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Myeloma risk factors overview

Less than 1% of myeloma cases each year in the UK are linked to major lifestyle and other risk factors.1

Myeloma risk is associated with a number of risk factors (Table 4.1).4,5

Table 4.1: Myeloma Risk Factors

Increases risk ('sufficient' or 'convincing' evidence) May increase risk ('limited' or 'probable' evidence) Decreases risk ('sufficient' or 'convincing' evidence) May decrease risk ('limited' or 'probable' evidence)
-
  • Benzene
  • Ethylene oxide
  • X-radiation, gamma radiation
- -

International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classifications. Find out more about IARC and WCRF/AICR classifications.

Use our interactive tool to explore risk factors for myeloma.

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Age, sex and ethnicity

Myeloma is more common in older people, males and black people.

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Family history and genetic conditions

Family history

Myeloma risk is 2.3 times higher in people with a first-degree relative (parent, sibling or child) with myeloma compared with the general population, a cohort study showed.6

This may be due to shared genetic or environmental factors, or a combination of these.

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Genetic conditions

Myeloma risk is higher in people with Gaucher disease, a systematic review showed.7

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Immune system

Autoimmune conditions

Myeloma risk is 50% higher in people with pernicious anaemia, versus those without the disease, meta-analyses have shown.8 MGUS risk is 67% higher in people with pernicious anaemia.8

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Myeloma risk is higher in people with ankylosing spondylitis,9 autoimmune haemolytic anaemia,8 or systemic lupus erythematosis;10 and lower in people with psoriasis,8 meta-analyses have shown.

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Organ transplant

Myeloma risk is around 40% higher in solid organ transplant recipients versus the general population, a cross-sectional study showed.11 Post-transplant myeloma develops in less than 1% of organ recipients.12

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Infections

Human immunodeficiency virus (HIV)

Myeloma risk is 2.6 times higher in people with HIV/AIDS, compared with the general population, a meta-analysis showed.13

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Overweight and obesity

Myeloma risk is 12% higher per 5-unit body mass index (BMI) increment, a meta-analysis showed.14

Obese people may produce more of the protein interleukin-6 (IL-6), affecting proliferation and development of normal and malignant plasma cells.15

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Ionising radiation

X radiation and gamma radiation are classified by IARC as probable causes of myeloma, based on limited evidence (Table 4.1).4

Myeloma is not associated with exposure to radiation from atomic bombs, a cohort study showed.16 Myeloma is probably not associated with other sources of ionising radiation.17

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Occupational exposures

Benzene and ethylene oxide are classified by IARC as probable causes of myeloma, based on limited evidence (Table 4.1).4 An estimated 0.3% of myeloma cases in the UK are linked to occupational exposures.1

Myeloma risk is not associated with occupational benzene exposure, a meta-analysis showed.18

Myeloma risk is not associated with occupational ethylene oxide exposure, a cohort study showed.19

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Factors shown to have no effect on myeloma risk

Myeloma risk is not associated with the following factors, meta- and pooled analyses or systematic reviews have shown:

  • Tobacco smoking.20
  • Alcohol21 (though some evidence of risk decrease at high intake levels21,22 or in women23).
  • Physical activity.24
  • Rheumatoid arthritis.8,9
  • Diabetes.25
  • Pesticide/herbicide exposure.26-28
  • Diet (some evidence of lower risk in vegetarians29).2
  • Working with livestock.30
  • Working in the meat industry.31
  • Working as a metal processor, cleaner, or with high exposure to organic solvents.28
  • Hair dyes.32,33
  • Pneumonia (evidence of risk increase but unclear whether causal association).34-36
  • Trichloroethylene.37
  • Methylene chloride (though some evidence of risk increase in case-control studies).38

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References for myeloma risk factors

