Risk factors versus causal inferences: the implications on multiple myeloma in developed versus developing countries

Abstract

Author(s): Ogbonna C. Nwabuko*, Ifeanyi C. Nnezianya, Uche B. Aguocha

Multiple myeloma (MM) is a cancer of the bone marrow. It is a non-communicable disease of public health importance. It is currently the second most popular haematological malignancy (after non-Hodgkins lymphoma) which targets the middle-aged and elderly population, especially those of the black race. It is a disease known for its ability to cause skeletal complications (i.e., chronic bone pain, osteoporosis and pathological fracture) at advanced stage. One of the greatest challenges in the diagnosis and management of MM especially in low-income countries is difficulty identifying the potential hazards and/or proximate causes of the disease both environmentally and biologically. This study aims to highlight some of the potential risk factors of multiple myeloma and their possible stratification based on the hazards risk levels. Methods: This was evidence-based review essay of 29 references related to descriptive epidemiology of MM, risk factors of the disease and their possible implications (clear links) to the disease control approximately over the past two decades (2001-2018). Two keywords: (MM and Risk factors/Descriptive epidemiology in developed and developing countries) were used as search strategy to identify answers to research questions. PubMed, Medline, Google Scholar, African Journal Online (AJOL) were the search database reviewed. The risk assessment were categorized broadly into environmental (i.e., lifestyle) and biological (cytogenetic karyotypes). Each of these groups is stratified into three sub-divisions of low (standard)-, Intermediate- and High risk- level sub-divisions. The identification of risk factors of MM helps in the risk management. The risk management is a-two-way-approach (i.e., preventive and cure) which include the public health safety measures to prevent exposure to the potential hazards and the clinical approach which uses therapeutic interventions (individualized therapy) in disease control. These strategies could be useful in navigating the course, prognosis and the disease outcome both in the developed and developing countries.

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