Some of the biggest challenges in medical care are diseases that are hard to spot early on, those that get misdiagnosed, and those that are tough to treat. “And multiple myeloma is all three,” explains Vanessa Snow, Head of Medical Affairs, Johnson & Johnson Innovative Medicine, South Africa.
Multiple myeloma (MM) is an incurable type of blood cancer that arises from malignant plasma cells in the bone marrow. These abnormal cells multiply uncontrollably, crowding out healthy blood-forming cells and producing large amounts of non‑functional antibodies (M‑protein). This weakens the immune system, damages bones, and can impair kidney function. Although multiple myeloma remains incurable, modern treatments can control the disease for long periods and improve quality of life.
While people usually think of cancer as having visible lumps or tumours, MM primarily affects the bone marrow and can initially develop without noticeable symptoms. In many cases, it evolves from a benign precursor condition known as monoclonal gammopathy of undetermined significance (MGUS). As a result, the disease is frequently diagnosed at a more advanced stage, when organ damage has already occurred.
MM accounts for approximately 10–15% of haematological malignancies worldwide. In Southern Africa, GLOBOCAN 2022 estimates indicate that approximately 1,265 new cases of multiple myeloma were diagnosed in 2022, with South Africa contributing significantly to the regional burden.
The disease mostly affects older adults, typically those aged 70 years and above. Unfortunately, symptoms such as long-lasting bone pain, fatigue, and low red blood cell count (anaemia) are often dismissed as normal ageing, which can lead to delayed diagnosis.
Diagnostic delays remain a major concern, particularly where awareness among frontline healthcare professionals is limited or access to specialised diagnostic testing is constrained. Consequently, many patients present with advanced disease and serious complications such as kidney failure, fractures, or severe anaemia. “What makes matters worse,” Snow continues, “is that these symptoms may be treated in isolation instead of being recognised as signs of an underlying blood cancer.”
Research conducted in South Africa has shown that while hospital-based clinicians may have a reasonable understanding of multiple myeloma, early warning signs are frequently overlooked in primary healthcare settings, contributing to delayed referrals and poorer outcomes. Early detection through routine blood and urine testing, followed by confirmatory bone marrow biopsy and imaging, can help initiate treatment before irreversible damage occurs.
These challenges are not unique to South Africa. Long-term analyses across BRICS countries demonstrate that the burden of multiple myeloma has increased substantially over the past three decades, with South Africa consistently reporting among the highest age-standardised incidence and mortality rates. These trends underscore the impact of population ageing and highlight the importance of strengthening early diagnosis and referral pathways.
Despite advances in therapy, relapsed or refractory multiple myeloma remains challenging to treat, with treatment responses declining as patients progress through successive lines of therapy. Most patients will eventually experience disease relapse, reinforcing the need for continued innovation and improved disease awareness.
The higher burden of disease among Black South Africans, combined with diagnostic challenges and disparities in healthcare access, particularly in rural areas, highlights the need for greater public awareness, enhanced healthcare worker education, and more efficient referral systems. (9) Snow concludes that “raising awareness among both the public and healthcare professionals about symptoms such as persistent bone pain or unexplained fatigue could reduce delays, alleviate suffering, and improve outcomes in this vulnerable population.”
