Myeloma incidence statistics

Myeloma is the 17th most common cancer in the UK (2009), accounting for around 1.5% of all new cases. It is the 14th most common cancer among men in the UK, and the 17th most common cancer among women, accounting for more than 1% of all cancers in each sex. In 2009, 4,784 people were diagnosed with myeloma in the UK (Table 1.1): 2,714 (57%) men and 2,070 (43%) women, giving a male:female ratio of 13:10.1-4 The crude rate shows that this equates to around 8 cases for every 100,000 people in the UK population. Myeloma is more common in men than women (European age-standardised (AS) rate 7.1 cases per 100,000 UK men compared with 4.3 cases per 100,000 UK women), and age-standardised rates are broadly similar across the whole of the UK.1-4 The lifetime risk of developing myeloma is around 1 in 115 for men and 1 in 155 for women.5

Table 1.1: Myeloma (C90), Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 Population, UK, 2009

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*95% LCL and 95% UCL are the 95% lower and upper confidence limits around the AS Rate

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Myeloma is predominantly a disease of older people, with 71% of cases diagnosed in people aged 65 years and over (Figure 1.1).1-4 Very few cases are diagnosed in people younger than 40 and most cases are diagnosed in people aged 75-79. Incidence rates increase steadily with age and peak in those aged 85 and over. Incidence rates are higher for males than females and this gap widens with increasing age, with the male:female ratio of age-specific incidence rates (to account for the different proportions of males to females in each age group) increasing from 16:10 in 50-54 year-olds to 17:10 in people aged 85 and over.1-4

Figure 1.1: Myeloma (C90), Average Number of New Cases Per Year and Age-Specific Incidence Rates, UK, 2007-2009

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Over the last decade, myeloma incidence rates in Britain have remained reasonably stable at 6-7 cases per 100,000 men and around 4 per 100,000 women (Figure 1.2).1-3 Prior to this, incidence rates increased steadily for around 25 years: rates were 65% (males) and 57% (females) higher in 2000-2002 than 1975-1977. Several research groups have argued that true incidence has remained stable, and increases are due to improved diagnostic techniques and data registration, particularly in older age groups.6-8 Although one recent study estimated that the rates of myeloma will decrease in coming decades in the UK,9 the quality of the data on which this result is based, coupled with the emergence of new diagnostic technologies, means that this is unlikely to be true.

Figure 1.2: Myeloma (C90), European Age-Standardised Incidence Rates, Great Britain, 1975-2009

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Lifetime risk is an estimation of the risk that a newborn child has of being diagnosed with cancer at some point during their life.  It is a summary of risk in the population but genetic and lifestyle factors affect the risk of cancer and so the risk for every individual is different.

In 2010, in the UK, the lifetime risk of developing myeloma is 1 in 120 for men and 1 in 155 for women.30

The lifetime risk for myeloma has been calculated by the Statistical Information Team using the ‘Current Probability’ method; this is a different method used from most other cancer sites since the possibility of having more than one diagnosis of myeloma over the course of their lifetime is very low.31

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Although cancer registration has a long history in many countries, particularly in the more affluent regions of the world such as the UK, nearly 80% of the world’s population live in regions that are not covered by such systems.10 Nonetheless, with a view to characterising the global burden of disease, the International Agency for Research on Cancer (IARC) routinely uses the available data to estimate worldwide cancer incidence. An estimated 103,000 people across the world were diagnosed with myeloma in 2008, accounting for around 1% of all cancers diagnosed, and around 12% of all haematological cancers diagnosed.11

Misdiagnosis and under-reporting are recognised problems for cancers such as myeloma characterised by intermittent and non-specific symptoms, even in countries with well-developed healthcare systems. In this context it is perhaps unsurprising that the estimated incidence of myeloma varies worldwide, with the highest rates being reported in the most economically developed regions of the world (e.g. Europe, North America, Australia/New Zealand) and the lowest rates in the least developed regions (e.g. parts of Africa, Asia and parts of Latin America) (Figures 1.3 and 1.4).12

Figure 1.3: Myeloma (C88 and C90), World Age-Standardised Incidence Rates, World Regions, 2008 Estimates

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Figure 1.4: Myeloma (C88 and C90), European Age-Standardised Incidence Rates, EU-27 Countries, 2008 Estimates

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The most recent England-wide data for 2000-2004 showed slightly lower myeloma incidence rates for men living in more deprived areas, though no differences were reported for women.13 In this analysis, levels of deprivation were measured according to the Income Domain of the Index of Multiple Deprivation (IMD) 2007, and using information on benefit receipt as a proxy indicator for income deprivation, patients were allocated a deprivation score based on their area of residence.

