Original Article

Should Mammography Be a Prerequisite Prior to Initiation of Biological Agents in Patients With Psoriasis?

Author Affiliation(s)


Introduction: Psoriasis patients may be susceptible to malignancy due to chronic inflammation. Moreover, biological agents which are used in the treatment of psoriasis might increase the risk of malignancy due to their immunosuppressive effect.

Objectives: We evaluated the mammography results of female patients with psoriasis aged over 40 before the initiation of biological agent treatment. We aimed to determine whether breast cancer screening with mammography should be a prerequisite before the initiation of biological agent treatment for psoriasis.

Methods: Between April 2019 and March 2021, medical records of female psoriasis patients aged over 40 were reviewed retrospectively.

Results: This study included 42 female psoriasis patients (mean age: 53.52±7.09). BI-RADS score was 2 in 18 (42.9%) patients, 1 in 13 (31%) patients, 3 in 9 (21.4%) patients and 4A in 1(2.4%) patient. Isodense masses were detected in 10 (23.8%) patients, while 6 (14.3%) patients had intramammary lymph nodes. Mammography revealed microcalcifications in 6 (14.3%) patients, macrocalcifications in 1 (2.4%) patient and a hamartoma in 1 (2.4%) patient. Isodense masses, calcifications and intramammary lymph nodes were associated with long disease duration (>10 years). Intramammary lymph nodes were more common in patients treated with biological agents previously compared to biologic-naive patients.  

Conclusions: We suggest that female patients over 40, especially who had a long disease duration, family history of breast cancer and previous history of treatment with biological agents should undergo mammography before the initiation of biological agents for the treatment of psoriasis.

Keywords : Biological agents, breast cancer, mammography, psoriasis


1. Kovitwanichkanont T, Chong AH, Foley P. Beyond skin deep: addressing comorbidities in psoriasis. Med J Aust. 2020;212(11):528-534. 2. Trafford AM, Parisi R, Kontopantelis E, et al. Association of psoriasis with the risk of developing or dying of cancer: a systematic review and meta-analysis. JAMA Dermatol. 2019;155(12):1390-1403. 3. Kimball AB, Sundaram M, Cloutier M, et al. Increased prevalence of cancer in adult patients with psoriasis in the United States: a claims based analysis. J Drugs Dermatol. 2018;17(2):180-186. 4. Pouplard C, Brenaut E, Horreau C, et al. Risk of cancer in psoriasis: a systematic review and meta-analysis of epidemiological studies. J Eur Acad Dermatol Venereol. 2013;27(suppl 3):36-46. 5. Fiorentino D, Ho V, Lebwohl MG, et al. Risk of malignancy with systemic psoriasis treatment in the Psoriasis Longitudinal Assessment Registry. J Am Acad Dermatol. 2017;77(5):845-854. 6. Morizane S, Sugimoto S, Motoki T, et al. A case of psoriasis complicated by breast cancer after systemic treatments including biologics. Acta Med Okayama. 2018;72(2):185-187. 7. Subhadarshani S, Yusuf N, Elmets CA. IL-23 and the tumor microenvironment. Adv Exp Med Biol. 2021;1290:89-98. 8. Poelman SM, Keeling CP, Metelitsa AI. Practical guidelines for managing patients with psoriasis on biologics: an update. J Cutan Med Surg. 2019;23(suppl 1):3-12. 9. Smith CH, Yiu ZZN, Bale T, et al. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2020: a rapid update. Br J Dermatol. 2020;183(4):628-637. 10. Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80(4):1029-1072. 11. Barbieri JS, Wang S, Ogdie AR, et al. Age-appropriate cancer screening: a cohort study of adults with psoriasis prescribed biologics, adults in the general population, and adults with hypertension. J Am Acad Dermatol. 2021;84(6):1602-1609. 12. Magny SJ, Shikhman R, Keppke AL. Breast imaging reporting and data system. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. 13. Alkabban FM, Ferguson T. Breast cancer. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. 14. Oeffinger KC, Fontham ET, Etzioni R, et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA. 2015;314(15):1599-1614. 15. Practice Bulletin Number 179: Breast cancer risk assessment and screening in average-risk women. Obstet Gynecol. 2017;130(1):1-16. 16. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151(10):716-26, w-236. 17. Siu AL. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(4):279-296. 18. Rademaker M, Rubel DM, Agnew K, et al. Psoriasis and cancer. An Australian/New Zealand narrative. Australas J Dermatol. 2019;60(1):12-18. 19. Chiesa Fuxench ZC, Shin DB, Ogdie Beatty A, et al. The risk of cancer in patients with psoriasis: a population-based cohort study in the health improvement network. JAMA Dermatol. 2016;152(3):282-290. 20. Yang H, Brand JS, Li J, et al. Risk and predictors of psoriasis in patients with breast cancer: a Swedish population-based cohort study. BMC Med. 2017;15(1):154. 21. Peleva E, Exton LS, Kelley K, et al. Risk of cancer in patients with psoriasis on biological therapies: a systematic review. Br J Dermatol. 2018;178(1):103-113. 22. Wolinsky C, Lebwohl M. Biologic therapy and the risk of malignancy in psoriasis. Psoriasis Forum. 2011;17(4):238-253. 23. Menter A, Gelfand JM, Connor C, et al. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. J Am Acad Dermatol. 2020;82(6):1445-1486. 24. Nast A, Spuls PI, van der Kraaij G, et al. European S3-Guideline on the systemic treatment of psoriasis vulgaris - update apremilast and secukinumab - EDF in cooperation with EADV and IPC. J Eur Acad Dermatol Venereol. 2017;31(12):1951-1963. 25. Pathirana D, Ormerod AD, Saiag P, et al. European S3-guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol. 2009(suppl 2);23:1-70. 26. Saeki H, Terui T, Morita A, et al. Japanese guidance for use of biologics for psoriasis (the 2019 version). J Dermatol. 2020;47(3):201-222.

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