Cancer and Metastasis Reviews 22: 87–93, 2003. # 2003 Kluwer Academic Publishers. Manufactured in The Netherlands. Myeloma and race: A review of the literature Michael Benjamin*, Sreekanth Reddy, and Otis W. Brawley Winship Cancer Institute, Emory University, Atlanta, Georgia Key words: multiple myeloma, race, epidemiology, etiology Summary Multiple myeloma is an uncommon disease, with approximately 12,000 cases per year diagnosed in America.Blackshavehadatleastdoubletheriskofbeingdiagnosedwithmyeloma,andhavehadtwicethe mortalityratefromthediseasecomparedtowhites[1].Researchoftheoriginsofthisdifferencehasyielded bothinsightandcontroversy.Obesityislikelyariskfactorformyeloma,inbothblacksandwhites.Obesity is more prevalent in the black population, and this may help explain some of the increased incidence of myeloma.Also,geneticfactorssuchasHLAantigensandfamilyhistoryseemtobeimportantinexplaining 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 finding, 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.TheSEERdatabase,alarge,population- baseddatabase,hasshownthatblackshavehadat least double the risk of being diagnosed with myeloma, and have had twice the mortality rate fromthediseasecomparedtowhites.Thisrelation- ship has lasted for the 25 years between 1973 and 1998[1].Researchintotheoriginsofthisdifference has yielded both insight and controversy. Attempts have been made to explain this increased risk of myeloma incidence and mortality inblacksbyexaminingenvironmentalfactorssuch as immune system challenges, diet, tobacco, alcohol, obesity, distance from treatment centers, andsocioeconomicstatus,andgeneticfactorssuch as family history and human leukocyte antigen phenotypes. Monoclonal gammopathy of undetermined sig- nificance (MGUS) is theorized to be a pre- myelomatous condition. It clearly is a risk factor for multiple myeloma. Patients with MGUS have an M-protein in the serum without findings of multiple myeloma, macroglobulinemia, amyloido- sis,orlymphomaandwithfewerthan10% plasma cells in the bone marrow. These patients are asymptomatic and are not to be treated. Approxi- mately2% peryearwillprogresstodeveloponeof the symptomatic B-cell neoplasms and may then require therapy. In at least one study black Americans had a higher prevalence of MGUS [2]. Environmental determinants of myeloma risk Several epidemiologic studies have looked at occupation and risk of myeloma. Populations with increased multiple myeloma include health care workers especially among nurses, laboratory workers, and pharmacists [3,4]. Two well designed studies of refinery and oil workers showed they have a higher risk of the disease. Dement and * Corresponding author. E-mail: mbenjam@emory.edu