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==Overview==
==Overview==
The most potent risk factor in the development of multiple myeloma is old age. Other risk factors include positive family history, positive history of [[monoclonal gammopathy of undetermined significance]] (MGUS), and occupational exposure to radiation and toxic chemicals.<ref name="press">Press Releases. Compugen (2015)http://www.cgen.com/media-center/press-releases/-314 Accessed on September, 20th 2015</ref><ref name="radio">Multiple myeloma. Radiopaedia (2015)http://radiopaedia.org/articles/multiple-myeloma-1 Accessed on September, 20th 2015</ref>
Risk factors for multiple myeloma include advanced age, African American race, male gender, obesity, exposure to chemicals and radiation, the presence of family history of hematologic conditions.
 
<ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref>
 
MM is a multifactorial disease, encompassing a wide variety of risk factors that span numerous life aspects.PMID:26294217
 
Multiple myeloma (MM) is a mature B-cell neoplastic proliferative disease and is also known as plasma cell myeloma, myelomatosis, or Kahler disease.                                                    Bone marrow plasmacytosis and production of monoclonal immunoglobulin are key features, while symptomatic disease is associated with anemia, hypercalcemia, renal insufficiency, and osteolytic bone disease.                                                    MM is the second most common hematologic malignancy and represents 10% to 20% of all hematologic malignancies. Interestingly, its prevalence is expected to rise in Western countries in light of the aging population, given that nearly 30% of patients are aged 75 years or older.                                                    The 5-year relative survival has been estimated at approximately 41%.                           
 
The epidemiology of MM is an increasingly investigated field, with many controversies. Older age, positive family history, male sex, black race, and genetic factors                                                    have been described as risk factors for the disease.                                                    Monoclonal gammopathy of undetermined significance is a condition that precedes MM                                                    and is the most important factor associated with the development of MM. Regarding environmental factors, exposure to benzene, petroleum products, and ionizing radiation, as well as agricultural or industrial occupation have been acknowledged, whereas tobacco smoking, obesity, and dietary characteristics are probably less implicated but have been addressed in the literature.


==Risk Factors==
==Risk Factors==


The table below lists the risk factors for multiple myeloma:
The table below lists the risk factors for multiple myeloma:
 
{|
{| style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;" {{table}} cellspacing="0" cellpadding="4"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Risk Factor
| align="center" style="background:#4479BA;" |'''Risk Factor'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Description
 
|-
| align="center" style="background:#4479BA;" |'''Description'''
! align="center" style="background:#DCDCDC;" + |Age
 
| align="left" style="background:#F5F5F5;" + |The chance of developing multiple myeloma increases with age, as somatic mutations in plasma cells accumulate with aging. The median age of diagnosis of multiple myeloma is 61. Only 1% of multiple myeloma cases are diagnosed in patients younger than 35 years.<ref name="press">Press Releases. Compugen (2015)http://www.cgen.com/media-center/press-releases/-314 Accessed on September, 20th 2015</ref><ref name="radio">Multiple myeloma. Radiopaedia (2015)http://radiopaedia.org/articles/multiple-myeloma-1 Accessed on September, 20th 2015</ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref>
|-
|-
 
! align="center" style="background:#DCDCDC;" + |Race
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | '''Age'''|| style="padding: 5px 5px; background: #F5F5F5;" |The chance to develop multiple myeloma increases as patients get older, where only 1% of multiple myeloma cases are diagnosed in patients younger than 35 years.<ref name="press">Press Releases. Compugen (2015)http://www.cgen.com/media-center/press-releases/-314 Accessed on September, 20th 2015</ref><ref name="radio">Multiple myeloma. Radiopaedia (2015)http://radiopaedia.org/articles/multiple-myeloma-1 Accessed on September, 20th 2015</ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref>
| align="left" style="background:#F5F5F5;" + |African Americans and Native Pacific Islanders are at higher risk of developing multiple myeloma compared to Caucasians.<ref name="wiki">Multiple myeloma. Wikipedia (2015)https://en.wikipedia.org/wiki/Multiple_myeloma#Pathophysiology Accessed on September, 20th 2015</ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref><ref>Seer stat fact sheet. National cancer institute (2015)http://seer.cancer.gov/statfacts/html/mulmy.html Accessed on September, 20th 2015</ref>
 
