Chapter 4: Cancer incidence in Canada: trends and projections (1983-2032) – Multiple myeloma - HPCDP: Volume 35, Supplement 1, Spring 2015

Chapter 4: Projections by Cancer Site

22. Multiple myeloma

Multiple myeloma (MM), or plasma cell myeloma, is the third most common lymphohematopoietic cancer, after NHL and leukemia. During 2003–2007, the average annual number of newly diagnosed MM cases was 1065 for males and 875 for females in Canada, which represented 1.3% and 1.2% of all new male and female cancer cases, respectively (Tables 4.22.1 and 4.22.2).

TABLE 4.22.1
Observed (2003–2007) and projected average annual new cases by age and province/territories combined (TC), multiple myeloma, males, Canada, 2003–2032
Period Age New cases
CA BC AB SK MB ON QC NB NS PE NL TC

Abbreviations: AB, Alberta; BC, British Columbia; CA, Canada; MB, Manitoba; NB, New Brunswick; NL, Newfoundland and Labrador; NS, Nova Scotia; ON, Ontario; PE, Prince Edward Island; QC, Quebec; SK, Saskatchewan; TC, All Territories (Yukon, Northwest Territories and Nunavut).

Note: Totals may not add up due to rounding.

2003–07 <45 30 5 5 0 0 15 5 0 0 0 0 0
45–54 110 10 10 5 5 45 25 0 0 0 0 0
55–64 240 30 20 10 5 95 60 5 10 0 5 0
65–74 295 30 30 10 10 110 80 10 10 0 5 0
75–84 300 40 20 10 10 120 80 5 10 0 0 0
85+ 90 15 10 5 5 50 35 5 5 0 0 0
Total 1065 130 95 35 35 425 270 25 30 10 10 0
2008–12 <45 30 5 5 0 0 10 10 0 0 0 0 0
45–54 130 15 10 5 5 60 30 0 5 0 0 0
55–64 290 35 30 10 10 115 70 10 10 0 5 0
65–74 365 40 35 10 10 140 95 10 10 5 5 0
75–84 335 40 30 10 10 135 90 5 10 5 0 0
85+ 125 20 10 5 5 50 35 5 5 0 0 0
Total 1270 150 115 35 40 510 330 30 35 10 10 5
2013–17 <45 35 5 5 0 0 10 10 0 0 0 0 0
45–54 130 10 10 5 5 60 35 0 5 0 0 0
55–64 335 40 35 10 10 140 80 10 10 5 5 0
65–74 480 55 45 10 15 185 120 15 15 5 5 0
75–84 380 45 35 10 10 145 105 10 10 5 5 0
85+ 155 20 15 5 5 65 45 5 5 0 0 0
Total 1515 175 135 40 45 615 385 35 40 10 15 5
2018–22 <45 40 5 5 0 0 10 10 0 0 0 0 0
45–54 120 10 10 5 5 50 30 0 5 0 0 0
55–64 385 45 35 10 10 175 85 10 10 5 5 0
65–74 585 70 60 15 15 230 140 15 15 5 5 0
75–84 475 55 40 10 15 190 135 10 15 5 5 0
85+ 190 25 20 5 5 75 55 5 5 0 0 0
Total 1790 205 165 45 50 730 455 40 45 15 15 5
2023–27 <45 40 5 5 0 0 15 10 0 0 0 0 0
45–54 130 10 10 5 5 50 30 0 5 0 0 0
55–64 385 40 30 10 10 175 90 10 10 5 5 0
65–74 680 80 75 20 20 285 160 20 20 5 5 0
75–84 630 75 60 15 15 250 165 15 15 5 5 0
85+ 225 30 20 5 5 90 65 5 5 0 0 0
Total 2085 240 195 50 55 860 520 45 55 15 15 5
2028–32 <45 40 5 5 0 0 15 10 0 0 0 0 0
45–54 135 15 10 5 5 50 35 0 5 0 0 0
55–64 355 40 30 10 10 145 80 5 10 5 5 0
65–74 780 90 75 20 20 350 175 20 20 5 5 0
75–84 780 90 80 20 20 310 200 15 20 5 5 0
85+ 300 40 25 5 5 125 90 5 5 0 0 0
Total 2395 275 225 55 65 995 585 50 60 20 15 5
TABLE 4.22.2
Observed (2003–2007) and projected average annual new cases by age and province/territories combined (TC), multiple myeloma, females, Canada, 2003–2032
Period Age New cases
CA BC AB SK MB ON QC NB NS PE NL TC

Abbreviations: AB, Alberta; BC, British Columbia; CA, Canada; MB, Manitoba; NB, New Brunswick; NL, Newfoundland and Labrador; NS, Nova Scotia; ON, Ontario; PE, Prince Edward Island; QC, Quebec; SK, Saskatchewan; TC, All Territories (Yukon, Northwest Territories and Nunavut).

