. Psoriasis and the risk of developing cancer: a systematic review and meta-analysis of observational studies. Presented at: British Association of Dermatologists’ 99th Annual Meeting; July 2-4, 2019; Liverpool, United Kingdom. Abstract P025.