Hidradenitis Suppurativa Tied to Increased Cancer Risk

By Marilynn Larkin

June 04, 2020

NEW YORK (Reuters Health) - Hidradenitis suppurativa (HS) was associated with an increased risk of cancer in a population-based study in Korea.

Dr. Mi Woo Lee of the University of Ulsan College of Medicine in Seoul investigated overall and specific cancer incidence rates in more than 22,000 HS patients and close to 180,000 matched controls. The mean age was 34 and 64% in both groups were male.

As reported in JAMA Dermatology, comorbidities were more common in HS patients than controls, such as hypertension (13% vs.11.5%), type 2 diabetes (7.9% vs. 5.4%), dyslipidemia (12.7% vs. 9%) and chronic kidney disease (0.6% vs. 0.4%).

The adjusted hazard ratio of cancer overall was 1.28. Specifically, HS patients were at significantly higher risk for Hodgkin lymphoma (aHR, 5.0), oral cavity and pharyngeal cancer (OCPC; aHR, 3.10), central nervous system cancer (CNS; aHR, 2.40), nonmelanoma skin cancer (HR, 2.06), prostate cancer (aHR, 2.05) and colorectal cancer (aHR, 1.45).

The overall cancer risk was not significantly higher in female HS patients than in female controls (aHR, 1.15). However, female HS patients had a higher risk of OCPC (aHR, 3.95) and colorectal cancer (aHR, 1.79).

By contrast, the overall cancer risk was significantly higher in male HS patients than in male controls (aHR, 1.37), and male patients had a higher risk of Hodgkin lymphoma (aHR, 8.68), CNS cancer (aHR, 3.14), OCPC (aHR, 2.80), nonmelanoma skin cancer (aHR, 2.73), and prostate cancer (aHR, 2.05)

Further analyses revealed higher overall cancer risks in both younger (<40 years: aHR, 1.34) and older (aHR, 1.26) HS patients compared with their age-matched controls, and in patients with moderate-to-severe disease (HR, 1.49) compared with mild disease (HR, 1.24).

Dr. Suzanne Friedler, Clinical Instructor of Dermatology at Mount Sinai Medical Center in New York City, commented in an email to Reuters Health, "HS patients tend to be overweight, depressed and have more comorbidities than the general population. This includes obesity, diabetes, hyperlipidemias, hypertension, alcoholic liver disease, chronic obstructive pulmonary disease and heart disease. Being in a chronic inflammatory state is a risk factor for cancer, as are the comorbidities."

"It is hard to say how much these concurrent conditions contributed to the development of the cancers and whether this study, which only looked at Korean patients, would hold up when applied to other ethnic groups," she said. "It is clear that patients with HS need to be counseled on healthy behaviors to reduce their risk factors for obesity, diabetes, alcoholism, etc. Any underlying conditions should be treated promptly and physicians should be on the lookout for any signs of cancer or other systemic disease."

Dr. Gretchen Frieling, a dermatopathologist in Wellesley, Massachusetts, commented by email, "Clinicians should be aware of this association and apparent increased (cancer) risk. They should educate their patients on these risks and symptoms to be aware of. There should be a lower threshold for cancer screening in these patients."

She also advised, as Dr. Friedler noted, that patients be counseled on a healthy diet and lifestyle.

Dr. Lee did not respond to requests for a comment.

SOURCE: https://bit.ly/2Xma630 JAMA Dermatology, online May 27, 2020.