MULTIPLE MYELOMA Data Highlights Incidence rates for multiple myeloma reported from the National Cancer Institute's SEER Program show the highest risks in blacks. The 1992-96 average annual age-adjusted incidence rates for Pennsylvania show the same relationship. The rates for black male and black female residents were 1.6 and 7.2, respectively, versus 4. per 1, for all reported cases. Multiple myeloma accounted for 766 cancer cases diagnosed among Pennsylvania residents in 1996, the highest annual number of such cases recorded since statewide reporting began in 1985. Annual age-adjusted incidence rates between 1987 and 1996 have generally been on the increase among black males since 1991 and, since 1993, among black females. There have also been increases in recent years in the rates for white males and white females. A distinct feature of multiple myeloma is the strong association with age. The average annual (1992-96) age-specific incidence rates were highest among those age 7 and older. The mortality rates for multiple myeloma approximate the incidence rates, largely because almost all cases were diagnosed at an advanced stage of the disease. However, no discernible trends in the annual age-adjusted mortality rates by sex or race could be observed over the ten-year period of 1987 through 1996. The average annual (1992-96) age-specific death rates showed that black males and black females had the highest rates, especially in the oldest age groups. NOTE: This site includes multiple myelomas and plasmacytomas (plasma cell tumors, malignant). Multiple myelomas are always staged as distant. However, plasmacytomas can be staged as other than distant. FIGURE 23 Average Annual Age-Adjusted Incidence and Mortality Rates* by Sex and Race, Incidence Mortality Race/Sex All Cases/Deaths All Males All Females 4. 2.9 3.6 3.3 3.3 2.5 2.9 2.2 4.6 5. 5.7 7.2 8.2 1.6 2 4 6 8 1 Age-Adjusted Rate *per 1, 197 U.S. standard million population. Risk Factors Etiological factors are unknown. Blacks are predisposed. Early Detection None proven to be effective or currently being evaluated. Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1992-1996 - Page 196
Multiple Myeloma: INCIDENCE TABLE 23-A Number of Cancer Cases, Age-Adjusted Incidence Rates and Range for 95% Confidence Intervals by Sex, Race and Year, Pennsylvania Residents, 1987-1996 All Cases* All Races* White Black All Races* White Black Year No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- 1996 766 4.5.3 389 5.4.5 336 5..5 5 11.1 3.1 377 3.7.4 31 3.3.4 6 8.7 2.2 1995 735 4.3.3 367 5.2.5 35 4.6.5 53 11.9 3.2 368 3.6.4 34 3.1.3 58 8.4 2.2 1994 686 4..3 352 5..5 298 4.6.5 5 11.1 3.1 334 3.2.3 28 2.9.3 54 7.6 2. 