Multiple myeloma is a cancer of the bone marrow associated with mutations in several genes. These include genes which control division of human cells, like the cyclin D1 genes.

As several environmental factors have theoretical links to genetic mutations, and because there have been several papers suggesting the importance of these environmental factors in multiple myeloma, the question “does what I do or where I live affect whether I get multiple myeloma” has been the subject of many studies and much debate.

The disease has been consistently linked to age, male sex and obesity. But I also get the occasional patient who tells me he might have had exposure to industrial chemicals, radioactive substances or other environmental factors before. So, while the disease is a lot more treatable then ten years ago, I wanted to see if I can reduce my risk of getting the disease and did some search of current literature pertaining to this question. So what did I find?

Studies have shown a higher incidence of the disease in African Americans, as well as those with a family history of lympho-haematopoietic cancers, suggesting that genetic factors are probably more important in this case.

Despite a theoretical link with exposure to pesticides, studies in farmers have had mixed reports: some studies show an increased incidence of myeloma, but other studies do not. It is thought that although farmers have a higher degree of exposure, they also lead a healthier lifestyle with exercise and consumption of fresh vegetables, consequently mitigating their risk.

Consumption of fresh fish has been felt to be reduce the risk of myeloma, but studies have had mixed reports with a reduced risk in some fishermen and an increased risk in others; perhaps related to the type of fish they consume. Similarly, studies in chemical, petroleum and radiation workers have also had mixed results. Reports on increased incidence of multiple myeloma related to place of stay are likely to be diluted by many other factors which might contribute to disease causation.

Such reports also need to be read carefully. If a report from a particular hospital suggests that many patients with multiple myeloma stay in the Southern part of Singapore and work in Jurong, for example, then this report needs to be balanced against the distribution of people who come to that hospital. That is to say, “Do most people who come to that hospital work in the Southern part of Singapore and work in Jurong anyway?” So read such reports carefully and with a pinch of salt.

What would I do to reduce my risk? I can’t change my race, sex, genetics or the fact that I will grow old; but I can try to lose some weight and lead a healthy lifestyle. Studies in pesticides, chemicals and radiation are conflicting, but I will try to eat thoroughly washed greens (I can’t afford organic, and I still need a bit more convincing) and I will take extra care when I need to handle chemicals or radiation in the laboratory, or when I need to handle chemotherapy drugs in the ward.

As for where I stay, I think I will let my real estate agent advise me.

 

Dr William Hwang, MBBS, MMed (Int Med), FRCP (London), FAMS (Haematology)

The author is a Senior Consultant Haematologist at the Singapore General Hospital, Senior Medical Scientist of the SingHealth Office of Research and Assistant Professor of the Duke-NUS Graduate Medical School. He currently stays in the Northern-Central part of Singapore not too far from the MacRitchie Reservoir.