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Multiple Myeloma

Understanding Multiple Myeloma: Treatment Gaps, Racial Disparities, and Early Diagnosis

By September 10, 2023No Comments

Intro: Hi everyone. My name is Shaina Rozell. I’m a hematologist-oncologist here with Affiliated Oncology. I also practice out of Advocate Christ as well as Advocate South Suburban. My emphasis is both hematology and oncology so I see multiple myeloma. I run a genetics clinic at Advocate Christ and also am very instrumental in our teaching hospital at Advocate Christ. 

Hi, I’m Muhammad Kelta. I’m one of the practicing hematologist oncologists at Advocate Christ Medical Center and Affiliated Oncologists. I consider multiple myeloma one of my favorite topics. 

This is MD Newsline. Today’s topic is: Multiple Myeloma: Overcoming the Gaps in Treatment and Overcoming Disparities. 

Question: It’s my understanding that multiple myeloma impacts different populations differently. Can you talk a little bit about the differences in the prevalence and incidence of multiple myeloma in various populations and which populations are most heavily impacted? 

Answer: Multiple myeloma is considered a second malignant disorder. If you take newcomers, African Americans on average will have a double incidence as compared to Caucasians. 

The N1 incidence nowadays is considered around 36,000. African American represent 14% of the population and among patients with multiple myeloma, they are about 20%  compared to their Caucasian counterparts. 

It comes down to the genetics of it, nobody knows exactly the right answer as to why African American would have a higher incidence rate. As I said, it’s usually around 2% for all population, on average, African Americans would have double. 

Question: Now, you mentioned genetics are their epigenetic factors that, you know, we’ve identified.

Answer: So interesting, there are not really any epigenetics that we have identified. Those are the questions that we typically receive from our patients: Why did this happen? Is there something that I’ve done? Is there something, you know, related to any socio economic factors that may have contributed? But for this disease, unlike many others, there is none that we have really identified? 

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Question: Are there differences in the presentation and symptoms of multiple myeloma in different populations? And are there any key differences that you want to point out.

Answer: I generally don’t see a difference in the main presentation of multi myeloma, those who present usually have general symptoms usually fatigue and this is related to anemia, they may have weakness, they may have worsening kidney function, because of the myeloma protein. So for the most part, they really present similarly. 

However, the degree of reporting of those symptoms is different among different cultures. So some people tend to rate more symptoms, and they don’t present until the late stage where they have really very advanced disease. 

Yes, I would agree, I think, you know, in my practice, and even going to different areas in the city, if you’re more in an urban area versus a rural area, you would really see that degree or  difference in presentation. In certain cultures, we really understand that patients may go to each other, they may go to their churches, they may talk to family members about these symptoms and what to do, and everyone has their own antidote. And it’s not really until they’re at a later and advanced stage, that they actually seek medical attention. And that’s a whole plethora of reasons, right? We know the stigma that is associated with coming to see the doctor. So for that reason, we do see different populations, different minorities seeking health care at later or advanced stages. 

And then the other part of this story is that physicians may not recognize the symptoms early on, and they may blame the high blood pressure or diabetes for the symptoms. On average it can take about three visits for a medical physician to pick up multiple myeloma. Initially, it takes some effort from the patient to show up on time and stick to the right clinic. Go through the testing, lab testing and urine testing and some imaging study. So that’s why on average it takes 3 visits to get the diagnosis right.

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