Data from the Haematological Malignancy Research Network (HMRN) region for 2004-2009 showed a similar result, with lower rates of myeloma incidence in the more deprived areas for both sexes combined.14 Rather than reflecting disease aetiology, these observations are compatible with the theory that socio-economic factors impact on the likelihood of recognising symptoms (especially the non-specific symptoms common in myeloma) and seeking medical care.15,16

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The most recent England-wide data for 2002-2006 showed myeloma was almost twice as common in black people as in white and Asian people.17 This difference was evident in both men and women. Estimated age-standardised incidence rates were in the ranges 10.9-18.2 per 100,000 black men, 6.1-6.5 per 100,000 white men, and 3.6-6.4 per 100,000 Asian men. Rates for women were lower than those for men, but the difference between ethnic groups remained. In this analysis, ethnicity was self-reported for 76% of patients, largely at the time of admission as an inpatient of day case; 24% of patients had no ethnic group recorded. The rates shown are the lower and upper range of 95% confidence intervals across three methods used to assign ethnic group to ethnicity-unknown patients: 1) assuming distribution of ethnic groups was the same for ethnicity-unknown as ethnicity-known patients, 2) assuming all ethnicity-unknown cases were white, 3) assuming all ethnicity-unknown cases were non-white.

A similar ethnic pattern has been observed in the US for almost 40 years, with myeloma occurring around twice as frequently in African Americans as Caucasians.18 It appears that, in comparison with white people, black people have younger myeloma onset,19 and a higher incidence of the precursor condition monoclonal gammopathy of undetermined significance (MGUS) (though no difference in progression risk).20 However, the reasons underpinning these ethnic differences have yet to be explained, and are currently the subject of much research.20,21

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Some otherwise healthy people can produce myeloma-causing cells, resulting in the asymptomatic condition MGUS. Rates of progression from MGUS to myeloma are low at around 1% per year,22 but all myeloma patients have MGUS as a precursor to their myeloma.23

Although cases of MGUS are not systematically recorded by the UK cancer registries, information on these diagnoses is routinely collected in the Haematological Malignancy Research Network (HMRN) region in the north of England. In 2004-2009 there were on average 4.9 cases of MGUS per 100,000 people per year.24 Like myeloma, MGUS is more common in men than women, with average age-standardised rates of 6.3 cases per 100,000 men and 3.5 cases per 100,000 women in the HMRN region in 2004-2010.24

UK estimates based on data from the HMRN region show that the age and sex distribution of MGUS patients is very similar to that of myeloma patients (Figure 1.5).24

Figure 1.5: Monoclonal Gammopathy of Undetermined Significance (MGUS, ICD-O-3 9765/1), Average Number of New Cases Per Year and Age-Specific Incidence Rates, UK estimates based on data from HMRN region, 2004-2010

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MGUS prevalence has been found to be twice as high in black Ghanaian men,25 and in black men of African origin living in America, compared with white men, suggesting that race-related susceptibility to MGUS and myeloma could be genetic rather than due to environmental factors.26

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The latest prevalence estimate for the UK suggests that at the end of 2006, there were over 12,000 myeloma patients alive up to ten years after their diagnosis (Table 1.2).27 This study showed the age-standardised proportion was equivalent to 16 myeloma patients alive ten years post-diagnosis per 100,000 people in the population, giving myeloma the 13th highest ten-year age-standardised prevalence rate in the UK (excluding sex-specific cancers). UK prevalence estimates based on HMRN region data for 2004-2009 were slightly higher than these nationally reported data, although they were for a later time period: one-year prevalence estimates were 1,883 males and 1,477 females, and five-year prevalence estimates were 5,898 males and 4,529 females.28 Worldwide, it is estimated that in 2008 there were almost 211,000 myeloma patients alive up to five years after their diagnosis.29

Myeloma survival is expected to improve markedly in the coming years due to further novel therapies being developed; as such myeloma prevalence is also likely to increase – not because people are more likely to develop myeloma, but because people who do develop it are more likely to survive for longer.

Table 1.2: Myeloma (C88 & C90), One-, Five- and Ten-Year Prevalence, UK, 31st December 2006

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