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January 2013 Archives : Myeloma Voices

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My recent blog, "New Study Provides Clues to What Causes Myeloma," clearly struck a chord with many myeloma patients. The heartfelt comments and questions are noted and really appreciated. A first point is that New York residents or people working in New York who believe they were exposed to toxins by the 9/11 event ARE indeed eligible for screening and treatment under the Zadroga Act and World Trade Center Health Program. But the powerful vision of toxic exposures in New York reminded many of you of possible or probable toxic exposures in your own cases. From 1-3 butadiene exposure at Rexam Graphics to pesticide exposures, tours of duty in Vietnam (and/or neighboring countries) with Agent Orange and dioxin exposures, fumes from asphalt and/or construction sites, or general industrial pollution, very valid correlations and concerns are raised.

For New Yorkers, it is very important to seek screening and follow-up or treatment. The designated centers of excellence are noted in the link above. Early assessment, diagnosis, and treatment are keys to achieve the best outcomes.

For others with broader concerns and questions about toxic exposures, much more needs to be done. In a new editorial in the New York Times (Sunday, January 20, 2013), Nicholas D. Kristof discusses what he calls "warnings from a flabby mouse." You may be aware that obesity has been linked to an increased likelihood of myeloma. The key question has been: "Does obesity in some way trigger myeloma or does some chemical or toxic exposure trigger obesity, diabetes, myeloma, and possibly other cancers?" Nicholas highlights the work of renowned researcher, Bruce Blumberg, at the University of California, who coined the term, "obesogen," for chemicals that cause increased fat storage. These obesogens are the exact same types of chemicals that can cause myeloma: endocrine disrupter chemicals including dioxins, chemicals from plastics and rubber, agricultural chemicals, as well as chemicals in foam cushions and jet fuel (http://endo.endojournals.org/content/147/6/s50.full.pdf+html).

So it seems that the epidemic of obesity and diabetes may be linked to increases in the incidence of myeloma in recent years. Thus, as they say, "the plot thickens." The scenario of widespread environmental chemical pollution, how to assess it, and what to do about it is such a large and important topic that I will return to it in future blogs.

For now, be aware and seek advice as needed. The overriding motto of the IMF is "knowledge is power."

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Six months ago, cancer was added to the list of illnesses covered by the $3.4 billion World Trade Center fund. Now, as reported on December 19th in the New York Times, the New York City Health Department has completed a study that compares cancer rates among 9/11 responders with overall cancer rates for New York State. Myeloma is at the top of the list of cancers occurring at a statistically higher rate in 9/11 responders. Myeloma is occurring at a 3-fold increased rate: the rate being +185% versus the average for New York State. Thyroid cancer was at +102% and prostate cancer at +43%. All others were not statistically increased in this study.

The findings are controversial in part because it is very early to be assessing the ultimate risks--and therefore much too soon to be drawing conclusions for most cancers, the occurrence of which will increase over time. However, the early increase in myeloma cases is quite remarkable and suggests a particular susceptibility to the exposures at 9/11 sites.

The specific chemical identified by the Zadroga Act reviewers (6 months ago) was 1-3 butadiene, a chemical linked to rubbers and other  fumes present at the 9/11 sites.  The chemical 1-3 butadiene is metabolized in the body via an epoxy mechanism. A study which I published in 2009 (Leukemia article on DNA SNP) showed that myeloma patients are more likely to have a defect in this epoxy metabolism, and, therefore, are potentially more susceptible to the toxic effects.

So it seems that a story is coming together linking exposure, susceptibility, and early onset of myeloma in the 9/11 setting. More studies and follow-ups are needed, but these findings are plausible and satisfy elements of what are called the "Bradford Hill Criteria," used to link toxic exposures and the development of cancer such as myeloma. There is already "proof of principle" that several toxic chemicals can cause myeloma, including pesticides, solvents, and chemicals such as 1-3 butadiene.

With this knowledge, there is now an opportunity for early screening to diagnose any case as soon as possible and look toward even curative intervention.  Every cloud has a silver lining--in this case, the ability to understand the process and intervene early.

To my dear friends,

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As I set to retire on January 31st I can only tell you how fulfilling this endeavor has been for me and how wonderful it has been sharing this time with all of you. I thank you for welcoming me to your meetings and am grateful for how much you taught me over the years as I visited you or met many of you at a Patient and Family Seminar, Regional Community Workshops or other places in my travels.

 More than eight years ago Susie Novis and Dr. Brian Durie gave me the opportunity to carry my wife Cathy's legacy forward and meet and assist the most wonderful people in the world, the multiple myeloma support group leaders, patients and caregivers. That period is coming to an end. It saddens me deeply, but life goes on. I will miss all of you and the wonderful IMF staff I have worked with over the years.

My new wife, Juanita, and I will now be able to spend more time together, though I plan to find something to do that will fill some of my time (Juanita's "honey-do-list"?). I have thought about volunteering at a local hospital or other institution. God will guide me as he's done all my life.

Leaders, please do not forget that educating and assisting the patients and caregivers is, in my opinion, the most important thing we do. Please feel free to contact any time you think I may be able to assist you in any way.

Last but certainly not least, please be as gracious to Anne (Pacowta), Nancy (Bruno) and Sue (Enright) as you were to me as they embark on their journey with you.

Thank you and God Bless,

Andy Lebkuecher