Multiple myeloma (MM) is a blood cancer that’s twice as common in the Black community as in other groups. Almost one-quarter of Americans with MM are Black. They’re twice as likely to die from this cancer as people of other races.

MM: Hard to Diagnose Early

Overall, people with multiple myeloma have a 5-year survival rate of 54%. That means 54% of people with MM are still alive 5 years after their cancer is found.

For the 5% of people who find their MM in the early stage, 75% are alive 5 years later. But about 95% of all cases of MM are diagnosed in later stages, when cancer has spread. When this is the case, only 53% of people with this diagnosis are alive 5 years later.

MM is tough to detect and diagnose in early stages. Early on, you may have no signs or symptoms that alert you to see your doctor. You may have vague symptoms that are mistaken for other conditions or ignored.

Delays in Diagnosis and Treatment

Earlier diagnosis can help Black people with MM have better results from treatment. Black people with MM tend to be diagnosed at a younger age than white people, or about 5-10 years earlier in life. But their diagnosis comes later in the course of their cancer than that of white people. They also take longer to start cancer treatments.

Delayed diagnosis and treatment may cause you to have more cancer complications and can even shorten your life.

Black people with MM who receive cancer treatments have good results. If you’re prescribed the latest treatments, you may be able to slow down or stop your cancer from getting worse.

  • One study of 639 people newly diagnosed with MM found that Black people diagnosed and treated at later stages of their cancer fared worse. They were also less likely than white people to receive newer, more aggressive combination drug treatments or an autologous stem cell transplant (ASCT) that can control their cancer.
  • Research shows that these newer treatments help people with MM live longer. In one recent study of 28,450 people with MM, Black people were less likely than white people to be prescribed stem cell treatment, especially if they were 60 or older.
  • Black people with MM wait longer to have a stem cell transplant. A study of 453 people with MM found that the median wait time for Black patients to get a transplant was 1.3 years. Once they had a transplant, Black patients in this study lived longer than white patients.
  • In another large study of people with MM on Medicare, Black people waited about twice as long as others to start one of the newer treatments after they were diagnosed.

 

Equal Treatment Access, Better Survival

When Black people with MM do receive aggressive treatments, they have better results and live longer. In a large study of military veterans with MM who received equal access to the latest cancer treatments, all people with MM ages 65 and older had the same survival rates.

Why the Delays?

People with MM who are diagnosed at an earlier stage of their cancer tend to have better results from treatment and live longer. But many people can wait 3 months or longer to get a diagnosis. Some people may see their primary care doctor a few times about their symptoms before they’re referred to a specialist and diagnosed with MM.

Doctors don’t often screen people for two very early, precancerous conditions that can progress to MM:

  • Monoclonal gammopathy of undetermined significance (MGUS): Black people have this condition more often than others. Black people in their 40s have even higher rates of MGUS, compared to others the same age.
  • Smoldering multiple myeloma (SMM): This condition is more prevalent in Black people than in white people. It may cause no or only mild symptoms. Black people who have it have twice the risk of death as people of other races.

Early screening could help diagnose Black people with one of these precancerous conditions before it turns into cancer.

Watching and waiting. Usually, doctors only spot MGUS when you have a routine blood test at your checkup. MGUS isn’t treated in most cases. Your doctor will watch you to see if you go on to have MM and then start treatment.

Doctors also usually don’t prescribe treatment for SMM. You wait to see if you go on to get MM and then treat the cancer. But a new study from Spain looked at people with high-risk SMM. It found that those who had early treatment with lenalidomide (Revlimid) and a steroid called dexamethasone, followed by a course of just lenalidomide, took longer to get active MM than people who waited without treatment. They also lived longer.

Better screening may catch cancer before it starts. Earlier, targeted screening for MGUS could help Black people spot their precancer condition much earlier. MGUS starts at a younger age in Black people than in other groups. Even at 30, Black people have a higher rate of MGUS than white people.

Right now, no one is screened for either MGUS or SMM. Most people with these conditions don’t have symptoms. These early-stage conditions are only noticed on a routine blood test or if someone happens to have symptoms.

If routine screening is done for Black people who have risk factors for MM, such as family history or older age, instead of only people with symptoms, it may help them track or treat their disease earlier. If screening shows they have MGUS, they can have a yearly blood test to check if they’ve progressed to cancer, and if so, get treated. If screening shows that they have SMM, they can start treatment sooner, delay MM, and may even live longer.

More Awareness Needed

Few Black people enroll in cancer clinical trials. Research shows that Black people make up about 20% of all Americans with MM, but only 4.5% of those in myeloma clinical trials. In these trials, Black people with MM have more access to the latest treatments, and cancer experts learn more about how this cancer affects them.

Many Black people may not be aware that they’re at higher risk for MM. Your primary care doctor may also not be aware of your higher risk. They may not screen Black people for MM because the early symptoms seem normal at older ages.

If Black people and their doctors are more aware of their higher risk and how to recognize the early signs of MM, they can test for MM earlier and start treatment sooner. 

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SOURCES:

Multiple Myeloma Research Foundation: “Understanding Multiple Myeloma in the Black Community,” “Diagnosis,” “Multiple Myeloma in Black Patients.”

Dana-Farber Cancer Institute: “Multiple Myeloma Presents Added Burden for African Americans.”

Nature: “How researchers are addressing the racial imbalance in multiple myeloma.”

International Journal of Hematologic Oncology: “Methods for reducing delays in the diagnosis of multiple myeloma.”

American Society of Clinical Oncology: “Multiple Myeloma: Statistics.”

International Myeloma Foundation: “How is myeloma different in African Americans?”

Blood Cancer Journal: “Racial differences in treatment and outcomes in multiple myeloma: A Multiple Myeloma Research Foundation analysis,” “Prevalence, incidence, and survival of smoldering multiple myeloma in the United States,” “Dissecting racial disparities in multiple myeloma,” “Prevalence of myeloma precursor state monoclonal gammopathy of undetermined significance in 12372 individuals 10-49 years old: a population-based study from the National Health and Nutrition Examination Survey.”

Cancer: “Hispanics have the lowest stem cell transplant utilization rate for autologous hematopoietic transplantation for multiple myeloma in the United States: A CIBMTR Report,” “Disparities in black and white patients with multiple myeloma referred for autologous hematopoietic transplantation: A single center study.”

Blood Advances: “Racial disparities in treatment patterns and outcomes among patients with multiple myeloma: a SEER-Medicare analysis.”

Blood: “With equal access, African American patients have superior survival compared to white patients with multiple myeloma: A VA study,” “FDA Analysis of Racial Demographics in Multiple Myeloma Trials.”

City of Hope: “Targeting multiple myeloma in black communities.”

The New England Journal of Medicine: “Lenalidomide plus Dexamethasone for High-Risk Smoldering Multiple Myeloma.”

Memorial Sloan Kettering Cancer Center: “Myeloma Precursor Disease Can Start Much Earlier than Expected, Especially in African Americans.”

National Cancer Institute: “Multiple Myeloma Awareness and African American Disparities.”

American Cancer Society: “Can Multiple Myeloma Be Found Early?”