Note: Totals may not add up due to rounding.

2003–07 <45 20 0 0 0 0 10 5 0 0 0 0 0
45–54 75 5 5 5 5 35 20 0 0 0 0 0
55–64 165 15 15 5 5 65 45 5 5 0 0 0
65–74 230 20 20 10 5 100 60 5 5 0 5 0
75–84 275 30 20 10 10 115 70 5 5 0 5 0
85+ 110 10 5 0 5 45 30 0 5 0 0 0
Total 875 90 70 25 30 370 230 20 25 5 10 0
2008–12 <45 20 0 0 0 0 10 5 0 0 0 0 0
45–54 95 10 10 5 5 45 20 0 0 0 0 0
55–64 190 15 15 5 5 80 50 5 5 0 0 0
65–74 265 25 25 10 5 110 65 5 5 0 5 0
75–84 290 30 25 10 10 120 80 5 5 0 5 0
85+ 145 15 10 5 5 65 45 0 5 0 0 0
Total 1000 100 85 30 30 425 265 25 25 5 10 0
2013–17 <45 15 0 0 0 0 10 5 0 0 0 0 0
45–54 100 10 10 5 5 55 20 0 0 0 0 0
55–64 215 20 20 5 5 85 60 5 5 0 5 0
65–74 335 35 30 10 10 135 85 10 10 0 5 0
75–84 310 30 30 10 10 130 80 10 10 0 5 0
85+ 175 15 15 5 5 75 55 0 5 0 0 0
Total 1150 115 100 30 35 485 300 25 30 5 15 0
2018–22 <45 20 0 0 0 0 10 5 0 0 0 0 0
45–54 90 10 10 0 5 40 15 0 0 0 0 0
55–64 250 25 25 5 5 110 60 10 10 0 5 0
65–74 395 40 35 10 10 160 100 10 10 0 5 0
75–84 365 40 35 10 10 150 95 10 10 0 5 0
85+ 190 20 15 5 5 80 60 5 5 0 0 0
Total 1310 130 120 35 40 555 335 30 35 5 15 0
2023–27 <45 20 0 0 0 0 10 5 0 0 0 0 0
45–54 85 10 10 0 5 40 15 0 0 0 0 0
55–64 265 25 25 5 5 120 55 5 5 0 5 0
65–74 445 45 40 15 10 175 115 10 10 0 5 0
75–84 470 50 40 10 15 190 125 10 10 0 5 0
85+ 210 20 20 5 5 95 60 5 5 0 0 0
Total 1495 155 140 40 45 630 375 35 40 5 15 0
2028–32 <45 20 0 0 0 0 10 5 0 0 0 0 0
45–54 90 10 10 5 5 45 20 0 0 0 0 0
55–64 245 25 25 5 5 95 50 5 5 0 0 0
65–74 515 60 50 15 15 225 120 10 10 0 5 0
75–84 555 55 50 15 20 225 145 15 15 0 5 0
85+ 260 25 20 5 10 110 80 5 5 0 5 0
Total 1685 180 155 45 50 710 415 35 45 5 20 0

The estimated lifetime risk of developing MM is 1 in 131 for males and 1 in 157 for females.Endnote 1 Incidence was rare below age 45, accounting for 2.8% and 2.3% of the respective male and female cases in 2003–2007, while nearly 56% to 58% of the cases were diagnosed in people aged 65 to 84 (Tables 4.22.1 and 4.22.2). The incidence rates increased gradually with age (Tables 4.22.3 and 4.22.4). The overall male-to-female ratio was 1.5. MM has a poor prognosis among all lymphohematopoietic cancers, with a 5-year survival rate of 43% in 2006–2008.Endnote 1

TABLE 4.22.3
Observed (2003–2007) and projected age-standardized incidence rates (ASIRs) by age and province/territories combined (TC), multiple myeloma, males, Canada, 2003–2032
Period Age ASIRs
CA BC AB SK MB ON QC NB NS PE NL TC

Abbreviations: AB, Alberta; BC, British Columbia; CA, Canada; MB, Manitoba; NB, New Brunswick; NL, Newfoundland and Labrador; NS, Nova Scotia; ON, Ontario; PE, Prince Edward Island; QC, Quebec; SK, Saskatchewan; TC, All Territories (Yukon, Northwest Territories and Nunavut).

