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Key words: multiple myeloma, race, epidemiology, etiology
Summary
Multiple myeloma is an uncommon disease, with approximately 12,000 cases per year diagnosed in America. Blacks have had at least double the risk of being diagnosed with myeloma, and have had twice the mortality rate from the disease compared to whites [1]. Research of the origins of this difference has yielded both insight and controversy. Obesity is likely a risk factor for myeloma, in both blacks and whites. Obesity is more prevalent in the black population, and this may help explain some of the increased incidence of myeloma. Also, genetic factors such as HLA antigens and family history seem to be important in explaining the differential risk of myeloma. Exposure to immunological challenges, especially urinary tract infections in black men, seems important in explaining some of the excess risk in blacks. Factors such as socioeconomic status, dietary preferences, vitamin intake, alcohol and tobacco use, either lack a consensus .nding, or may not play a role in explaining the increased myeloma morbidity and mortality in blacks.
Introduction
Multiple myeloma is an uncommon disease, with approximately 12,000 cases per year diagnosed in America. The SEER database, a large, populationbased database, has shown that blacks have had at least double the risk of being diagnosed with myeloma, and have had twice the mortality rate from the disease compared to whites. This relationship has lasted for the 25 years between 1973 and 1998 [1]. Research into the origins of this difference has yielded both insight and controversy.
Attempts have been made to explain this increased risk of myeloma incidence and mortality in blacks by examining environmental factors such as immune system challenges, diet, tobacco, alcohol, obesity, distance from treatment centers, and socioeconomic status, and genetic factors such as family history and human leukocyte antigen phenotypes.
Monoclonal gammopathy of undetermined signi .cance (MGUS) is theorized to be a premyelomatous condition. It clearly is a risk factor for multiple myeloma. Patients with MGUS have an M-protein in the serum without .ndings of multiple myeloma, macroglobulinemia, amyloidosis, or lymphoma and with fewer than 10% plasma cells in the bone marrow. These patients are asymptomatic and are not to be treated. Approximately 2% per year will progress to develop one of the symptomatic B-cell...