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Multiple Myeloma is More Common in African Americans: Here’s What You Need To Know

Multiple Myeloma is More Common in African Americans: Here’s What You Need To Know

Multiple myeloma, a cancer that occurs in white blood cells, is considered a rare disease because it makes up a tiny amount of overall cancers. But it’s less rare in African Americans than in others. Blacks are twice as likely to develop multiple myeloma than whites. In fact, about 2 percent of all cancers in blacks are multiple myeloma, compared to 1 percent in whites.

Blacks are also usually younger than whites when multiple myeloma is diagnosed. The average age of diagnosis is 66 years old in black patients and 70 years old in white patients. The more encouraging news is that multiple myeloma in black patients may be less aggressive than it is in others, possibly because of genetic differences.

But how is the disease so different between blacks and whites? Scientists don’t have all the answers, but here’s what they do know.

Why does multiple myeloma occur more often in blacks than in whites?
It’s not completely clear why multiple myeloma is more common in African Americans, but researchers have found some contributing factors. A 2014 study of nearly 12,500 patients found blacks are more likely than whites to have a condition that increases risk of multiple myeloma. It’s called monoclonal gammopathy of undetermined significance (MGUS).

MGUS occurs when your blood contains an abnormal protein called M protein. Almost all multiple myeloma patients have MGUS. Different types of MGUS also exist, and the type more likely to lead to multiple myeloma is more common in blacks. But scientists still aren’t sure why.

Many people with MGUS never develop multiple myeloma, so it cannot completely explain the higher rates in blacks. Both environmental factors, such as radiation exposure, and genetic factors are probably involved. Right now, clinical trials need to include more black patients for scientists to learn more.

Still, the disease remains rare even in black patients. Of approximately 30,280 cases of multiple myeloma each year, fewer than 7,000 of those cases will occur in African Americans.

How is the disease different in black patients?
Some characteristics of the disease, such as higher rates of anemia, a condition characterized by too few red blood cells, are more common in black multiple myeloma patients. But most identifying characteristics of multiple myeloma are similar across patients of all races.

One study compared lab tests in nearly 300 black and white patients with multiple myeloma. The researchers looked at rates of anemia, high calcium levels (hypercalcemia), high creatinine levels (a waste product that indicates kidney problems when it’s high) and bone lesions where the cancer has damaged the bone. Aside from anemia, these measures were similar across all patients.

How does multiple myeloma differ genetically in black patients?
Multiple myeloma has about seven different subtypes based on people’s genetics. Some genetic subtypes respond better to therapy than others.

A 2015 study looked at four of these in more than 700 patients and found differences between blacks and whites. While 65 percent of white patients had one of the four genetic subtypes studied, only 37 percent of black patients did. (Presumably, black patients would have a higher percentage of subtypes the researchers did not look at.) The subtypes called t(11;14), t(4;14), monosomy 13/del13q and monosomy 17/del17p all occurred approximately half as often in black patients, depending on the subtype.

Does race affect patients’ treatment or likelihood of survival?
It’s complicated. When scientists study differences in treatment response and survival rates among different races and ethnicities, they try to figure out how much the differences are due to biology and how much they are due to social circumstances. For example, not as many black patients have private insurance compared to white patients. That could affect how much treatment they receive or the quality of the treatment.

Although blacks might be more likely to have a less aggressive cancer and survival rates are slightly higher in blacks, survival is mostly similar across all races and ethnicities when patients receive the same care. However, black patients overall do not receive the same level of care, or at least as quickly, as whites do.

Black patients are less likely to receive stem cell transplants than white patients, and, in one study, it took an average of 5 months longer for black patients to receive a referral than white patients. But after receiving a transplant, survival rates were similar regardless of race, around 6 years.

Black and white patients might respond a little differently to some therapies, though it’s not clear yet and the differences are minor. In the 2015 study, all patients had similar overall response rates to starting medication that readjusts the immune system, but more white patients had a deeper response to the therapy.

More recently, a 2018 study found little difference in survival rates across different races, but it did find minority patients were less likely to receive newer treatments. So, speak with your doctor about all the options available so you can decide together what therapy is best for you.

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