Should individuals diagnosed with Smoldering Multiple Myeloma take bone strengthening agents?

00:00:08:14 - 00:00:12:10 Should there be screening for precursor conditions as part of routine care? 00:00:12:13 - 00:00:14:14 There has been two studies that have been done to date 00:00:14:17 - 00:00:17:16 the iStop study in Iceland where they screened basically their whole 00:00:17:16 - 00:00:21:02 population, 80,000 people, and they're following them to date. 00:00:21:07 - 00:00:24:17 And we decided on using a more risk stratified approach. 00:00:24:20 - 00:00:28:01 We said, let's screen people who are at risk of developing 00:00:28:03 - 00:00:31:04 multiple myeloma so that we're not screening the whole general population. 00:00:31:08 - 00:00:33:11 So we're screening people who are African-American 00:00:33:11 - 00:00:34:16 or of African descent 00:00:34:19 - 00:00:35:05 or people 00:00:35:05 - 00:00:39:06 who have a first degree family member with a plasma cell or a blood cancer. 00:00:39:10 - 00:00:43:09 So think mom, dad, sisters, brothers, because now they have a much higher risk 00:00:43:14 - 00:00:45:03 of developing a monoclonal protein. 00:00:45:05 - 00:00:49:04 And we also use a much more sensitive test called mass spectrometry, 00:00:49:06 - 00:00:52:21 instead of using the traditional methods of serum protein electrophoresis. 00:00:53:01 - 00:00:55:12 And by doing that, you need to ask the question, 00:00:55:15 - 00:00:57:18 is there a benefit for someone to be screened? 00:00:57:18 - 00:01:00:18 And the answer is, if I can find MGUS at an early stage, 00:01:00:21 - 00:01:02:13 we like potentially treat that patient 00:01:02:13 - 00:01:04:14 to prevent progression and change the survival. 00:01:04:17 - 00:01:06:15 And if the answer is yes, then we should be screening 00:01:06:15 - 00:01:09:11 everyone instead of waiting for it to be incidentally found. 00:01:09:14 - 00:01:12:23 Now I think of cancer screening saves lives and there are four cancers 00:01:13:02 - 00:01:17:11 that we currently screen for, breast, colon, as well as cervical cancer. 00:01:17:16 - 00:01:18:17 And if you think about it, 00:01:18:20 - 00:01:22:23 why are we not screening with a blood sample to look for monoclonal gammopathy 00:01:23:02 - 00:01:24:06 or other blood cancers? 00:01:24:09 - 00:01:28:08 Once we show that indeed we can do it, and because we can treat those patients, 00:01:28:11 - 00:01:29:15 think about smoldering myeloma, 00:01:29:15 - 00:01:31:22 we can treat those patients as changed their survival. 00:01:32:01 - 00:01:34:23 And you can notice that smoldering myeloma, unless we find it 00:01:34:23 - 00:01:39:01 either incidentally, because by chance your doctor tested it or by screening. 00:01:39:06 - 00:01:42:17 So if you screen and you won't do anything until they are at the point 00:01:42:19 - 00:01:46:13 of changing from that normal phenotype to a malignant phenotype from 00:01:46:15 - 00:01:49:11 there is no chance of progression to yes, there is a chance of progression. 00:01:49:11 - 00:01:50:09 I would do something. 00:01:50:12 - 00:01:52:05 That's when you could potentially cure them. 00:01:52:08 - 00:01:54:12 But you also need to screen them to find them 00:01:54:12 - 00:01:56:22 so that it's not by pure chance that your doctor found it. 00:01:57:01 - 00:01:59:14 It's truly because you're at risk and then they found it. 00:01:59:17 - 00:02:03:02 I would also not advocate to screen the general population because 00:02:03:05 - 00:02:06:11 still the numbers are low despite this showing that the numbers are much higher. 