2003–07 <45 0.3 0.2 0.2 0.2 0.4 0.3 0.3 0.2 0.4 0.0 0.2 0.0
45–54 4.3 3.6 3.9 4.3 4.2 5.0 4.4 3.0 1.8 11.8 4.4 0.0
55–64 14.2 12.0 14.7 17.2 12.9 15.2 13.4 15.0 13.9 31.3 11.4 3.6
65–74 27.3 21.1 31.8 25.8 22.9 27.0 29.6 37.8 26.2 47.1 19.2 59.5
75–84 48.3 43.6 41.5 37.7 48.0 50.9 53.8 33.2 51.1 67.0 16.8 57.5
85+ 59.3 53.8 61.8 42.6 36.2 61.9 72.4 72.9 37.3 79.7 8.9 0.0
Total 6.1 5.1 6.1 5.6 5.5 6.4 6.5 6.2 5.7 10.4 3.6 6.4
2008–12 <45 0.3 0.2 0.2 0.3 0.4 0.3 0.3 0.2 0.4 0.5 0.1 0.3
45–54 4.6 3.6 3.5 4.8 4.2 5.5 4.7 3.9 4.1 7.9 3.4 5.3
55–64 14.0 11.9 14.2 14.5 11.2 14.9 13.5 14.6 12.9 23.9 9.6 15.8
65–74 29.4 23.9 32.5 27.9 25.4 30.4 30.4 34.0 27.2 50.1 19.3 33.2
75–84 47.9 38.5 48.4 41.5 43.8 49.7 54.0 43.9 45.1 81.8 21.9 54.2
85+ 59.9 57.6 58.7 41.6 46.5 60.6 74.6 56.8 47.8 102.2 7.0 67.7
Total 6.2 5.2 6.3 5.8 5.5 6.5 6.7 6.3 5.8 10.7 3.4 7.1
2013–17 <45 0.3 0.2 0.2 0.3 0.4 0.3 0.4 0.2 0.4 0.6 0.1 0.4
45–54 4.7 3.3 2.8 4.8 4.2 5.3 5.2 3.8 4.1 8.0 3.4 5.3
55–64 14.2 11.8 13.6 14.7 11.1 15.9 13.8 14.4 13.0 24.3 9.6 16.1
65–74 30.7 25.4 32.8 28.4 25.3 32.1 30.5 34.4 27.3 52.3 19.0 34.7
75–84 49.1 38.4 53.2 42.1 43.6 49.9 56.6 44.7 45.3 83.9 21.0 55.6
85+ 58.6 50.8 55.8 42.2 46.3 62.5 72.1 57.3 48.0 100.0 6.6 66.3
Total 6.4 5.2 6.3 5.9 5.5 6.7 6.8 6.3 5.8 10.9 3.4 7.3
2018–22 <45 0.3 0.2 0.2 0.3 0.4 0.3 0.4 0.2 0.4 0.6 0.1 0.4
45–54 4.6 3.3 2.7 4.9 4.2 4.7 5.3 3.8 4.1 7.9 3.4 5.3
55–64 14.8 12.2 12.3 14.9 11.1 17.3 14.3 14.2 13.0 25.2 9.6 16.7
65–74 31.0 24.8 34.3 28.7 25.2 32.5 30.6 34.3 27.4 53.0 18.8 35.1
75–84 50.9 40.1 51.9 42.5 43.4 53.3 57.9 45.4 45.4 86.9 20.5 57.6
85+ 60.5 51.9 63.3 42.6 46.1 61.6 76.2 58.4 48.1 103.4 6.4 68.5
Total 6.6 5.2 6.3 5.9 5.4 6.9 7.0 6.3 5.8 11.2 3.3 7.4
2023–27 <45 0.3 0.2 0.2 0.3 0.4 0.3 0.4 0.2 0.4 0.6 0.1 0.4
45–54 5.0 3.3 2.7 4.9 4.2 4.7 5.3 3.7 4.1 8.5 3.4 5.7
55–64 14.7 11.4 10.6 15.0 11.1 16.6 15.2 14.0 13.1 25.1 9.6 16.6
65–74 31.2 25.2 33.5 28.8 25.1 34.2 30.7 33.8 27.4 53.3 18.7 35.3
75–84 52.3 42.4 53.9 42.7 43.3 55.1 57.2 45.8 45.5 89.2 20.2 59.1
85+ 60.9 51.1 68.3 42.8 46.1 62.0 77.9 59.4 48.2 104.0 6.3 68.9
Total 6.7 5.3 6.3 5.9 5.4 7.1 7.1 6.3 5.9 11.4 3.3 7.5
2028–32 <45 0.4 0.2 0.2 0.3 0.4 0.3 0.4 0.2 0.4 0.6 0.1 0.4
45–54 5.0 3.3 2.7 4.9 4.2 4.8 5.4 3.7 4.1 8.6 3.4 5.7
55–64 14.5 11.4 10.5 15.1 11.0 14.9 15.3 13.8 13.1 24.7 9.6 16.4
65–74 32.1 25.5 30.5 29.0 25.1 36.5 31.8 33.3 27.4 54.9 18.6 36.4
75–84 52.6 41.3 55.5 42.9 43.3 55.6 57.2 45.6 45.5 89.8 19.9 59.5
85+ 63.8 55.8 62.7 43.0 46.0 68.0 78.8 60.2 48.2 108.9 6.2 72.2
Total 6.8 5.3 6.0 6.0 5.4 7.2 7.2 6.2 5.9 11.5 3.3 7.6
TABLE 4.22.4
Observed (2003–2007) and projected age-standardized incidence rates (ASIRs) by age and province/territories combined (TC), multiple myeloma, females, Canada, 2003–2032
Period Age ASIRs
CA BC AB SK MB ON QC NB NS PE NL TC

