Some Jobs Carry Greater Multiple Myeloma Risk

Article Summary
  • Firefighters and others exposed to carcinogenic compounds on the job are at higher risk for the blood cancer multiple myeloma.
  • Dr. C. Ola Landgren and his colleagues have led large studies identifying environmental risk factors for multiple myeloma.
  • Known environmental risk factors include exposure to pesticides, Agent Orange and the World Trade Center disaster.

When his bloodwork results came in, David Perez was feeling fine.

Perez just had a routine physical at the North Collier, Florida fire station where he’d been working as a firefighter for 14 years. He had no indication anything might be amiss. But in the results of his complete blood count, several markers were off. The physician recommended he see a hematologist.

Perez eventually made his way to Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine. He was diagnosed in early 2020 with the blood cancer multiple myeloma.

Firefighter David Perez on top of a mountain
Firefighters like David Perez are at elevated risk for cancers like multiple myeloma.

By the time the diagnosis came through, a few months after his physical, he’d started having fatigue and severe nosebleeds. After two years of intensive chemotherapy treatments, he was diagnosed again with mantle cell lymphoma, another blood cancer. He’s now six months out from a stem cell transplant for that second cancer and is currently cancer-free.

Carcinogens Contribute to Cancer Risk

Firefighters like Perez are at higher risk for certain cancers, likely due to their high levels of exposure to carcinogens released into the air when buildings burn. He knew about that risk before he was diagnosed, he said, but it didn’t seem like a real threat.

“I had an inkling that cancer was a big issue in the fire service, but I don’t have any cancer in my family, so I guess I decided to just keep my head buried in the sand,” Perez said. “I didn’t think it would affect me because I wasn’t predisposed to it. I definitely took my health for granted.”

Firefighters have a 9% increased incidence of cancer compared to the general public. But some cancers, like multiple myeloma, mesothelioma and skin cancer, have much higher rates among firefighters. The incidence of multiple myeloma is about 50% higher in firefighters than in the general population.

Recognizing Cancer Patterns

Other occupations bring an increased risk of multiple myeloma, said C. Ola Landgren, M.D., Ph.D., chief of the Division of Myeloma and director of the Sylvester Myeloma Institute. In previous roles at Memorial Sloan Kettering Cancer Center in New York and the National Institutes of Health’s National Cancer Institute, Dr. Landgren led large studies investigating links between certain exposures and multiple myeloma.

Sylvester Comprehensive Cancer Center physician-scientist C. Ola Landgren in his white coat.
Dr. C. Ola Landgren’s investigations into cancer risks are often inspired by patients he sees in clinic.

Many of these collaborative studies were inspired by patients he’d seen in his clinic, Dr. Landgren said. He saw enough cases of myeloma in certain populations and wondered if a larger pattern was at play. When he lived in New York, he had three myeloma patients who lived on the same block in Staten Island. Their houses had all been covered by a huge amount of dust after the World Trade Center towers fell.

“Seeing these things as a doctor triggered me to think about it and see if we could bring some more clarity to the situation,” Dr. Landgren said. “These were very patient-derived questions. Much of the time, science comes from these clinical observations.”

Multiple myeloma is often preceded by a precancerous condition known as monoclonal gammopathy of undetermined significance, or MGUS. Dr. Landgren’s studies showed higher levels of MGUS linked to pesticide use among farmers, exposure to Agent Orange among veterans of the Vietnam War and in firefighters, police officers and construction workers who were at the World Trade Center immediately after the 9/11 attacks. 

Together with Sylvester myeloma researcher and Sylvester Myeloma Institute Associate Director Dickran Kazandjian, M.D., Dr. Landgren is now co-leading a large study looking at risks of multiple myeloma in military officers linked to burning pits used to burn trash in U.S. military bases during the Gulf War. The results from this investigation will be available later this year. 

Other demographic factors can increase the risk for multiple myeloma. The rates of this cancer are higher in men, Black people, older adults, obese people and those with a family history of myeloma. With external collaborators, Dr. Landgren is also co-leading a study investigating the risk of myeloma and MGUS in people with certain inherited immune disorders. The results from this work will be ready in the fall of 2024. 

Searching for Multiple Myeloma Causes

Because the cancer can develop decades after occupational exposure, unpacking the exact cause of the disease can be difficult, said Francesco Maura, M.D., a Sylvester assistant professor and myeloma researcher who is investigating racial disparities in multiple myeloma.

Sylvester Comprehensive Cancer Center physician-scientist Francesco Maura
Identifying the cause of multiple myeloma is difficult, according to Dr. Franceso Maura, because diagnosis can occur decades after the disease develops.

“According to our data, myeloma might take more than 20 or 30 years to develop,” Dr. Maura said. “During this time, there might be a lot of other factors that come up that also influence cancer development, so we don’t know the full picture.”

Many organizations are now seeking to define the clinical value of increased screening for multiple myeloma and MGUS in firefighters and other high-risk populations. Although no curative treatment exists, catching and treating the disease early can prevent some of its more serious complications, like broken bones from bone lesions, Dr. Maura said. 

Firefighter Cancer Initiative

Researchers at Sylvester’s Firefighter Cancer Initiative (FCI) are working to increase screening for several types of cancer in firefighters and conducting studies to better understand how to decrease risks. The initiative recently concluded its annual symposium, with experts from the cancer research and firefighting communities coming together to talk about cancer risk.

Perez, the Naples firefighter, initially kept his cancer diagnosis quiet, but a colleague mentioned the symposium and the Dolphins Challenge Cancer, a fundraiser that Perez attended for the first time a few years ago. He’s returned every year since and presented a poster at the most recent FCI symposium. He said that coming to the events made him realize how large his community is.

“My eyes really opened up as to how many firefighters have been diagnosed with cancer and how many people there are fighting for us,” Perez said.

Tags: Dr. C. Ola Landgren, Dr. Dickran Kazandjian, Dr. Francesco Maura, Firefighter Cancer Initiative, multiple myeloma, Sylvester Comprehensive Cancer Center