Cancer Among Native Americans in Arizona and New

Cancer Among Native Americans in Arizona and New Mexico Data Provided by Arizona Cancer Registry at the Arizona Department of Health Services and the New Mexico Cancer Council

2

4

Age when Diagnosed with Cancer (Arizona Native Americans, 2005 -2009) 5

HIGH PREVENTION POTENTIAL 6

Yearly average count of new cancers among Arizona Native Americans Cancer Sites Breast Male Female 1 58 Prostate 56 Colorectal 30 25 Kidney/Renal Pelvis 30 14 Corpus Uteri 27 Lung and Bronchus 11 11 Stomach 14 6 8 11 Other sites combined 48 33 Liver and Intrahepatic Bile Duct 12 6 Thyroid 4 12 Leukemia 9 7 Non-Hodgkin Lymphoma Ovary 14 Gallbladder and Other Biliary 5 9 Pancreas 6 7 Oral Cavity 7 4 Cervix Uteri 11 Myeloma 5 5 Brain and Other Nervous System 6 4 Source: ACR, 2005 -2009

11

12

CONCLUSIONS • AIAN elders increasing proportion of the population • Cancer screening will be an important aspect of maintaining health as people age • Looking at the “whole person” remains the most important determinant for good care 13

Introduction to Myeloma: Diagnosis, Treatment, Risk Factors and Prevalence Scottsdale, Arizona Rochester, Minnesota Jacksonville, Florida Alan Bryce, MD Staff Oncologist, Mayo Clinic Arizona

Multiple Myeloma - Introduction • Myeloma is a cancer of the Plasma Cells • They grow out of control in the bone marrow (at least 10% and as high as nearly 100%) • This results in many problems including: • Low hemoglobin (anemia) and platelets • Elevated abnormal immunoglobulins (proteins) • Bone pain and fractures • Infections (partly due to low normal immunoglobulins) • Kidney problems • Other complications…

Spectrum of Myeloma Normal plasma cell MGUS Monoclonal gammopathy of unknown significance Asymptomatic Myeloma Active Myeloma Aggressive Myeloma

How do plasma cells become “evil”?

Multiple Myeloma – Causes? • The cause of myeloma is still unknown • Some have suggested: • Radiation- Nuclear Bomb Survivors • Chemicals (benzenes), herbicides and insecticides- The “Myeloma Belt” • Genetics or even viruses • Familial Myeloma – still rare • However, nothing is conclusive, and it is likely a combination of many factors…

Multiple Myeloma • Unfortunately, MM is not a curable disease (yet!!) • Historically most people did not live for much more than 2 years… • However, the average survival is now at least 8 years • This has been a result of three key developments: 1. Early Detection 2. Autologous Stem Cell Transplant 3. Novel Drugs (thalidomide, bortezomib, lenalidomide)

Myeloma rate in Arizona among race groups, 1995 -2009 20

Common Symptoms • • Not all patients will have all of these symptoms Fatigue Lack of Appetite Infection Bone Pain Kidney Failure Confusion, dehydration, and constipation (high calcium)

Myeloma Treatment • Principles of therapy • 1. Stop the production of the abnormal plasma cells (chemo) • 2. Strengthen the bone and prevent fractures • 3. Increase the hemoglobin count and reduce fatigue • 4. Reduce risk of infections • 5. Promote well being and quality of life

Conclusions • New Treatments for myeloma have improved survival • Myeloma is usually preceded by many years of MGUS • Screening and early detection can allow therapy to begin before organ damage develops • Bone Marrow transplant and Clinical Trials should be considered when appropriate 23