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Question: So how does multiple myeloma typically start? At which point in that journey do the people who are most impacted end up in front of a doctor?

Answer: I would say those patients who actually seek care or who actually go to the doctor may be getting blood tests. And that astute position may say, “I see a protein gap, something may be up. And I would refer you to a hematologist who is then going to evaluate you for that”. But it’s different for those patients who don’t even seek health care from a general internist or a primary care doctor, right. And so as Dr. Kelta was saying, many times they’re attributing their back pain to something else and by that time, now, they already have some lytic lesion or change in their spine. And that is considered multiple myeloma. And so in that that case, that patient is coming at a later advanced age. On the flip side, again, you may have patients who are a little bit more aggressive in getting bloodwork and following up and taking a little bit better care for themselves. As far as going to the doctor regularly, they may be diagnosed earlier. 

Questions: Are there any key symptoms? And if not, how can people get to early detection?  

Answer: I think it’s very hard to diagnose multiple myeloma. In fact, there is no screening test for multiple myeloma and it’s not like you’re going to your doctor for a mammogram or you’re going to get your colonoscopy, this is a little bit different. A lot of times you’re not detected until you have symptoms or until you’re having just plain old blood work that prompted someone to actually decide that this needed to be investigated more. So I think that’s a challenge for diagnosing multiple myeloma. And at this current time.

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There’s no standard screening for male we have the PSA, we have the colonoscopy. For females we have a mammogram, but there is no standard screening test for multi myeloma. However, when patients present to their primary care physician and they have unexplained hypercalcemia, or they have unexplained worsening kidney function, this can trigger some of the workup. On average, we have two blood tests that we do and one urine test that for the most part, will give us almost 97% certainty that we have something called Plasma cell dyscrasias in which myeloma is reported. So yes, there is no standard testing. However, there are tests which once they’re done, they are very informative.  

But I think also you have to really be an astute physician, because how many patients are coming in for worsening kidney function that you may attribute it to high blood pressure or diabetes. The first thing that doesn’t come on your radar is multiple myeloma, right? It’s, let’s fix their blood pressure, let’s fix their diabetes. It is not until you actually see things that are concerning in the blood tests that make you say hmm could something else be going on.

And that’s what makes it a challenging diagnosis. And that’s part of the delay in getting the diagnosis right and then starting correct treatment.

Unfortunately, there is no, there’s no test.I have patients who are very healthy who have been diagnosed with multiple myeloma, on the flip side of patients who have a lot of medical comorbidity, who also have been diagnosed with multiple myeloma. And the unifying theme is maybe they may have a gene mutation. Maybe they’ve lived in a certain population. We don’t know. Maybe they have a family history. There’s still no identifiable feature even in family history. So I know we wish we had an answer. We don’t unfortunately, we don’t guys, we do not have an answer. I wish we had one but we don’t. 

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