|-
|-
 
! align="center" style="background:#DCDCDC;" + |Gender
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | '''Race'''|| style="padding: 5px 5px; background: #F5F5F5;" |African American and Native Pacific Islanders descents are at increased risk of developing multiple myeloma.<ref name="wiki">Multiple myeloma. Wikipedia (2015)https://en.wikipedia.org/wiki/Multiple_myeloma#Pathophysiology Accessed on September, 20th 2015</ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref><ref>Seer stat fact sheet. National cancer institute (2015)http://seer.cancer.gov/statfacts/html/mulmy.html Accessed on September, 20th 2015</ref>
| align="left" style="background:#F5F5F5;" + |Males are more commonly affected by multiple myeloma than females.<ref name="radio">Multiple myeloma. Radiopaedia (2015)http://radiopaedia.org/articles/multiple-myeloma-1 Accessed on September, 20th 2015</ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref>
 
|-
|-
 
! align="center" style="background:#DCDCDC;" + |Presence of other plasma cell disorders
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | '''Gender'''|| style="padding: 5px 5px; background: #F5F5F5;" |Males are more commonly affected with multiple myeloma than females. The male to female ratio is approximately 2 to 1.<ref name="radio">Multiple myeloma. Radiopaedia (2015)http://radiopaedia.org/articles/multiple-myeloma-1 Accessed on September, 20th 2015</ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref>
| align="left" style="background:#F5F5F5;" + |Patients with other [[plasma cell]] disorders such as [[monoclonal gammopathy of undetermined significance]] (MGUS) or smoldering multiple myeloma are at increased risk for development of active multiple myeloma.<ref name="mediline">Multiple myeloma. MedlinePlus (2015)http://www.wikidoc.org/index.php?title=Multiple_myeloma_risk_factors&action=edit&section=2 Accessed on Septmeber, 20th 2015 </ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref> The risk for progression to active multiple myeloma depends on the plasma cell burden, free light chain ratio, and subtype of paraprotein.
|-
|-
 
! align="center" style="background:#DCDCDC;" + |Family history
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | '''Having other plasma cell diseases'''|| style="padding: 5px 5px; background: #F5F5F5;" |Patients with other [[plasma cell]] diseases such as [[monoclonal gammopathy of undetermined significance]]  develop multiple myeloma later in their lives.<ref name="mediline">Multiple myeloma. MedlinePlus (2015)http://www.wikidoc.org/index.php?title=Multiple_myeloma_risk_factors&action=edit&section=2 Accessed on Septmeber, 20th 2015 </ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref>
| align="left" style="background:#F5F5F5;" + |A familial predisposition to myeloma exists due to [[hyperphosphorylation]] of specific proteins that may contribute to a higher rates of multiple myeloma in certain groups.<ref name="Bourguet-1985">{{Cite journal  | last1 = Bourguet | first1 = CC. | last2 = Grufferman | first2 = S. | last3 = Delzell | first3 = E. | last4 = DeLong | first4 = ER. | last5 = Cohen | first5 = HJ. | title = Multiple myeloma and family history of cancer. A case-control study. | journal = Cancer | volume = 56 | issue = 8 | pages = 2133-9 | month = Oct | year = 1985 | doi =  | PMID = 4027940 }}</ref><ref name="wiki">Multiple myeloma. Wikipedia (2015)https://en.wikipedia.org/wiki/Multiple_myeloma#Pathophysiology Accessed on September, 20th 2015</ref><ref name="pmid23926460">{{cite journal| author=Koura DT, Langston AA| title=Inherited predisposition to multiple myeloma. | journal=Ther Adv Hematol | year= 2013 | volume= 4 | issue= 4 | pages= 291-7 | pmid=23926460 | doi=10.1177/2040620713485375 | pmc=PMC3734900 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23926460  }} </ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref> Patients with germline mutations in tumor suppressors such as ''TP53'' may be at increased risk for multiple myeloma.
 