  1. Parkin DM, Boyd L, Walker LC. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Summary and conclusions. Br J Cancer 2011;105 (S2):S77-S81.
  2. Alexander DD, Mink PJ, Adami HO, et al. Multiple myeloma: a review of the epidemiologic literature. Int J Cancer 2007;120 Suppl 12:40-61.
  3. Cogliano VJ, Baan R, Straif K, et al. Preventable Exposures Associated With Human Cancers. Journal of the National Cancer Institute 2011;103(24):1827-39.
  4. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Available from http://monographs.iarc.fr/ENG/Classification/index.php. Accessed May 2014.
  5. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007.
  6. Frank C, Fallah M, Ji J, et al. The population impact of familial cancer, a major cause of cancer. Int J Cancer 2014;134(8):1899-906.
  7. Arends M, van Dussen L, Biegstraaten M, et al. Malignancies and monoclonal gammopathy in Gaucher disease; a systematic review of the literature. Br J Haematol. 2013;161(6):832-42.
  8. McShane CM, Murray LJ, Landgren O, et al. Prior autoimmune disease and risk of monoclonal gammopathy of undetermined significance and multiple myeloma: a systematic review. Cancer Epidemiol Biomarkers Prev. 2014 Feb;23(2):332-42.
  9. Shen K, Xu G, Wu Q, et al. Risk of multiple myeloma in rheumatoid arthritis: a meta-analysis of case-control and cohort studies. PLoS One. 2014;9(3):e91461
  10. Apor E, O'Brien J, Stephen M, Castillo JJ. Systemic lupus erythematosus is associated with increased incidence of hematologic malignancies: a meta-analysis of prospective cohort studies. Leuk Res 2014;38(9):1067-71.
  11. Engels EA, Clarke CA, Pfeiffer RM, et al. Plasma cell neoplasms in US solid organ transplant recipients. Am J Transplant. 2013;13(6):1523-32.
  12. Caillard S, Agodoa LY, Bohen EM, et al. Myeloma, Hodgkin disease, and lymphoid leukemia after renal transplantation: characteristics, risk factors and prognosis. Transplantation 2006;81(6):888-95.
  13. Shiels MS, Cole SR, Kirk GD, et al. A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acq Immun Def Synd 2009;52(5):611-22.
  14. Wallin A, Larsson SC. Body mass index and risk of multiple myeloma: a meta-analysis of prospective studies. Eur J Cancer. 2011;47(11):1606-15.
  15. Larsson SC, Wolk A. Body mass index and risk of multiple myeloma: A meta-analysis. Int J Cancer 2007.
  16. Hsu WL, Preston DL, Soda M, et al. The incidence of leukemia, lymphoma and multiple myeloma among atomic bomb survivors: 1950-2001. Radiat Res 2013;179(3):361-82.
  17. United Nations Scientific Committee on the Effects of Atomic Radiation 2009. UNSCEAR 2006 Report to the General Assembly, with scientific annexes. Annex A.
  18. Vlaanderen J, Lan Q, Kromhout H, et al. Occupational benzene exposure and the risk of lymphoma subtypes: a meta-analysis of cohort studies incorporating three study quality dimensions. Environ Health Perspect 2011;119(2):159-67.
  19. Mikoczy Z, Tinnerberg H, Björk J, Albin M. Cancer incidence and mortality in Swedish sterilant workers exposed to ethylene oxide: updated cohort study findings 1972-2006. Int J Environ Res Public Health 2011;8(6):2009-19.
  20. Psaltopoulou T, Sergentanis TN, Kanellias N, et al. Tobacco smoking and risk of multiple myeloma: a meta-analysis of 40 observational studies. Int J Cancer. 2013 May 15;132(10):2413-31.
  21. Rota M, Porta L, Pelucchi C, et al. Alcohol drinking and multiple myeloma risk--a systematic review and meta-analysis of the dose-risk relationship. Eur J Cancer Prev. 2014 Mar;23(2):113-21.
  22. Ji J, Sundquist J, Sundquist K. Alcohol consumption has a protective effect against hematological malignancies: a population-based study in sweden including 420,489 individuals with alcohol use disorders. Neoplasia 2014;16(3):229-34.
  23. Psaltopoulou T, Sergentanis TN, Sergentanis IN, et al. Alcohol intake, alcoholic beverage type and multiple myeloma risk: a meta-analysis of 26 observational studies. Leuk Lymphoma 2014 20:1-18.
  24. Jochem C, Leitzmann MF, Keimling M, et al. Physical activity in relation to risk of hematologic cancers: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2014;23(5):833-46.
  25. Castillo JJ, Mull N, Reagan JL, et al. Increased incidence of non-Hodgkin lymphoma, leukemia, and myeloma in patients with diabetes mellitus type 2: a meta-analysis of observational studies. Blood. 2012;119(21):4845-50.
  26. Jones DR, Sutton AJ, Abrams KR, et al. Systematic review and meta-analysis of mortality in crop protection product manufacturing workers. Occup Environ Med 2009;66(1):7-15.
  27. Merhi M, Raynal H, Cahuzac E, et al. Occupational exposure to pesticides and risk of hematopoietic cancers: meta-analysis of case-control studies. Cancer Cause Control 2007;18(10):1209-26.
  28. Perrotta C, Kleefeld S, Staines A, et al. Multiple myeloma and occupation: a pooled analysis by the International Multiple Myeloma Consortium. Cancer Epidemiol. 2013;37(3):300-5.
  29. Key TJ, Appleby PN, Crowe FL, et al. Cancer in British vegetarians: updated analyses of 4998 incident cancers in a cohort of 32,491 meat eaters, 8612 fish eaters, 18,298 vegetarians, and 2246 vegans. Am J Clin Nutr 2014;100(Supplement 1):378S-385S.
  30. Perrotta C, Staines A, Cocco P. Multiple myeloma and farming. A systematic review of 30 years of research. Where next? J Occup Med Toxicol 2008;3:27.
  31. Moore T, Brennan P, Becker N, et al. Occupational exposure to meat and risk of lymphoma: a multicenter case-control study from Europe. Int J Cancer 2007;121(12):2761-6.
  32. Takkouche B, Regueira-Mendez C, Montes-Martinez A. Risk of cancer among hairdressers and related workers: a meta-analysis. Int J Epidemiol 2009;38(6):1512-31.
  33. Rollison DE, Helzlsouer KJ, Pinney SM. Personal hair dye use and cancer: a systematic literature review and evaluation of exposure assessment in studies published since 1992. J Toxicol Env Heal B 2006;9(5):413-39.
  34. Brown LM, Gridley G, Check D, et al. Risk of multiple myeloma and monoclonal gammopathy of undetermined significance among white and black male United States veterans with prior autoimmune, infectious, inflammatory, and allergic disorders. Blood 2008;111(7):3388-94.
  35. Landgren O, Rapkin JS, Mellemkjaer L, et al. Respiratory tract infections in the pathway to multiple myeloma: a population-based study in Scandinavia. Haematologica 2006;91(12):1697-700
  36. Søgaard KK, Farkas DK, Pedersen L, et al. Pneumonia and the incidence of cancer: a Danish nationwide cohort study. J Intern Med. 2014.
  37. Karami S, Bassig B, Stewart PA, et al. Occupational trichloroethylene exposure and risk of lymphatic and haematopoietic cancers: a meta-analysis. Occup Environ Med. 2013 Aug;70(8):591-9.
  38. Liu T, Xu QE, Zhang CH, et al. Occupational exposure to methylene chloride and risk of cancer: a meta-analysis. Cancer Causes Control. 2013;24(12):2037-49.
Updated: 16 February 2015