Risk and predictors of psoriasis in patients with breast cancer: a Swedish population-based cohort study

Haomin Yang,Judith S Brand,Jonas F Ludvigsson,Emilio Ugalde-Morales,Flaminia Chiesa,Kamila Czene,Per Hall,Jingmei Li

doi:10.1186/s12916-017-0915-4

Haomin Yang, Judith S Brand + Show 6 more

Open Access

https://doi.org/10.1186/s12916-017-0915-4

Copy DOI

Journal: BMC Medicine	Publication Date: Aug 11, 2017
Citations: 13	License type: open-access

Affiliation: Karolinska Institutet, Örebro University Hospital

Abstract

BackgroundThe risk of psoriasis in patients with breast cancer is largely unknown, as available evidence is limited to case findings. We systematically examined the incidence and risk factors of psoriasis in patients with breast cancer.MethodsA Swedish nationwide cohort of 56,235 breast cancer patients (2001–2012) was compared to 280,854 matched reference individuals from the general population to estimate the incidence and hazard ratio (HR) of new-onset psoriasis. We also calculated HRs for psoriasis according to treatment, genetic, and lifestyle factors in a regional cohort of 8987 patients.ResultsIn the nationwide cohort, 599 patients with breast cancer were diagnosed with psoriasis during a median follow-up of 5.1 years compared to 2795 cases in the matched reference individuals. This corresponded to an incidence rate of 1.9/1000 person-years in breast cancer patients vs. 1.7/1000 person-years in matched reference individuals. Breast cancer patients were at an increased risk of psoriasis (HR = 1.17; 95% confidence interval (CI) = 1.07–1.28), especially its most common subtype (psoriasis vulgaris; HR = 1.33; 95% CI = 1.17–1.52). The risk of psoriasis vulgaris was highest shortly after diagnosis but remained increased up to 12 years. Treatment-specific analyses indicated a higher risk of psoriasis in patients treated with radiotherapy (HR = 2.44; 95% CI = 1.44–4.12) and mastectomy (HR = 1.54, 95% CI = 1.03–2.31). Apart from treatment-specific effects, we identified genetic predisposition, obesity, and smoking as independent risk factors for psoriasis in breast cancer patients.ConclusionsThe incidence of psoriasis is slightly elevated among patients with breast cancer, with treatment, lifestyle, and genetic factors defining the individual risk profile.

Highlights

The risk of psoriasis in patients with breast cancer is largely unknown, as available evidence is limited to case findings
Risk of psoriasis in patients with breast cancer as compared to matched reference individuals In total, 599 cases of psoriasis were observed during a median follow-up of 5.1 years in the nationwide breast cancer cohort compared to 2795 cases in the matched reference individuals
The increased risk of psoriasis was mainly attributed to psoriasis vulgaris (HR = 1.33, 95% confidence interval (CI) = 1.17–1.52), with no overall risk increase being observed for the other psoriasis subtypes

Summary

Introduction

The risk of psoriasis in patients with breast cancer is largely unknown, as available evidence is limited to case findings. Estimates of the incidence and relative risk of psoriasis as compared to the general population, are unknown, as the available evidence is limited to case reports with a predominant focus on patients who were previously diagnosed with psoriasis [8,9,10,11]. No study to date has systematically examined the impact of different treatment-related factors including surgery and radiotherapy on psoriasis incidence, despite the fact that skin trauma has been shown to be a triggering factor for more than half of the new-onset psoriasis cases [12].

Objectives

Methods

Results

Discussion

Conclusion