1993 627 3.7.3 36 5.1.5 315 4.8.5 41 9.2 2.8 267 2.7.3 223 2.4.3 39 5.8 1.8 1992 622 3.7.3 34 4.5.5 254 4..5 42 9.6 2.9 318 3.1.3 278 3..4 37 5.3 1.7 1991 577 3.5.3 265 3.9.5 227 3.5.5 37 8.6 2.8 312 3.2.4 261 2.9.4 5 7.5 2.1 199 59 3.6.3 31 4.7.5 277 4.5.5 29 6.5 2.4 28 2.8.3 239 2.6.3 38 5.7 1.8 1989 586 3.7.3 279 4.2.5 245 4..5 32 7.5 2.6 37 3.3.4 267 3.1.4 39 5.9 1.9 1988 562 3.6.3 277 4.2.5 242 4..5 31 7.2 2.5 285 3.1.4 246 2.9.4 37 5.6 1.8 1987 472 3.1.3 232 3.6.5 23 3.4.5 26 6.3 2.4 24 2.7.3 197 2.3.3 4 6.4 2. * Includes any unknowns. NOTES: Age-adjusted rates are per 1, and are computed by the direct method using the 197 U.S. standard million population. Rates based on less than 2 events are considered statistically unreliable. The value of CI+/- added to and subtracted from the age-adjusted rate = 95% confidence interval. The value of CI+/- was calculated using a formula for estimating the standard error or SE (see Technical Notes). 14 FIGURE 23-A Age-Adjusted Incidence Rates by Sex and Race Pennsylvania Residents, 1987-1996 12 1 Rate per 1, 8 6 4 2 1987 1988 1989 199 1991 1992 1993 1994 1995 1996 Year Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1992-1996 - Page 197
Multiple Myeloma: INCIDENCE TABLE 23-B Average Annual Age-Specific Incidence Rates by Sex and Race Age Group All Cases All Races White Black All Races White Black Total 5.7 6.1 5.8 8.7 5.3 5. 8.1 Under 5 - - - - - - - 5-9 - - - - - - - 1-14 - - - - - - - 15-19 - - - - - - - 2-24 - - - - - - - 25-29.1.1.1.4. - - 3-34.3.3.3.5.3.2 1.2 35-39.7 1..8 2.9.5.3 1.7 4-44 1.7 2.5 2.2 5.1 1..9 1.9 45-49 2.6 3.9 3.4 1.7 1.4 1.3 2.9 5-54 5.3 6.3 5.5 16.1 4.3 3.4 13.1 55-59 7.1 8.6 7.4 25.2 5.7 5.1 11.7 6-64 14. 17.9 16.1 37.3 1.6 9.5 23.2 65-69 18.9 22.2 2. 53.3 16.3 14.8 33.5 7-74 25.6 32.9 3.6 6.1 2.3 18.6 4. 75-79 3.7 37.5 35. 7.7 26.4 24.4 55.6 8-84 32.4 36.9 35.2 57.2 3. 27.6 65.7 85+ 27.9 38.4 37.6 43.2 23.7 21.6 56.6 NOTE: Rates are per 1, population (1992-1996) for each specified group. FIGURE 23-B Average Annual Age-Specific Incidence Rates by Sex and Race 8 6 RATE PER 1, 4 2 Under 5 5-9 1-14 2-24 3-34 4-44 5-54 6-64 7-74 8-84 15-19 25-29 35-39 45-49 55-59 65-69 75-79 AGE GROUP 85+ Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1992-1996 - Page 198
Multiple Myeloma: INCIDENCE TABLE 23-C Total Number of Cancer Cases by Age, Sex and Race Age Group All Cases* All Races* White Black All Races* White Black Total 3,436 1,772 1,58 236 1,664 1,395 248 Under 5 5-9 1-14 15-19 2-24 25-29 4 3 2 1 1 3-34 15 8 7 1 7 4 3 35-39 33 22 16 6 11 6 4 4-44 76 54 43 9 22 18 4 45-49 11 73 58 15 28 22 5 5-54 168 97 77 18 71 51 19 55-59 198 114 9 24 84 68 15 6-64 384 227 189 32 157 128 28 65-69 525 273 228 42 252 211 37 7-74 633 341 298 37 292 249 37 75-79 596 282 248 3 314 272 4 8-84 412 164 147 14 248 214 32 85+ 291 114 15 7 177 152 24 * Includes any unknowns. FIGURE 23-C Stage of Disease at Diagnosis, Percent by Sex and Race Pennsylvania Residents, 1996 12 1 97.6 98. 98.1 98.3 In Situ Local Regional Distant 8 Percent 6 4 2 1.8 2. 1.9 1.7.6 Number and Percent of Cases Microscopically Confirmed: 653-85.3% Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1992-1996 - Page 199
