What are the risk factors of developing myeloma?

What are the risk factors for developing myeloma? In general, this is a very actively studied research question and there are some things that we know but there are many things that we don't know and that may reflect the fact that we don't know a lot of the risk factors associated with myeloma. In general, with multiple myeloma and as with many other blood cancers, some of the risk factors that we do know about include industrial solvents and other chemicals, certain pesticides and fertilizers, but at the individual level it's always hard to say what may have caused one's myeloma. It's a little bit easier to see those sort of risk factors at the population level. We do see though a very interesting dynamic with race, ethnicity and sex with myeloma in that African Americans compared to white Americans have a higher incidence and men compared to women have also a higher incidence. The number one risk factor for myeloma though overall continues to be really age in that we see myeloma to being a disease of the elderly and less so of those in the young. We do not typically think of myeloma as being a very heritable condition, but we do see family clustering again at the population level for reasons that we don't fully understand. It implies that there is some sort of genetic underpinning which is a very active area of research right now. There's some ongoing cohort studies that have been trying to answer this question and we'll hopefully see some more data come from them in the coming years. So there are some diseases where we know a lot more about exposures or various factors that predispose, but here's what we know from the population-based and epidemiologic studies as well as of course by observing how our patients present and what do they look like. One very important factor is age. As we all know, it's the disease of older age and the average or the median age at diagnosis is between 65 to 67 or 67 to 69 years. So again, older age is one risk factor. Again, that doesn't mean that it doesn't happen in younger patients, but only about 10% of myeloma patients are younger than 50 and only about 2% are younger than 40. So those of us who take care of myeloma patients do see younger patients, but then they are obviously far rarer than older patients. Second thing in terms of race or ethnicity, for unknown reasons, and again, a lot of work is being done and research is going on, but in the United States, it would be African-Americans, but even Africans outside of the United States in the continent, studies show are at greater risk and the incidence in African-American population in the United States is about twice that of non-African-Americans here. So that is another group that is at greater risk of developing multiple myeloma. We do not fully understand the mechanisms where people are, of course, doing the work. It is relatively more common in men. Most of the population-based studies, it's about 1.5 to 1 ratio, 1.4 to 1 ratio in men. So it's a rare disease, but in patients where one family member is involved, other family members are at a slightly higher risk of developing multiple myeloma. Again, it's a rare disease and there are no universal guidelines for screening the families, but studies have pointed out that there could be a three to four-fold increase of myeloma incidence in families. And then there are some studies that have pointed out that perhaps increased body weight may be associated with greater risk. So these are some of the risk factors where there is an agreement and where there are more data about myeloma. So myeloma is in general a rare cancer. It's the second most common cancer in people in the older age group, but second most major hematologic cancer in the older age group. But as far as the risk factors go, most of these myelomas tend to begin life as an MGUS, or a monoclonal gammopathy of undetermined significance. So first of all, if you have an MGUS, then you have a greater chance of developing myeloma. Secondly, it's a disease of the older age group. So older age obviously is a risk factor for myeloma. And then patients with certain ethnicity, like African Americans, tend to be younger when they're diagnosed with myeloma, and they tend to have a higher risk for developing the disease. And even though we don't say it's an inherited condition, it is not passed on from your parents to the kids, but if you have members in your family which have been diagnosed with myeloma, it does increase your risk of developing the disease as well. Is there evidence that exposure to environmental factors can cause myeloma? Yeah, so as far as environmental factors go, we don't have a clear association with environmental factors, but it has been reported that people who may have been exposed to Agent Orange may have had a higher risk of developing myeloma. And even patients with certain infections like advanced HIV, they generally have a higher risk for developing malignancies, and multiple myeloma could be one of those as well.