Abbreviations: AB, Alberta; BC, British Columbia; CA, Canada; MB, Manitoba; NB, New Brunswick; NL, Newfoundland and Labrador; NS, Nova Scotia; ON, Ontario; PE, Prince Edward Island; QC, Quebec; SK, Saskatchewan; TC, All Territories (Yukon, Northwest Territories and Nunavut).

2003–07 <45 0.2 0.1 0.2 0.1 0.2 0.2 0.2 0.1 0.3 0.4 0.1 0.0
45–54 3.1 2.2 2.7 3.7 3.0 3.5 3.1 2.2 2.6 1.7 2.3 2.8
55–64 9.4 6.4 10.7 10.8 7.5 9.8 9.6 15.9 10.0 13.9 3.2 0.0
65–74 19.1 14.0 20.2 20.1 13.3 21.5 18.9 21.1 15.2 18.6 18.5 14.3
75–84 31.2 26.6 30.0 23.9 33.0 33.9 33.1 25.4 24.7 11.9 21.6 0.0
85+ 32.3 23.3 26.3 14.0 36.2 37.8 38.7 21.0 25.5 10.7 7.8 0.0
Total 4.0 3.0 4.1 3.8 3.6 4.5 4.2 4.2 3.6 3.5 2.7 1.3
2008–12 <45 0.2 0.1 0.2 0.1 0.1 0.2 0.2 0.1 0.3 0.3 0.1 0.1
45–54 3.4 2.8 2.7 3.6 3.2 4.3 3.0 2.7 2.6 3.1 2.3 1.1
55–64 9.0 5.9 9.1 8.5 7.1 10.0 9.6 12.1 9.7 8.9 6.1 2.9
65–74 19.4 14.6 21.2 20.8 15.7 21.3 18.9 18.4 15.8 16.0 13.1 6.3
75–84 31.7 24.9 32.2 28.7 32.2 33.2 33.8 34.1 26.3 21.5 21.3 10.3
85+ 33.4 21.5 32.7 20.5 29.5 38.9 42.2 14.3 27.5 24.7 22.5 10.9
Total 4.1 3.0 4.1 3.8 3.6 4.5 4.2 4.0 3.6 3.4 2.7 1.3
2013–17 <45 0.2 0.1 0.2 0.1 0.1 0.2 0.2 0.1 0.3 0.3 0.1 0.1
45–54 3.7 2.7 2.8 3.6 3.2 4.7 2.9 2.7 2.6 3.0 2.5 1.2
55–64 8.9 5.5 9.0 8.7 7.1 9.4 9.9 12.1 9.8 8.3 6.0 2.9
65–74 19.8 15.0 19.5 21.1 15.6 21.5 20.3 17.9 15.9 15.1 13.3 6.4
75–84 31.9 24.5 36.5 29.2 32.1 34.2 32.4 33.5 26.5 20.8 21.5 10.4
85+ 33.9 22.4 33.0 20.9 29.3 37.8 42.3 17.9 27.7 24.0 22.8 11.0
Total 4.1 3.0 4.2 3.9 3.5 4.5 4.3 4.0 3.6 3.2 2.8 1.3
2018–22 <45 0.2 0.1 0.2 0.1 0.1 0.2 0.2 0.1 0.3 0.3 0.1 0.1
45–54 3.6 2.6 2.9 3.6 3.2 3.9 3.0 2.7 2.6 2.8 2.4 1.2
55–64 9.5 7.1 9.3 8.8 7.0 10.7 9.9 12.1 9.8 7.8 6.4 3.1
