1. 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

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5. ©2012 MFMER | slide-5 Age when Diagnosed with Cancer (Arizona Native Americans, 2005-2009)

6. ©2012 MFMER | slide-6 HIGH PREVENTION POTENTIAL

9. Yearly average count of new cancers among Arizona Native Americans Cancer SitesMaleFemale Breast158 Prostate56 Colorectal3025 Kidney/Renal Pelvis3014 Corpus Uteri27 Lung and Bronchus11 Stomach146 Non-Hodgkin Lymphoma811 Other sites combined4833 Liver and Intrahepatic Bile Duct126 Thyroid412 Leukemia97 Ovary14 Gallbladder and Other Biliary59 Pancreas67 Oral Cavity74 Cervix Uteri11 Myeloma55 Brain and Other Nervous System64 Source: ACR, 2005-2009

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13. ©2012 MFMER | slide-13 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

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

15. 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…

16. Spectrum of Myeloma Normal plasma cell Asymp- tomatic Myeloma Aggressive Myeloma Active Myeloma Monoclonal gammopathy of unknown significance MGUS

17. How do plasma cells become “evil”?

18. 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…

19. 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)

20. ©2012 MFMER | slide-20 Myeloma rate in Arizona among race groups, 1995-2009

21. 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)

22. 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

23. ©2012 MFMER | slide-23 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