Breast Cancer and Psoriasis: Are Biologics Safe?

Psoriasis has been linked to an increased risk of cancers such as lung cancer, non-melanoma skin cancer, and lymphoma. Current research, however, indicates that the risk of developing these cancers is still relatively low–at around 6% for those with psoriasis, compared to those without.  While there seems to be a trend indicating that with more severe psoriasis types, the greater the risk of cancer, more research needs to be done to determine if this risk is from psoriasis or another factor. The fact that psoriasis is an autoimmune disease can also have a still-to-be substantiated role in the risk of developing certain cancers. It is also not clear if there is elevated cancer risk because of the use of systemic and biologic treatments used to treat more severe psoriasis cases.1

The role of inflammation

Chronic inflammation and cancer have a confusing, and slightly contradictory relationship.  On one hand, the inflammatory response can act as an anti-tumorigenic (tumor regulating) agent, as it forces the immune system to perform constant surveillance on itself.  On the other hand, the same processes that lead to chronic inflammation (the dysregulated immune system that is part of having an autoimmune disease)  could increase the likelihood that cancerous cells develop. Constant inflammation could potentially introduce mutagens into a cell or alter a cell’s DNA, leading to tumor growth and proliferation.  Just as anti-inflammatory agents like aspirin can reduce cancer risk, it makes sense that constant inflammation could increase it.  However, much more research is necessary to further clarify this relationship.2

Treatment options

One area of interest for people with psoriasis is the range of treatment options and their potential connection to breast cancer—specifically, is it safe for individuals with a history of, or who are currently overcoming, breast cancer to use biologics to treat their psoriasis?  Nearly 12% of the U.S. population currently has breast cancer (and many more who have had a history of the disease in the past), and nearly 3% have psoriasis, so just in terms of these numbers, there will be some overlap between these groups.3-4

So what does this mean for individuals with psoriasis who also have a history of breast cancer or who demonstrate a predisposition to the condition?  Well, the answer may not be as clear as we would hope.  Biologic treatment for severe psoriasis can be a scary idea, as one might think immunosuppression could lead to an increase in malignancy (tumor growth), or the development of new malignancies.  For example, one biologic treatment utilizes a TNF (tumor necrosis factor) inhibitor as the drug target.  TNF is utilized by the body to recognize and destroy tumors as they begin to grow or are currently growing.  Without TNF, won’t our body just become a tumor factory?

According to current research, this is not the case.  Although the data is scarce, there is data to suggest that cancer risk will not be elevated with the use of biologics. Right now there is a lack of extensive, large, and long-term studies and trials to demonstrate this. However, the balance of research seems to be shifted in favor of the safety and efficacy of biologics for treating psoriasis, even for those people with certain cancers, like breast cancer.5  Some studies specifically look at those with a recent, previous cancer history, that are then treated with biologics for psoriasis. In these studies, the use of biologics did not demonstrate any increased risk of cancer recurrence or increased development of malignancies.

The verdict

With all of this taken into consideration, prescribing biologics, or choosing to take them, can be cause for concern and hesitancy.  However, current data suggests that the risk of complications of cancers seems to be negligible. People with psoriasis should be prepared to talk to their healthcare provider about this and weigh these considerations as you talk about your treatment options. The potential increase in quality of life and prevention of other co-morbid conditions with psoriasis (such as cardiovascular complications) are good reasons to consider utilizing biologics if warranted by the severity of your psoriasis.

Due to the lack of treatment guidelines and specific trial data that compare treatments head-to-head with cancer factored into the study, it is important to talk to an oncologist along with your usual healthcare provider. If you have had, currently have, or could develop cancers like breast cancer you should have these discussions prior to starting treatment with biologics. Including an oncologist along with your psoriasis healthcare team in these discussions will help you determine what is best for you and to plan treatment accordingly.  Hopefully, additional research and more conclusive data will come out in the near future to help crack this mystery completely, but for now, taking things on a case-by-case basis seems to be the way to go!

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