65–74 19.2 13.3 19.1 21.3 15.6 20.7 20.4 17.6 16.0 14.2 12.9 6.3
75–84 32.5 24.1 34.8 29.5 32.0 34.9 33.3 32.5 26.7 19.9 21.9 10.6
85+ 33.5 22.5 34.3 21.1 29.3 36.7 41.2 19.8 27.9 23.3 22.6 10.9
Total 4.1 3.0 4.1 3.9 3.5 4.5 4.3 3.9 3.7 3.1 2.8 1.3
2023–27 <45 0.2 0.1 0.2 0.1 0.1 0.2 0.2 0.1 0.3 0.2 0.1 0.1
45–54 3.2 2.6 3.0 3.6 3.2 3.9 3.1 2.7 2.6 2.7 2.2 1.0
55–64 10.1 7.1 9.4 8.8 7.0 11.2 9.5 12.1 9.9 7.4 6.8 3.3
65–74 19.0 13.9 18.5 21.5 15.5 19.7 20.6 17.4 16.0 13.3 12.8 6.2
75–84 32.8 25.4 32.1 29.6 32.0 34.9 34.6 32.3 26.7 18.7 22.1 10.7
85+ 33.9 22.3 39.5 21.2 29.2 38.8 38.4 18.7 27.9 22.4 22.8 11.0
Total 4.2 3.0 4.1 4.0 3.5 4.5 4.3 3.9 3.7 2.9 2.8 1.4
2028–32 <45 0.2 0.1 0.2 0.1 0.1 0.2 0.2 0.1 0.3 0.2 0.1 0.1
45–54 3.2 2.5 3.0 3.6 3.2 3.9 3.1 2.7 2.6 2.5 2.2 1.1
55–64 9.9 7.0 9.6 8.9 7.0 9.6 9.6 12.1 9.9 7.0 6.7 3.2
65–74 20.2 16.7 18.8 21.6 15.5 22.3 20.3 17.3 16.1 12.4 13.6 6.6
75–84 31.6 22.2 30.7 29.8 31.9 33.4 34.4 32.0 26.8 17.5 21.3 10.3
85+ 34.5 22.1 32.6 21.3 29.2 38.4 41.5 18.5 28.0 21.3 23.3 11.2
Total 4.2 3.1 4.0 4.0 3.5 4.5 4.4 3.9 3.7 2.7 2.8 1.4

The overall incidence rates of MM have increased marginally throughout the whole observation period in males (Figure 4.22.1). The similar magnitude of the increase in females showed levelling off in the last 10 years. During 1998–2007, the ASIRs for MM increased non-significantly in males by 0.4% per year and were stable in females (Figures 3.1 and 3.2). Rate stabilization has been observed in all regions, the only variation being a decrease in British Columbia in the last period. The interregional differences in ASIRs were small, ranged from 5.0 to 6.7 per 100 000 in males and 3.0 to 4.5 in females.

