April 13, 2017, by Dr. Shaji Kumar, Dr. Rich Little, & Catasha Davis
As part of Minority Cancer Awareness Week, we want to discuss cancers that disproportionately affect minorities. One such cancer is multiple myeloma.
So, what is multiple myeloma? It is a rare and incurable cancer of a person’s white plasma cells, the cells that fight infection and disease, and it can permanently weaken bones and damage organs.
African Americans are not only at twice the risk of developing multiple myeloma when compared to white Americans, they are also more likely to be diagnosed at a younger age. African Americans, on average, are diagnosed around 66 years old, while white Americans are around age 70.
There are many reasons why these disparities exist, and one reason is low levels of awareness. In African American communities, even among primary care physicians, there simply isn’t enough awareness about the disease itself and how it effects the community. Without proper awareness, those who are at the highest risk cannot take the necessary precautions needed to find the disease and treat it.
If a patient presents with signs or symptoms of the disease, the patient and their doctor may not know they should be tested for multiple myeloma. Often the common symptoms of multiple myeloma—unrelenting back pain, weakness, tiredness, frequent urination and constipation—get confused with symptoms of “just-getting older.” Primary care physicians who are aware that their patients are at higher risk for multiple myeloma may run additional blood and urine tests.
Another important factor that contributes to these disparities is access to health care and services. About 51% of African Americans under the age of 65 and 28% over 65 have private insurance, in comparison to 67% of white Americans under 65 and 44% over 65. (CDC, 2015). These differences in insurance coverage may result in different experiences in treatment.
A study by Warren and colleagues (2013) among patients with newly diagnosed multiple myeloma found that non-white recipients of Medicaid or Medicare were significantly less likely to be treated with novel agents or transplant when compared to non-white patients with private insurance. African Americans make up a quarter of Medicare patients and a quarter of Medicare Advantage patients.
Finally, researchers must continue to work to understand multiple myeloma in African American populations. There is some debate about why African Americans are at greater risk. Some research suggests the cause may be environmental factors such as exposure to radiation, but other research points to genetic factors playing a role. One way to better understand the effect of multiple myeloma in African Americans is by increasing their participation in clinical trials.
NCI’s Cancer Therapy Evaluation Program has several trials including the Endurance E1A11 Study, which seeks to better understand the best treatment for multiple myeloma. Clinical trials like the Endurance Study benefit when African Americans diagnosed with multiple myeloma understand the treatments available and make an informed decision to participate in clinical trials.