|-
|-
 
! align="center" style="background:#DCDCDC;" + |Obesity
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | '''Family history'''|| style="padding: 5px 5px; background: #F5F5F5;" |A familial predisposition to myeloma exists due to [[hyperphosphorylation]] of specific proteins that may contribute to a higher rates of multiple myeloma in certain groups.<ref name="Bourguet-1985">{{Cite journal  | last1 = Bourguet | first1 = CC. | last2 = Grufferman | first2 = S. | last3 = Delzell | first3 = E. | last4 = DeLong | first4 = ER. | last5 = Cohen | first5 = HJ. | title = Multiple myeloma and family history of cancer. A case-control study. | journal = Cancer | volume = 56 | issue = 8 | pages = 2133-9 | month = Oct | year = 1985 | doi =  | PMID = 4027940 }}</ref><ref name="wiki">Multiple myeloma. Wikipedia (2015)https://en.wikipedia.org/wiki/Multiple_myeloma#Pathophysiology Accessed on September, 20th 2015</ref><ref name="pmid23926460">{{cite journal| author=Koura DT, Langston AA| title=Inherited predisposition to multiple myeloma. | journal=Ther Adv Hematol | year= 2013 | volume= 4 | issue= 4 | pages= 291-7 | pmid=23926460 | doi=10.1177/2040620713485375 | pmc=PMC3734900 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23926460  }} </ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref>
| align="left" style="background:#F5F5F5;" + |Obesity increases a person's risk of developing multiple myeloma, as is true for other types of malignancies.<ref name="mediline">Multiple myeloma. MedlinePlus (2015)http://www.wikidoc.org/index.php?title=Multiple_myeloma_risk_factors&action=edit&section=2 Accessed on Septmeber, 20th 2015 </ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref> The pathophysiologic basis for the link between obesity and multiple myeloma is not well described.
 
|-
|-
 
! align="center" style="background:#DCDCDC;" + |Workplace exposures
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | '''Obesity'''|| style="padding: 5px 5px; background: #F5F5F5;" | Being overweight increases a person's risk of developing multiple myeloma.<ref name="mediline">Multiple myeloma. MedlinePlus (2015)http://www.wikidoc.org/index.php?title=Multiple_myeloma_risk_factors&action=edit&section=2 Accessed on Septmeber, 20th 2015 </ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref>
| align="left" style="background:#F5F5F5;" + |Petroleum workers and farmers tend to have higher incidence of multiple myeloma relative to other occupations.<ref name="Gallagher-1983">{{Cite journal  | last1 = Gallagher | first1 = RP. | last2 = Spinelli | first2 = JJ. | last3 = Elwood | first3 = JM. | last4 = Skippen | first4 = DH. | title = Allergies and agricultural exposure as risk factors for multiple myeloma. | journal = Br J Cancer | volume = 48 | issue = 6 | pages = 853-7 | month = Dec | year = 1983 | doi =  | PMID = 6652026 }}</ref><ref name="mediline">Multiple myeloma. MedlinePlus (2015)http://www.wikidoc.org/index.php?title=Multiple_myeloma_risk_factors&action=edit&section=2 Accessed on Septmeber, 20th 2015 </ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref> Agent Orange exposure may also be linked to the development of multiple myeloma. Agent Orange exposure is common among U.S. veterans.
 