Multiple Myeloma: MORTALITY TABLE 23-D Number of Deaths, Age-Adjusted Death Rates and Range for 95% Confidence Intervals by Sex, Race and Year, Pennsylvania Residents, 1987-1996 All Deaths* All Races* White Black All Races* White Black Year No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- No. Rate CI+/- 1996 53 3..3 285 3.9.5 247 3.6.4 38 8.5 2.7 245 2.3.3 23 2..3 42 6.4 1.9 1995 518 2.8.2 242 3.3.4 216 3.2.4 26 5.9 2.3 276 2.4.3 24 2.2.3 34 4.4 1.5 1994 543 3.1.3 282 4..5 237 3.6.5 45 1.4 3. 261 2.4.3 222 2.2.3 39 5.6 1.8 1993 53 3..3 245 3.5.4 27 3.1.4 37 8.6 2.8 285 2.7.3 242 2.5.3 43 5.9 1.8 1992 51 2.9.3 235 3.3.4 21 3..4 32 7.3 2.5 275 2.6.3 234 2.3.3 41 6.3 1.9 1991 517 2.9.2 243 3.5.4 218 3.4.5 25 5.7 2.2 274 2.5.3 235 2.3.3 37 5.3 1.7 199 54 3..3 258 3.9.5 224 3.6.5 32 7.8 2.7 246 2.4.3 221 2.4.3 25 3.6 1.4 1989 487 2.9.3 223 3.4.4 187 3..4 36 8.9 2.9 264 2.7.3 219 2.4.3 44 6.4 1.9 1988 51 3.1.3 234 3.5.4 22 3.3.5 32 7.7 2.7 267 2.8.3 22 2.5.3 44 6.6 2. 1987 433 2.7.3 216 3.3.4 195 3.2.4 21 5. 2.1 217 2.2.3 191 2.1.3 26 4. 1.5 * Includes any unknowns. NOTES: Age-adjusted rates are per 1, and are computed by the direct method using the 197 U.S. standard million population. Rates based on less than 2 events are considered statistically unreliable. The value of CI+/- added to and subtracted from the age-adjusted rate = 95% confidence interval. The value of CI+/- was calculated using a formula for estimating the standard error or SE (see Technical Notes). FIGURE 23-D Age-Adjusted Death Rates by Sex and Race Pennsylvania Residents, 1987-1996 12 1 8 Rate per 1, 6 4 2 1987 1988 1989 199 1991 1992 1993 1994 1995 1996 Year Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1992-1996 - Page 2
Multiple Myeloma: MORTALITY TABLE 23-E Number of Deaths and Average Annual Age-Specific Death Rates by Sex and Race All Deaths* All Races* White Black All Races* White Black Age Group No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate Total* 2,631 4.4 1,289 4.5 1,18 4.3 178 6.6 1,342 4.3 1,141 4.1 199 6.5 Under 5 - - - - - - - 5-9 - - - - - - - 1-14 - - - - - - - 15-19 - - - - - - - 2-24 - - - - - - - 25-29 - - - - - - - 3-34 3.1 3.1 3.1 - - - - 35-39 6.1 3.1 2.1 1.5 3.1 3.1-4-44 31.7 2.9 16.8 4 2.3 11.5 7.3 4 1.9 45-49 36.9 2 1.1 19 1.1 1.7 16.8 1.6 6 3.4 5-54 93 2.9 56 3.7 44 3.1 12 1.8 37 2.2 24 1.6 13 9. 55-59 134 4.8 85 6.4 67 5.5 18 18.9 49 3.3 31 2.3 17 13.3 6-64 26 9.5 139 11. 11 9.4 29 33.8 121 8.2 12 7.6 18 14.9 65-69 354 12.8 189 15.4 164 14.4 25 31.7 165 1.7 145 1.1 2 18.1 7-74 55 2.4 254 24.5 216 22.2 36 58.5 251 17.5 215 16.1 36 38.9 75-79 52 25.8 239 31.7 211 29.8 28 65.9 263 22.1 229 2.5 34 47.3 8-84 385 3.3 159 35.8 148 35.4 1 4.8 226 27.3 22 26.1 24 49.2 85+ 322 3.8 122 41.1 18 38.7 14 86.3 2 26.8 173 24.6 27 63.6 * Includes any unknowns. NOTE: Rates are per 1, population (1992-1996) for each specified group. FIGURE 23-E Average Annual Age-Specific Death Rates by Sex and Race 1 8 Rate per 1, 6 4 2 Under 5 5-9 1-14 2-24 15-19 3-34 25-29 35-39 4-44 45-49 Age Group 5-54 55-59 6-64 65-69 7-74 75-79 8-84 85+ Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1992-1996 - Page 21
