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Note: The incidence rates were compared for males and females of all races diagnosed between 1973 and 1980 split by the age at diagnosis (30-39, 40-49, 50-59, 60-69, 70+). The P-value is zero to four decimal places, meaning that the trend is highly significant. The incidence rate of myeloma increases with aging across all groups. There is a higher incidence rate among male population than among females and is more in blacks than in whites. Source: From Ref. 3. Rates are per 100,000 and age-adjusted to the 2000 US (19 age groups) standard.

Note: The incidence rates were compared for males and females of all races diagnosed between 1973 and 1980 split by the age at diagnosis (30-39, 40-49, 50-59, 60-69, 70+). The P-value is zero to four decimal places, meaning that the trend is highly significant. The incidence rate of myeloma increases with aging across all groups. There is a higher incidence rate among male population than among females and is more in blacks than in whites. Source: From Ref. 3. Rates are per 100,000 and age-adjusted to the 2000 US (19 age groups) standard.

or alcoholic beverages, and no consistent patterns with either intensity or duration of use of either were seen. These data are consistent with several studies indicating that smoking and drinking are not associated with MM.17 Another area of controversy is the difference of dietary habits across different racial groups and its relation to the incidence of MM. The use of vitamin C supplements by whites and the higher frequency of obesity among blacks may explain part of the higher incidence of MM among blacks. However such conjecture cannot explain the noted worldwide racial disparity of MM.18

Whether genetic factors contribute to the high incidence of MM among blacks is another area of controversy. Serologic typing of HLAs was conducted for blacks (46 patients and 88 controls) and whites (85 patients and 122 controls). Black patients had significantly higher frequencies than black controls for Bw65, Cw2, and DRw14. White patients had higher frequencies than white controls for A3 and Cw2. Cw2 allele had a relative MM risk of 5.7 (95% CI 1.5-26.6) and 2.6 (95% CI 1.0-7.2) for blacks and whites, respectively.19 Some studies had reported a lower survival rate for blacks than for whites, though others did not find such a difference.20 In a Southwest Oncology Group (SWOG) randomized trial, the survival for black patients was similar to that for white patients, both overall and adjusted for prognostic factors such as stage.21 Not all blacks have a high incidence rate of MM; the incidence of MM in blacks living in Caribbean island is the lowest compared to other countries. Again, the younger age and aggressive presentation were noted with overall poor survival.22

Figure 80.1 SEER incidence and US death rates due to myeloma, by race and sex. (Source: SEER nine areas and NCHS public use data file. Rates are age-adjusted to the 2000 US standard million population by 5-year age groups. Regression lines are calculated using the Join Point Regression Program)
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