• Multiple myeloma occurs twice as often in Black Americans as in white Americans.
  • Genetic differences, environmental factors, and disparities in healthcare access all contribute to the increased rate of diagnosis in Black people.
  • Multiple myeloma has a better outlook in Black people than in white people when they have equal access to care.

Multiple myeloma (MM) is a type of cancer that affects bone marrow plasma cells.

Plasma cells are part of adaptive immunity. This means they make antibodies in response to harmful invaders like bacteria and viruses. When MM attacks plasma cells, however, it interferes with antibody production and reduces the body’s ability to fight infection.

Because MM suppresses the immune system, people with this cancer are more likely to experience recurring infections.

MM is rare in young people. According to the American Cancer Society, fewer than 1 percent of MM cases occur in people ages 35 and under, and most diagnoses occur in people over age 65.

Males develop MM slightly more often than females. Other factors can also increase the chance of diagnosis. These include:

  • family history
  • obesity and overweight
  • history of other plasma cell diseases

While MM can affect people of all races, Black Americans are twice as likely to be diagnosed as white Americans. The research includes people who self-identified as Black and people designated as Black by researchers.

This disparity raises questions about possible causes and how to bridge the gap to improve outlook.

What is MGUS, and why is it important?

MM begins with a blood abnormality called monoclonal gammopathy of undetermined significance (MGUS). It has no symptoms and is characterized by an atypical protein found in blood without any other MM criteria.

MGUS can remain premalignant (not yet but may become cancerous), or it can progress to become smoldering multiple myeloma (SMM) and finally MM.

MGUS and SMM always happen before MM, though many people who have MGUS or SMM never develop cancer. Only a small percentage of people develop malignant (cancerous) MM.

MGUS occurs in the general population, and rates of diagnosis increase with age. However, it’s found more often and diagnosed at earlier ages in Black Americans. This means they have an increased risk of developing MM.

A 2014 study of 13,000 people showed found 2.4 percent had MGUS. The prevalence was higher for some racial groups and lower for others. Prevalence is the actual occurrence of a condition in a population.

In the study, MGUS affected:

  • 3.7 percent of Black people
  • 2.3 percent of white people
  • 1.8 percent of Hispanic people

Asian Americans have been found to have lower rates of occurrence than non-Hispanic white people.

While more research is needed to understand why there are racial and ethnic disparities in MGUS and MM risk, some factors that may include:

  • family history and genetics
  • obesity
  • socioeconomic factors

Research from 2020 has revealed clusters of both MM and MGUS in Black families. There appears to be a higher heritable prevalence than in white families.

While there may be some genetic differences at work, it’s unclear how much — if at all — they influence the higher rates of MM diagnoses in people of color.

Other possible factors that may lead to MM, like obesity and type 2 diabetes (T2D), both have a higher prevalence in the Black American population. This may partially account for the increased MM diagnoses seen in this group.

Studies on socioeconomic factors and their relationship to racial differences in MM have found mixed results. More research is needed to determine if and how they contribute to the observed increase in MM risk for Black people.

What role might genetics play in MM outcomes for people of African ancestry?

It’s unclear whether Black people are more likely to have genetic variations that influence their chances of developing MM or the severity of the disease.

Research from 2021 shows they are more likely to have immunoglobulin heavy chain gene translocations on chromosome 14. This suggests a higher risk of the condition.

They are less likely to have a deletion of the gene TP53/17p, an indicator of pathology and shortened survival. This is positive, meaning they’re less likely to have the cancer and more likely to survive it if they do.

Black people are also less likely than white people to have monosomy 13 and monosomy 17, per a 2020 research analysis. These are MM prognostic markers used to measure the progress of a disease and guide treatment options.

Overall, Black people may have a more favorable prognosis after MM diagnosis, according to data from the National Cancer Institute.

Some research suggests that despite these favorable prognostic factors, Black people may fare more poorly because of socioeconomic factors, such as reduced access to care or reduced use of treatments.

More research in this area is needed to help address these disparities and enable equal access to care and treatment for all people who can benefit from it.

How do the rates of MM diagnosis in people of color compare?

The increased prevalence of MGUS in Black Americans leads to a significantly higher rate of MM diagnosis in this population. As of 2018, myeloma diagnosis rates by race were as follows:

  • Black (including Hispanic): 14.6 per 100,000 people
  • American Indian and Alaska Native (including Hispanic): 7.6 per 100,000 people
  • Hispanic (any race): 7.3 per 100,000 people
  • White (including Hispanic): 6.7 per 100,000 people
  • Non-Hispanic white: 6.6 per 100,000 people
  • Asian and Pacific Islander (including Hispanic): 3.8 per 100,000 people

According to the National Cancer Institute, MM is diagnosed in Black Americans at around age 66. The average age of diagnosis in white Americans is 70.