Multiple Myeloma: INCIDENCE TABLE 23-F Number of Cases, Average Annual Age-Adjusted Incidence Rates and Range for 95% Confidence Intervals by County and Sex, Total Total County Cases No. Rate CI+/- No. Rate CI+/- County Cases No. Rate CI+/- No. Rate CI+/- All Counties 3,436 1,772 5..2 1,664 3.3.2 Adams 16 8 3.4 2.4 8 2.1 1.5 Juniata 7 1 1.6 3.1 6 7.1 5.7 Allegheny 376 188 4.4.6 188 2.8.4 Lackawanna 66 33 4.5 1.5 33 3.1 1.1 Armstrong 28 21 7.9 3.4 7 2.6 1.9 Lancaster 88 48 4.2 1.2 4 2.4.7 Beaver 51 28 4.4 1.6 23 2.8 1.1 Lawrence 35 22 6.8 2.8 13 2.6 1.4 Bedford 15 8 5.1 3.5 7 3. 2.2 Lebanon 33 16 4.3 2.1 17 3.4 1.6 Berks 93 44 4.1 1.2 49 3.1.9 Lehigh 61 34 3.9 1.3 27 2.3.9 Blair 44 19 4.8 2.2 25 4. 1.6 Luzerne 135 65 5.8 1.4 7 4.1 1. Bradford 22 18 1.1 4.7 4 1.8 1.8 Lycoming 32 2 5.9 2.6 12 2.1 1.2 Bucks 122 65 4.6 1.1 57 3..8 McKean 12 7 4.6 3.4 5 2.3 2. Butler 49 29 6.6 2.4 2 3.4 1.5 Mercer 3 18 4.8 2.2 12 2.2 1.2 Cambria 52 32 5.5 1.9 2 2.1.9 Mifflin 17 8 5.7 3.9 9 4.7 3.1 Cameron 6 2 1.4 14.4 4 13.1 12.8 Monroe 3 16 5.3 2.6 14 3.6 1.9 Carbon 23 9 4.2 2.7 14 5. 2.6 Montgomery 219 113 5.5 1. 16 3.7.7 Centre 26 12 4.5 2.5 14 4.3 2.3 Montour 2 2 3.6 5. - - Chester 7 34 3.4 1.1 36 2.8.9 Northampton 74 37 5.1 1.6 37 3.7 1.2 Clarion 16 1 8.2 5.1 6 3.1 2.5 Northumberland 39 24 7.3 2.9 15 3.2 1.6 Clearfield 18 14 5.9 3.1 4 1. 1. Perry 6 3 2.9 3.3 3 1.8 2. Clinton 8 5 4.8 4.2 3 2.4 2.7 Philadelphia 567 278 7.1.8 289 4.6.5 Columbia 19 9 4.3 2.8 1 4. 2.5 Pike 6 4 4.1 4. 2 1.5 2.1 Crawford 32 13 4.9 2.7 19 4.7 2.1 Potter 2 2 3.4 4.7 - - Cumberland 35 18 3.3 1.5 17 2.1 1. Schuylkill 58 27 5.2 2. 31 4.6 1.6 Dauphin 53 3 4.7 1.7 23 2.4 1. Snyder 13 9 8.8 5.7 4 2.9 2.8 Delaware 121 66 4.2 1. 55 2.3.6 Somerset 22 1 3.9 2.4 12 3.2 1.8 Elk 13 3 2.5 2.8 1 8.6 5.3 Sullivan 3 1 7.5 14.7 2 8.1 11.2 Erie 7 36 4.8 1.6 34 3. 1. Susquehanna 7 5 4. 3.5 2 1.4 1.9 Fayette 52 25 5.4 2.1 27 3.3 1.2 Tioga 8 3 2.5 2.8 5 3.8 3.3 Forest 3 1 4. 7.8 2 1.9 15.1 Union 12 1 9.7 6. 2 1.6 2.2 Franklin 4 2 5.4 2.4 2 3.9 1.7 Venango 14 7 3.6 2.7 7 2.8 2.1 Fulton 2 1 2.7 5.3 1 1.9 3.7 Warren 8 4 2.9 2.8 4 2.5 2.5 Greene 8 2 2. 2.8 6 2.5 2. Washington 71 41 6. 1.8 3 3.5 1.3 Huntingdon 15 11 8.7 5.1 4 2.6 2.5 Wayne 17 6 4.6 3.7 11 5.2 3.1 Indiana 27 15 6.2 3.1 12 3.4 1.9 Westmoreland 118 52 4.1 1.1 66 3.8.9 Jefferson 13 4 2.9 2.8 9 3.9 2.5 Wyoming 8 5 6.7 5.9 3 2.2 2.5 York 78 41 4.2 1.3 37 2.9.9 NOTES: Age-adjusted rates are per 1, and are computed by the direct method using the 197 U.S. standard million population. Rates based on less than 2 events are considered statistically unreliable. The value of CI+/- added to and subtracted from the age-adjusted rate = 95% confidence interval. The value of CI+/- was calculated using a formula for estimating the standard error or SE (see Technical Notes). Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1992-1996 - Page 22