|-
|-
 
! align="center" style="background:#DCDCDC;" + |Presence of other diseases
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | '''Workplace exposures'''|| style="padding: 5px 5px; background: #F5F5F5;" |Petroleum workers and farmers tend to have higher incidence of multiple myeloma relative to other occupations.<ref name="Gallagher-1983">{{Cite journal | last1 = Gallagher | first1 = RP. | last2 = Spinelli | first2 = JJ. | last3 = Elwood | first3 = JM. | last4 = Skippen | first4 = DH. | title = Allergies and agricultural exposure as risk factors for multiple myeloma. | journal = Br J Cancer | volume = 48 | issue = 6 | pages = 853-7 | month = Dec | year = 1983 | doi = | PMID = 6652026 }}</ref><ref name="mediline">Multiple myeloma. MedlinePlus (2015)http://www.wikidoc.org/index.php?title=Multiple_myeloma_risk_factors&action=edit&section=2 Accessed on Septmeber, 20th 2015 </ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref>
| align="left" style="background:#F5F5F5;" + |There is a slight increase in the risk for developing multiple myeloma among patients with type 2 diabetes mellitus. There is a weak association between [[systemic lupus erythematosus]] (SLE) and multiple myeloma, especially in the United States and Canada. Other autoimmune conditions such as pernicious anemia and ankylosing spondylitis are associated with significantly increased risk for developing multiple myeloma.<ref name="pmid26294217">{{cite journal |vauthors=Sergentanis TN, Zagouri F, Tsilimidos G, Tsagianni A, Tseliou M, Dimopoulos MA, Psaltopoulou T |title=Risk Factors for Multiple Myeloma: A Systematic Review of Meta-Analyses |journal=Clin Lymphoma Myeloma Leuk |volume=15 |issue=10 |pages=563–77.e1–3 |date=October 2015 |pmid=26294217 |doi=10.1016/j.clml.2015.06.003 |url=}}</ref>
|-
|-
 
! align="center" style="background:#DCDCDC;" + |Radiation
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | '''Radiation'''|| style="padding: 5px 5px; background: #F5F5F5;" | Areas with previous history of atoms bombs or nuclear accidents had higher risk of multiple myeloma due to increased rate of radiation exposure.<ref name="mediline">Multiple myeloma. MedlinePlus (2015)http://www.wikidoc.org/index.php?title=Multiple_myeloma_risk_factors&action=edit&section=2 Accessed on Septmeber, 20th 2015 </ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref>
| align="left" style="background:#F5F5F5;" + |People who were exposed to radiation (atomic bombs or nuclear accidents) have a higher risk for developing multiple myeloma.<ref name="mediline">Multiple myeloma. MedlinePlus (2015)http://www.wikidoc.org/index.php?title=Multiple_myeloma_risk_factors&action=edit&section=2 Accessed on Septmeber, 20th 2015 </ref><ref name="american">Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015</ref> Ionizing radiation is more likely to cause multiple myeloma compared to other types of radiation, as ionizing radiation induces DNA damage.
|}
|}
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]; Shyam Patel [3]

Overview

Risk factors for multiple myeloma include advanced age, African American race, male gender, obesity, exposure to chemicals and radiation, the presence of family history of hematologic conditions.

Risk Factors

The table below lists the risk factors for multiple myeloma:

