Early Screening for Myeloma: Advantages, Impact, and Benefits 

This week's "Ask Dr. Durie" comes from a patient who has heard about the IMF project in Iceland. The iStopMM Project, Iceland screens, treats or prevents multiple myeloma. And the question is, what could be the advantages of screening for the early disease to pick up MGUS or smoldering myeloma at the earliest possible time? 

So what are the advantages of trying to do that? So the first obvious advantage is that if you pick up the disease early, this is before CRAB criteria have developed. And so, you're picking up disease in individuals who do not have bone disease, who do not have anemia, who have not developed any kind of kidney damage. And so, this is a huge advantage that you have detected, with the possibility of intervening with treatment as necessary for patients before they've developed any kind of major complications. 

This has, advantages which are both wonderful for patients, but also, from a financial standpoint, you, reduce the need for, testing and treatment for things like bone disease. So this is very important because all kinds of imaging and X-rays are very expensive. Likewise for kidney disease, management of major kidney problems is also difficult, and expensive. 

In addition to that, we now know that patients who have MGUS and smoldering myeloma are also predisposed to some other medical issues including potential heart problems, or nerve problems, or kidney problems. And by diagnosing those early, we also have an opportunity to improve the survival and the quality of life for such patients by making adjustments to their ongoing care as early as possible. 

And so, the bottom line here is that, screening, has many advantages. One of them would be the advantage to the patient by being diagnosed early. Another would be, to the financial community where the costs for insurance and payers would be much less. But the big news is that it would be a complete change in the paradigm of the management of myeloma. 

We will be looking at a focus on how do we best care for patients with this very, very early stage of the disease process. A whole different way of looking at the disease. And so, the BOTTOM LINE in moving forward in this fashion is that coming out of Iceland, we have a randomized trial where some of the patients have been screened and had, full testing and early intervention. And we need to be able to demonstrate that this really does improve the survival and the quality of life for these patients who have been screened and had appropriate follow on management. 

And so, we are awaiting this result, which hopefully will be available within the next year or two. But if this does indeed prove to be well-established that survival and quality of life are benefited with screening, then as we say, screening will be the way to go. And I think it has huge potential advantages.