Introduction to Multiple Myeloma
For more than a year, Diane Hunter, now 72, had been experiencing vague symptoms — pain in her spine and hips, nausea, exhaustion, thirst, and frequent urination. Her primary care physician had ruled out diabetes before finally chalking up her ailments to getting older. But months of intense back pain eventually landed her in the emergency room, where a doctor suggested that Hunter might have multiple myeloma. Hunter’s first question was, “What is that?”
Understanding Multiple Myeloma
Multiple myeloma is a cancer that develops in bone marrow plasma cells, crowding out healthy blood cells and damaging the bones. It is one of the most common blood cancers — and the most diagnosed among African Americans. The mortality rate from multiple myeloma also is higher among African American patients than white people, with a number of studies showing that, in addition to disease biology, societal factors such as socioeconomic status and lack of access to health insurance or medical services delay timely diagnoses.
Delayed Diagnoses and Racial Disparities
A belated diagnosis is what happened to Hunter, a Black woman in Montgomery, Alabama. She said her primary care doctor dismissed a recommendation from her endocrinologist to refer her to a hematologist after finding high protein counts in her blood. Then, she said, he also refused to order a bone marrow biopsy after the ER doctor suggested she might have multiple myeloma. Fed up, she said, she found a new doctor, got tested, and learned she indeed had the disease.
Monique Hartley-Brown, a multiple myeloma researcher at the Dana-Farber Cancer Institute in Boston, said Hunter’s experience is fairly common, particularly among Black patients who live in underserved communities.
Challenges in Diagnosis and Treatment
“On average, patients see their primary doctor three times before being accurately diagnosed,” Hartley-Brown said. “The delay from symptom onset to diagnosis is even longer for Black Americans. Meanwhile, the disease is wreaking havoc — causing fractures, severe anemia, fatigue, weight loss, kidney problems.” Black and Hispanic patients are also less likely to receive the newest therapies, according to the Multiple Myeloma Research Foundation, and, when they do, they are more likely to do so later in the course of their disease than white patients.
Impact of Research Cuts and Racial Disparities
An analysis published in 2022 of racial and ethnic disparities in multiple myeloma drug approval trials submitted to the FDA concluded that Black patients made up only 4% of participants despite being roughly 20% of those living with the disease. Now, even though significant progress has been made in understanding the biology of multiple myeloma and how to treat it, those racial gaps may grow larger amid federal cuts to cancer research and the backlash against diversity and inclusion efforts.
Personal Stories of Resilience
Jim Washington of Charlotte, North Carolina, is back golfing after twice undergoing treatment for multiple myeloma, a form of blood cancer. With premium health insurance and a concierge doctor, he was able to benefit from the latest treatments both times. He was 61 when excruciating hip pain brought his regular tennis games to a sudden stop. Washington was fortunate to have a concierge doctor and premium health insurance. In quick succession, he underwent X-rays that revealed a lesion on his spine and received a referral to an oncologist, who identified a cancerous tumor.
Advances in Treatment and Hope for the Future
Washington had weeks of high-dose chemotherapy, followed by what is known as an autologous stem cell transplant, which used his own stem cells to regrow healthy blood cells in his body. It was a grueling process that ultimately left him with a clean bill of health. For the next several years, his doctors monitored him closely, including conducting an annual bone marrow biopsy. Before treatment, he said, myeloma had infiltrated 60% of his blood cells. The stem cell transplant brought those levels down to zero.
Conclusion
In conclusion, while multiple myeloma remains a challenging disease to diagnose and treat, especially for Black patients, there is hope on the horizon. Advances in treatment, such as CAR T-cell therapy, offer new possibilities for patients. However, addressing the racial disparities in diagnosis, treatment, and research participation is crucial to ensuring that all patients have equal access to these advances.
FAQs
Q: What is multiple myeloma?
A: Multiple myeloma is a cancer that develops in bone marrow plasma cells, crowding out healthy blood cells and damaging the bones.
Q: Why is multiple myeloma more common among African Americans?
A: Multiple myeloma is more common among African Americans due to a combination of genetic and societal factors, including socioeconomic status and lack of access to health insurance or medical services.
Q: What are the symptoms of multiple myeloma?
A: Symptoms of multiple myeloma include pain in the spine and hips, nausea, exhaustion, thirst, and frequent urination.
Q: How is multiple myeloma treated?
A: Multiple myeloma is treated with a combination of chemotherapy, stem cell transplants, and other therapies, such as CAR T-cell therapy.
Q: What can be done to address racial disparities in multiple myeloma diagnosis and treatment?
A: Addressing racial disparities in multiple myeloma diagnosis and treatment requires increasing access to healthcare, improving diversity in clinical trials, and raising awareness about the disease among African American communities.
