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

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.

We evaluated the mammography results of female patients with psoriasis aged over 40 years 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.

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

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.

We suggest that female patients over 40 years, especially those 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.