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  • br Author statement br Conflicts of interest br

    2019-08-20


    Author statement
    Conflicts of interest
    Funding sources This research is supported by a Canadian Cancer Society Partner Prevention Research Grant (grant #703106).
    Acknowledgements
    Introduction Multiple myeloma (MM) is the second most frequent haematological malignancy (∼15%), that is responsible for nearly 20% of all haematological malignancy-related deaths [[1], [2], [3]]. As per GLOBOCAN data from the International Agency for Research on Cancer (IARC), there were an estimated 114,000 new MM cases globally in 2012. [4]. More recent estimates suggested 159,985 newly diagnosed MM cases worldwide (i.e. about 0.9% of all cancers and 1.1% of all cancer deaths) in 2018 [5]. MM incidence displays striking dissimilarities across ethnicities [[6], [7], [8]]. For instance, African Americans are nearly two to three times more likely to be diagnosed with MM than European Americans [6,7]. These disparities may be due to differences in genetic susceptibility and the heterogeneity of molecular alterations underlying MM pathogenesis in various racial groups [6,9]. In comparison to Western nations, incidence data regarding MM from Asia is relatively scarce; particularly from low- and middle-income countries (LMIC) where cancer registries and vital registration systems are either non-existent or have low coverage [4,5]. Asians in general have a lesser incidence of MM than Caucasians [6,[10], [11], [12]]. In India as well, MM incidence is stated to be less than that in the Western countries [6]. Hospital based studies have reported certain unique features in MM patients from India, viz. greater proportion of symptomatic anaemia and skeletal abnormalities, higher serum creatinine, lesser proportion of hypercalcaemia, etc. [[13], [14], [15], [16]]. Such sporadic studies have also indicated the possible presence of some epidemiological peculiarities in the Indian setting, namely: an earlier age of onset (median age at diagnosis nearly a decade younger than in the USA) and a greater incidence of MM in the young (age < 40 years) than in the Western populations [[14], [15], [16], [17], [18]]. In fact, MM patients in India tended to be younger than MM patients of Indian descent living in the USA [19]. These peculiarities have crucial implications because they Norfloxacin may influence disease pathogenesis and presentation [[20], [21], [22], [23]], presence of secondary complications [24,25], choice of treatment and special medical requirements [[25], [26], [27]], and determine prognosis and survival [23,28,29]. India is a vast country with marked diversity in terms of ethnicity, demography and environmental conditions across its various regions. However, a systematic analysis about the country-wide incidence patterns of MM from India is lacking. Therefore, it is of interest to derive population level estimates for MM incidence in India and further analyze them as a function of age, sex and geographical region. This study investigates the incidence of MM across India and examines the differential patterns in terms of age, sex and geography.
    Materials and methods
    Results
    Discussion According to GLOBOCAN estimates, the worldwide age-adjusted incidence for MM in 2012 were 1.7 per 100,000 in men and 1.2 per 100,000 in women [4]. These rates varied between 0.4 and nearly 5 per 100,000 among different world regions. As opposed to the overall global rates, the PBCR-based age-adjusted MM rates in India in the 2012-14 period as derived in the current study [i.e. 1.13 (95% CI: 1.07–1.20) per 100,000 in men, and 0.81 (95% CI: 0.75-0.88) per 100,000 in women] were relatively low. But, these estimates suggest that MM incidence in India was higher than the Asian average (1 per 100,000 in men, and 0.7 per 100,000 in women), although significant differences were observed across different regions of the continent. For instance, these AARs for India were substantially higher than the GLOBOCAN AAR estimates for Eastern Asia (1 per 100,000 in men, and 0.6 per 100,000 in women) and Southeastern Asia (0.9 per 100,000 in men, and 0.8 per 100,000 in women), but lower than those for Western Asia (2.3 per 100,000 in men, and 1.7 per 100,000 in women). Although the MM incidence in Asia is relatively low than that in Europe (3.2 per 100,000 in men, and 2.1 per 100,000 in women), the Americas (3.1 per 100,000 in men, and 2.2 per 100,000 in women) and Oceania (4.2 per 100,000 in men, and 2.7 per 100,000 in women) [4], yet some Asian nations like South Korea and Taiwan have experienced a rapid surge in MM incidence recently – with industrialization, improved MM case detection and aging suspected to be the contributory factors [10,12,34]. India is the second most populous country in the world. And in view of the enhanced life expectancy, improved health care services and standards of living, and rapid urbanization that India is currently undergoing, increased rates of MM may be expected in the future.