Risk Factor Description
Age The chance of developing multiple myeloma increases with age, as somatic mutations in plasma cells accumulate with aging. The median age of diagnosis of multiple myeloma is 61. Only 1% of multiple myeloma cases are diagnosed in patients younger than 35 years.[1][2][3]
Race African Americans and Native Pacific Islanders are at higher risk of developing multiple myeloma compared to Caucasians.[4][3][5]
Gender Males are more commonly affected by multiple myeloma than females.[2][3]
Presence of other plasma cell disorders Patients with other plasma cell disorders such as monoclonal gammopathy of undetermined significance (MGUS) or smoldering multiple myeloma are at increased risk for development of active multiple myeloma.[6][3] The risk for progression to active multiple myeloma depends on the plasma cell burden, free light chain ratio, and subtype of paraprotein.
Family history A familial predisposition to myeloma exists due to hyperphosphorylation of specific proteins that may contribute to a higher rates of multiple myeloma in certain groups.[7][4][8][3] Patients with germline mutations in tumor suppressors such as TP53 may be at increased risk for multiple myeloma.
Obesity Obesity increases a person's risk of developing multiple myeloma, as is true for other types of malignancies.[6][3] The pathophysiologic basis for the link between obesity and multiple myeloma is not well described.
Workplace exposures Petroleum workers and farmers tend to have higher incidence of multiple myeloma relative to other occupations.[9][6][3] Agent Orange exposure may also be linked to the development of multiple myeloma. Agent Orange exposure is common among U.S. veterans.
Presence of other diseases There is a slight increase in the risk for developing multiple myeloma among patients with type 2 diabetes mellitus. There is a weak association between systemic lupus erythematosus (SLE) and multiple myeloma, especially in the United States and Canada. Other autoimmune conditions such as pernicious anemia and ankylosing spondylitis are associated with significantly increased risk for developing multiple myeloma.[10]
Radiation People who were exposed to radiation (atomic bombs or nuclear accidents) have a higher risk for developing multiple myeloma.[6][3] Ionizing radiation is more likely to cause multiple myeloma compared to other types of radiation, as ionizing radiation induces DNA damage.

References

  1. ↑ Press Releases. Compugen (2015)http://www.cgen.com/media-center/press-releases/-314 Accessed on September, 20th 2015
  2. ↑ 2.0 2.1 Multiple myeloma. Radiopaedia (2015)http://radiopaedia.org/articles/multiple-myeloma-1 Accessed on September, 20th 2015
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Multiple myeloma. The American Cancer Society (2015) http://www.cancer.org/cancer/multiplemyeloma/detailedguide/multiple-myeloma-risk-factors Accessed on September, 20 2015
  4. ↑ 4.0 4.1 Multiple myeloma. Wikipedia (2015)https://en.wikipedia.org/wiki/Multiple_myeloma#Pathophysiology Accessed on September, 20th 2015
  5. ↑ Seer stat fact sheet. National cancer institute (2015)http://seer.cancer.gov/statfacts/html/mulmy.html Accessed on September, 20th 2015
  6. ↑ 6.0 6.1 6.2 6.3 Multiple myeloma. MedlinePlus (2015)http://www.wikidoc.org/index.php?title=Multiple_myeloma_risk_factors&action=edit&section=2 Accessed on Septmeber, 20th 2015
  7. ↑ Bourguet, CC.; Grufferman, S.; Delzell, E.; DeLong, ER.; Cohen, HJ. (1985). "Multiple myeloma and family history of cancer. A case-control study". Cancer. 56 (8): 2133–9. PMID 4027940. Unknown parameter |month= ignored (help)
  8. ↑ Koura DT, Langston AA (2013). "Inherited predisposition to multiple myeloma". Ther Adv Hematol. 4 (4): 291–7. doi:10.1177/2040620713485375. PMC 3734900. PMID 23926460.
  9. ↑ Gallagher, RP.; Spinelli, JJ.; Elwood, JM.; Skippen, DH. (1983). "Allergies and agricultural exposure as risk factors for multiple myeloma". Br J Cancer. 48 (6): 853–7. PMID 6652026. Unknown parameter |month= ignored (help)
  10. ↑ Sergentanis TN, Zagouri F, Tsilimidos G, Tsagianni A, Tseliou M, Dimopoulos MA, Psaltopoulou T (October 2015). "Risk Factors for Multiple Myeloma: A Systematic Review of Meta-Analyses". Clin Lymphoma Myeloma Leuk. 15 (10): 563–77.e1–3. doi:10.1016/j.clml.2015.06.003. PMID 26294217.
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