How is MM diagnosed?

Healthcare professionals usually find MGUS unintentionally during blood tests done for other conditions, like anemia, bone problems, or kidney disorders.

If a doctor suspects MM, they can order additional tests such as urine, bone marrow, and imaging.

How much community awareness is there about MM?

Community awareness can lead to better outcomes in healthcare because patients know when and how to self-advocate. Doctors also know to run additional tests when presented with common symptoms.

MM is a relatively rare cancer and isn’t well known in Black communities. Even primary care physicians can incorrectly assume that natural aging is the culprit behind many of the usual MM symptoms, such as:

  • back pain
  • frequent urination
  • fatigue
  • weakness
  • constipation

Doctors need to be aware of racial differences in prevalence or family history of MM to avoid missing diagnoses and treatment opportunities.

Screening for MM can enable early detection and result in prompt intervention.

Cancers like prostate, breast, and colon are part of routine screening, and a simple blood test is all that’s required to identify plasma cell abnormalities associated with MM.

Targeted screening in higher-risk populations like Black Americans can speed up their treatment process.

Are there socioeconomic factors that affect diagnosis and treatment?

Access to healthcare services is an important factor for condition diagnosis and treatment. A smaller percentage of Black Americans than white Americans have access to private insurance, according to the National Cancer Institute.

People who are under age 65 with private insurance include 51 percent of Black Americans and 67 percent of white Americans.

People who are over age 65 years with private insurance include 28 percent of Black Americans and 44 percent of white Americans.

Less insurance coverage can mean fewer diagnostic steps and reduced treatment options.

Can clinical trials help people of color?

Clinical trials bring new life saving treatments to people who need them, and they often give early access to those treatments for trial participants.

However, a trial is only beneficial to the type of patient it represents. Too often, minority populations are underrepresented in trials, so the outcomes may not fully target the needs of their communities.

Black Americans are one such community. A series of lung cancer trials described by The American Society of Clinical Oncology had an African American participation rate of only 4 percent, and Black participants were similarly underrepresented in other cancer trials.

How effective is treatment?

MM may not be curable but it is treatable. The goal of treatment is to control cancer progression and improve quality of life.

Treatment usually starts after the stages of MGUS and SMM, when those affected have developed symptomatic MM.

Treatments for MM include:

  • high dose therapy
  • autologous stem cell transplantation
  • immunomodulatory drugs
  • proteasome inhibitors
  • monoclonal antibodies
  • histone deacetylase inhibitor
  • nuclear transport inhibitor
  • antibody drug conjugate

Public health experts agree that when MM outcomes are poorer for African Americans, it’s the result of socioeconomic factors that restrict access to timely and quality medical care.

In fact, multiple myeloma has a better outlook in Black people than in white people when they have equal access to care.

Is outlook better with early intervention or tailored treatment?

Whether early interventions can help people with MM depends on the stage or type of abnormality present.

Healthcare professionals will treat solitary plasmacytomas, or single plasma cell tumors, with radiation or surgery.

SMM is asymptomatic and treatment isn’t required. Instead, people with SMM are monitored in case they develop MM, at which point they’ll begin treatments.

How does outlook in people of color compare?

Despite the fact that the rate of diagnoses in Black Americans is double the rate in white Americans, the 5-year outlook appears to be much closer, based on the National Cancer Institute’s SEER database:

  • African Americans: 53.3 percent of people with the disease survived five years
  • White Americans: 50.9 percent of people with the disease survived five years

One study found that with standardized treatments, Black people have a better median survival time than white people — 7.7 years for African Americans versus 6.1 years for white Americans.

However, other studies have found no differences in median survival time. These studies may have been limited due to low numbers of Black participants.

It’s theorized that the better outlook for Black Americans could be the result of their lower incidence of chromosomal abnormalities t(4;14) and TP53, which are associated with high risk MM. White people have these abnormalities more often.

MM is a blood plasma cancer usually found in older adults. It’s diagnosed approximately twice as often in Black Americans as in white Americans.

Higher instances of the MM precursor MGUS occur in Black populations, as well as other MM predictive factors like family history, T2D, and overweight. However, it’s unclear whether genetic differences play a role in increased diagnosis.

Insufficient community awareness about MM, as well as reduced access to healthcare, likely play a role in the higher number of diagnoses in Black people. These communities are also underrepresented in clinical trials.

Increasing community awareness, access to adequate healthcare, and participation in clinical trials are all ways in which the Black population can close the diagnosis gap, reduce MM incidence, and improve treatment outcomes.