Are my family members at greater risk of developing myeloma?

A complicated question that often comes up is whether patients with family members with multiple myeloma, they themselves are at a higher risk or not. This is kind of a difficult question because in general, this is a complex disease that is modulated both by things that you inherit and also by environmental risk. The two in this disease specifically are very intertwined. This is a disease of the immune system and one such hypothesis has been that because people in the same family are often exposed to the same environmental factors, the risk might be just the fact that they grew up together and were exposed to the same things. There have been studies that have shown that there are some small heritable factors that can influence and perhaps increase the risk. There have been studies that say basically that the risk for a family member is double, but again, this is a relative risk. The absolute risk is still quite low for family members with multiple myeloma. Even if, let's say, the risk is doubled relatively, we're talking about a decimal point increase to double that decimal point increase. It's still very small. The long story short is that we currently don't recommend screening of family members for multiple myeloma if a family member has it, mostly because we don't really know what to do with that information, but we do still recommend age-appropriate cancer screening. If a person is very interested in trying to learn more, simple blood tests can be sent to try to understand whether a patient might have risk of developing the disease. Just to expand on that in terms of one specific genetic test that we can send to see if there's a heritable feature for multiple myeloma, there is not. There may be certain small mutations, or I shouldn't say mutations. There are small changes or differences in people's genomes and people's genetics that might confer them a little bit of a higher risk of developing something like this, but there is no one gene, there is no one mutation like BRCA that can govern the risk of a person developing this cancer in the future. People often are concerned that if they have a new diagnosis of multiple myeloma that they will have family members, their children in particular, but other family members as well, who may be at risk for developing the disease. Almost all circumstances, the answer to that is we don't have any strong evidence to suggest a familial component. We do not recommend screening family members or doing any additional testing for folks, family members, if they have a diagnosis. So people should be able to rest easy. Now there is one exception to that. That exception is in rare instances we see what we call probands, but basically there seems to be a genetic aspect or relationship that is not well understood where certain families, very rare, but certain families seem to have a predisposition to myeloma. And what do we do in that situation? Well first of all, it's incredibly rare. There aren't actually guidelines on it, but if a person is diagnosed with myeloma and they had a parent with myeloma and a sibling with myeloma and a grandparent, if there are multiple people, I think it is worth having further discussion with their physician, even maybe getting some input from a geneticist. Maybe more important, well I shouldn't say more importantly, but because there's no specific guidance on what to do differently, but I think it is really important to identify those families, they would be helping the field if we could understand what is it in these rare instances that is causing multiple people in a family to have the disease. But that is so rare that there is no evidence that one should be looking for this in everyone. It would actually I think cause more problems than do good, because you put people through testing where you might find something that you weren't looking for, something that's actually a non-issue, you cause a lot of worry and concern for people, and it turns out to be nothing, not to mention the cost of doing all that screening. And we just don't see it as being frequent, as occurring frequently enough that it makes sense for anyone, not for the patient, not for the family member, not from a sort of global cost benefit analysis in no, at this point, no evidence to do it. Maybe the field will change in the future. If we understand those families better, maybe at some point we'll understand who some small group who should do some additional testing, but I would not tell my own family member if someone had myeloma that everyone else should have any change in how they're tested.