00:02:06:15 - 00:02:10:16 You need to really think of who is at risk and how to stratify that so 00:02:10:17 - 00:02:13:22 that we're only screening people at risk and not the gender of population. 00:02:14:02 - 00:02:17:15 And it's the same for colon cancer and for breast cancer and cervical cancer. 00:02:17:18 - 00:02:21:14 We don't screen everyone with screening either at a certain age or people 00:02:21:17 - 00:02:23:01 who are really at high risk. 00:02:23:04 - 00:02:26:01 Lung cancer is the fourth one, especially for smokers. 00:02:26:04 - 00:02:28:23 So as we improve on it, we will get to screening. 00:02:28:23 - 00:02:31:08 It's an easy, simple test. 00:02:31:10 - 00:02:34:08 It’s highly specific and sensitive, which is the mass spectrometry 00:02:34:08 - 00:02:35:19 or serum protein electrophoresis. 00:02:35:22 - 00:02:37:10 It's easy to do, it’s a blood test. 00:02:37:12 - 00:02:40:04 Risk stratify patients and you can do something about it. 00:02:40:04 - 00:02:44:05 So it meets all the criteria of a potentially valuable 00:02:44:08 - 00:02:45:18 cancer screening tests. 00:02:45:20 - 00:02:48:06 So myeloma is obviously a rare disease. 00:02:48:06 - 00:02:52:17 So when you think of a screening test, you think about, 00:02:52:19 - 00:02:53:16 first of all, 00:02:53:16 - 00:02:56:17 what is the chance I'm going to find something. 00:02:56:20 - 00:03:01:02 And then the second part is if I do, 00:03:01:05 - 00:03:02:14 am I going to have an intervention 00:03:02:14 - 00:03:05:08 that's going to make a difference in terms of people living longer. 00:03:05:08 - 00:03:09:01 So it's a sort of a cost benefit analysis. 00:03:09:03 - 00:03:12:00 And I think in myeloma, if you think about it, first of all, 00:03:12:03 - 00:03:15:01 we don't even have agreement on people of smoldering myeloma 00:03:15:01 - 00:03:16:00 they should be treated. 00:03:16:00 - 00:03:19:12 So therefore, going back to screening for them, 00:03:19:15 - 00:03:24:04 I think is not necessarily something we should do. 00:03:24:06 - 00:03:27:05 Having said that, there is an initiative in Iceland 00:03:27:05 - 00:03:30:21 where they are obviously screening their entire population 00:03:30:22 - 00:03:35:03 for M proteins. 00:03:35:05 - 00:03:38:08 And not surprisingly, 00:03:38:11 - 00:03:41:17 you find it in a percentage of the population 00:03:41:20 - 00:03:44:19 because as you get older, it's not uncommon to develop 00:03:44:22 - 00:03:47:14 monoclonal gammopathy or abnormal M proteins. 00:03:47:14 - 00:03:51:07 But again, in the absence of showing that finding, 00:03:51:10 - 00:03:55:07 it isn’t going to make any difference in your life. 00:03:55:09 - 00:03:58:18 I don't think screening in that sense is is warranted. 00:03:58:20 - 00:04:03:16 There are certain populations maybe, for example, we and people have talked about 00:04:03:18 - 00:04:07:03 if you have multiple first degree relatives with it 00:04:07:04 - 00:04:10:10 because there is some familial, slightly 00:04:10:13 - 00:04:13:21 increased risk potentially perhaps, 00:04:13:21 - 00:04:15:10 patients who had 00:04:15:13 - 00:04:18:22 a develop it at a younger age and African-American again, 00:04:19:01 - 00:04:21:20 then you've sort of had a couple things to think about. 00:04:21:20 - 00:04:24:07 If you're a first degree relative or something like that, maybe. 00:04:24:08 - 00:04:26:13 So I think that's a little bit more individualized, 00:04:26:13 - 00:04:29:09 but certainly not generalized population screening. 00:04:29:09 - 00:04:30:23 We're not ready to do that.