Patients with active myeloma need the best treatment and, understandably, they are keenly interested in the search for a cure. But to prevent myeloma in the first place, we need a deep understanding of the disease. This understanding will lead to a world without myeloma by accelerating true disease eradication or cure. 

The Black Swan Research Initiative (https://www.myeloma.org/black-swan-research-initiative)-supported iStopMM (https://www.myeloma.org/black-swan-research-initiative/istopmm) program is a good example of the parallel paths of research into myeloma prevention and cure. The project’s investigators plan to sequentially introduce strategies to both prevent MGUS (monoclonal gammopathy of undetermined significance), smoldering multiple myeloma, and myeloma, and reduce disease progression.  Another area of investigation into prevention and cure are environmental factors that have been linked to cancer. Recent news reports brought this into perspective:

• Toxic, cancer-causing chemicals
  On May 13, Monsanto was hit with a $2-billion verdict in a Roundup cancer lawsuit trial (https://www.sfchronicle.com/bayarea/article/Monsanto-hit-with-2-billion-verdict-in-Roundup-13842033.php). A component of the weed killer, glyphosate, has been linked to both lymphomas and myeloma. That connection has been highly contested. So why did the jurors in this case, in which a husband and wife in their 70s both came down with cancer (non-Hodgkin’s lymphoma) after spraying Roundup on their property for about 30 years, render such a severe verdict? 

  As reported by CNN (https://www.cnn.com/2019/05/14/health/monsanto-2-billion-dollar-roundup-cancer-verdict/index.html), the jurors in the case were allowed to see a “mountain of evidence showing Monsanto’s manipulation of science, the media and regulatory agencies to forward their own agenda.” Included were text messages between Monsanto and EPA officials. Clearly, there are legitimate concerns about the safety of glyphosate and Roundup that have been kept from public view. This is especially important since the use of glyphosate (https://investigatemidwest.org/2019/05/26/controversial-pesticide-use-sees-dramatic-increase-across-the-midwest/) on crops has been dramatically increasing. 

  Beyond that, there are serious questions about so many other chemicals suspected of causing cancer and/or other major health problems. Everyone needs to be aware that the appropriate health warnings may be missing. The Hippocratic Oath includes “do no harm.” If chemicals may do harm, there must be every effort to avoid exposure. It will be important to develop comprehensive guidelines to achieve maximum protection from a whole range of chemicals. 

• Harmful chemicals in our food
  I have recently discussed (https://brianduriemd.myeloma.org/content/obesity-myeloma-and-younger-age-onset) the linkage between obesity and the increased likelihood of MGUS, MM and/or disease progression. The open question is: which factors contribute most strongly to the development of obesity? Three recent studies indicate that “ultra-processed foods,” that is, “foods made from cheap industrial ingredients and engineered to be super tasty and generally high in fat, sugar and salt” are both unhealthy and promote obesity. Those studies are:

  There are so many different additives, it is difficult to pinpoint just one or two of greatest concern. As I have emphasized so many times and is stated in these recent reports, eating “real food (https://www.myeloma.org/blog/dr-duries/fresh-and-healthy-food-choices-summer)” is the key to reducing obesity and improving health. 

  • It's Not Just Salt, Sugar, Fat: Study Finds Ultra-Processed Foods Drive Weight Gain (https://www.npr.org/sections/thesalt/2019/05/16/723693839/its-not-just-salt-sugar-fat-study-finds-ultra-processed-foods-drive-weight-gain)
  • Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (https://www.bmj.com/content/365/bmj.l1451)
  • Association between consumption of ultra-processed foods and all cause mortality: SUN prospective cohort study (https://www.bmj.com/content/365/bmj.l1949)

Prevention and the bigger picture
Avoiding toxic chemicals and eating real food can be part of a broader effort to produce a sustainable future. Avoiding myeloma and other illnesses will lead to the best future for our children and their children. Schoolchildren in Europe are protesting climate change, acting as the “adults in the room.” We adults should be thinking of their inheritance and their future, and working toward creating a healthy environment. 

As best treatments for myeloma and other diseases get more and more complicated and expensive, it is worth focusing on prevention measures that might be had for manageable costs. 

Bottom line
Myeloma prevention requires a multifaceted approach to understand the underlying risk factors and develop appropriate interventions. These will most likely help both those at risk for developing MGUS/SMM/MM and patients battling the disease. 
 

Dr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.