Multiple Myeloma: MORTALITY TABLE 23-G Number of Deaths, Average Annual Age-Adjusted Death Rates and Range for 95% Confidence Intervals By County and Sex, Total Total County Deaths No. Rate CI+/- No. Rate CI+/- County Deaths No. Rate CI+/- No. Rate CI+/- All Counties 2,631 1,289 3.6.2 1,342 2.5.1 Adams 17 9 3.8 2.5 8 2.4 1.7 Juniata 3 1 1.6 3.1 2 1.9 2.6 Allegheny 327 16 3.7.6 167 2.4.4 Lackawanna 57 25 3.6 1.4 32 2.5.9 Armstrong 26 18 6.8 3.1 8 2. 1.4 Lancaster 87 47 4. 1.1 4 2.2.7 Beaver 39 17 2.6 1.2 22 2.4 1. Lawrence 29 16 4.4 2.2 13 2.9 1.6 Bedford 12 8 4.9 3.4 4 1.4 1.4 Lebanon 16 7 1.9 1.4 9 1.8 1.2 Berks 56 25 2.3.9 31 2.2.8 Lehigh 57 26 3. 1.2 31 2.2.8 Blair 24 11 2.6 1.5 13 1.9 1. Luzerne 96 37 3.3 1.1 59 3.1.8 Bradford 16 7 4.1 3. 9 3.5 2.3 Lycoming 23 13 3.6 2. 1 1.7 1.1 Bucks 95 55 3.9 1. 4 2..6 McKean 12 4 2.5 2.5 8 4. 2.8 Butler 35 16 3.6 1.8 19 3.3 1.5 Mercer 28 13 3.1 1.7 15 2.7 1.4 Cambria 33 18 3.1 1.4 15 1.5.8 Mifflin 11 4 2.8 2.7 7 2.7 2. Cameron 3 2 9.1 12.6 1 3.1 6.1 Monroe 24 9 2.9 1.9 15 3.5 1.8 Carbon 22 8 3.8 2.6 14 4.6 2.4 Montgomery 134 71 3.3.8 63 2..5 Centre 15 6 2.3 1.8 9 2.5 1.6 Montour 3 2 3.6 5. 1 1.9 3.7 Chester 55 31 3.2 1.1 24 1.9.8 Northampton 53 29 3.9 1.4 24 2.3.9 Clarion 14 5 4.5 3.9 9 4.6 3. Northumberland 31 19 5.7 2.6 12 2.6 1.5 Clearfield 14 1 4.1 2.5 4 1.4 1.4 Perry 4 1 1. 2. 3 1.8 2. Clinton 7 6 5.7 4.6 1 1.1 2.2 Philadelphia 43 189 4.7.7 214 3.3.4 Columbia 16 11 5.7 3.4 5 1.8 1.6 Pike 6 2 2. 2.8 4 2.7 2.6 Crawford 21 5 1.9 1.7 16 4. 2. Potter 1 1 1.7 3.3 - - Cumberland 27 13 2.3 1.3 14 1.7.9 Schuylkill 41 2 3.5 1.5 21 2.3 1. Dauphin 44 27 4. 1.5 17 1.8.9 Snyder 1 8 7.6 5.3 2 1.1 1.5 Delaware 13 4 2.4.7 63 2.7.7 Somerset 16 8 2.9 2. 8 2.1 1.5 Elk 11 5 4.2 3.7 6 4.4 3.5 Sullivan 2 1 7.5 14.7 1 2. 3.9 Erie 59 28 3.8 1.4 31 2.5.9 Susquehanna 7 4 3.1 3. 3 1.4 1.6 Fayette 38 21 4.2 1.8 17 2. 1. Tioga 8 5 4. 3.5 3 2.3 2.6 Forest 3 - - 3 11.5 13. Union 14 1 1.2 6.3 4 3.6 3.5 Franklin 29 17 4.6 2.2 12 2.4 1.4 Venango 13 7 3.6 2.7 6 2. 1.6 Fulton 2 2 4.6 6.4 - - Warren 9 4 2.9 2.8 5 2.5 2.2 Greene 7 2 2.1 2.9 5 2.3 2. Washington 58 24 3.5 1.4 34 3.5 1.2 Huntingdon 14 1 7.8 4.8 4 2.1 2.1 Wayne 12 4 2.5 2.5 8 3.4 2.4 Indiana 21 12 5. 2.8 9 2.3 1.5 Westmoreland 94 46 3.6 1. 48 2.4.7 Jefferson 9 2 1.5 2.1 7 3.4 2.5 Wyoming 4 2 2.8 3.9 2 1.3 1.8 York 51 23 2.4 1. 28 2..7 NOTES: Age-adjusted rates are per 1, and are computed by the direct method using the 197 U.S. standard million population. Rates based on less than 2 events are considered statistically unreliable. The value of CI+/- added to and subtracted from the age-adjusted rate = 95% confidence interval. The value of CI+/- was calculated using a formula for estimating the standard error or SE (see Technical Notes). Pennsylvania Department of Health - Pennsylvania Cancer Incidence and Mortality 1992-1996 - Page 23