FIGURE 4.22.1
Age-standardized incidence rates (ASIRs) by region, multiple myeloma, 1983–2032

Age-standardized incidence rates (ASIRs) by region, multiple myeloma, 1983–2032

[Click to enlarge]

[FIGURE 4.22.1, Text Equivalent]

Health Promotion and Chronic Disease Prevention in Canada - Volume 35 · Supplement 1 · Spring 2015

FIGURE 4.22.1
Age-standardized incidence rates (ASIRs) by region, multiple myeloma, 1983-2032

The incidence rates of multiple myeloma in males are expected to increase by 3% to 13% in all regions from 2003-2007 to 2028-2032. When the Atlantic region is not considered, the observed east-west gradient in male rates that started in 1998-2002 will remain over the next 25 years, with the highest rates in Quebec and the lowest rates in British Columbia. The rates in females are projected to stabilize in the Atlantic region and Ontario and increase marginally (4%-8%) in the other regions. Females in Ontario are predicted to experience the highest incidence, whereas those in British Columbia will have the lowest rates.

The incidence rates of MM in males are expected to increase by 3% to 13% in all regions from 2003–2007 to 2028–2032 (Figure 4.22.1). When the Atlantic region is not considered, the observed east–west gradient in male rates that started in 1998– 2002 will remain over the next 25 years, with the highest rates in Quebec and the lowest rates in British Columbia. The rates in females are projected to stabilize in the Atlantic region and Ontario and increase marginally (4%–8%) in the other regions. Females in Ontario are predicted to experience the highest incidence, whereas those in British Columbia will have the lowest rates. The age-specific analysis illustrated in Figure 4.22.2 indicates that the ASIRs in Canada are expected to increase slightly or stabilize in each age group, resulting from continuation of their observed long-term trends.

FIGURE 4.22.2
Age-standardized incidence rates (ASIRs) for multiple myeloma by age group, Canada, 1983–2032 (red lines denote males, blue lines denote females)

Age-standardized incidence rates (ASIRs) for multiple myeloma by age group (males, females), Canada, 1983–2032

[Click to enlarge]

[FIGURE 4.22.2, Text Equivalent]

Health Promotion and Chronic Disease Prevention in Canada - Volume 35 · Supplement 1 · Spring 2015

FIGURE 4.22.2
Age-standardized incidence rates (ASIRs) for multiple myeloma by age group, Canada, 1983-2032

The age-specific analysis illustrated in Figure 4.22.2 indicates that the ASIRs of multiple myeloma in Canada are expected to increase slightly or stabilize in each age group, resulting from continuation of their observed long-term trends.

From 2003–2007 to 2028–2032, the ASIRs of MM for the country are projected to increase by 11% in males, from 6.1 to 6.8 per 100 000, and by 4% in females, from 4.0 to 4.2 per 100 000 (Tables 4.22.3 and 4.22.4). The annual number of new male cases is projected to increase by 125%, from 1065 to 2395, and the number of new female cases is projected to increase by 92%, from 875 to 1685 (Tables 4.22.1 and 4.22.2).

Comments

In accordance with recent reports from Sweden, England and US,Endnote 284, Endnote 285, Endnote 286 the overall incidence rates for MM increased marginally throughout the whole observation period in Canada. The apparent increasing trends of MM in Canada and worldwide may be due to improved diagnostic practices and better case ascertainment. The role of risk factors responsible for the trends in the disease frequency should also not be ruled out.

Other than older age, male gender, Black ethnicity, family history of lymphohematopoietic cancer, and monoclonal gammopathy of undetermined significance (MGUS), there are few known risk factors for the clinical entity.Endnote 287 However, several factors have been implicated as potentially etiologic, although findings are inconsistent.

Numerous studies have reported increased risk of developing MM in people with a family history of cancer, specifically lymphohematopoietic cancer, although the underlying mechanisms remain elusive and family history may be responsible for a relatively small proportion of new cases.Endnote 287, Endnote 289 MGUS, a condition of excessive plasma cell growth, has consistently been observed to progress to MM.Endnote 287 Annual risk of progression from MGUS to MM is about 1%.Endnote 289

Obesity has been associated consistently with an elevated risk of MM. Researchers at the Karolinsksa Institute, Stockholm, conducted a meta-analysis of 11 cohort studies and 4 case–control studies published from 1994 to May 2007.Endnote 290 In the cohort studies, overweight and obese people have a 12% and 27% increase in risk of MM, respectively. For case-control studies, the summary estimates were significantly higher. This effect was independent of age, sex and ethnicity. Their recent systematic review of 15 cohort studies is in line with these findings.Endnote 291

Chronic immune stimulation conditions or autoimmune disorders have not been consistently related to MM; however, the incidence of MM appears to be elevated in people with AIDS.Endnote 287 A meta-analysis published in 2008 found that MM was 2.6 times more prevalent in HIV-infected people than the general population.Endnote 292

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