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Anthropometric Characteristics and Multiple Myeloma Risk

Lu, Yani; Sullivan-Halley, Jane; Henderson, Katherine D.; Ma, Huiyan; Horn-Ross, Pamela L.; Reynolds, Peggy; Cress, Rosemary; Bernstein, Leslie

doi: 10.1097/EDE.0b013e3181cc9241

Division of Cancer Etiology; Department of Population Science; City of Hope National Medical Center; Duarte, CA (Lu, Sullivan-Halley, Henderson, Ma)

Northern California Cancer Center; Fremont, CA (Horn-Ross, Reynolds)

California Cancer Registry; Public Health Institute; Sacramento, CA (Cress)

Division of Cancer Etiology; Department of Population Science; City of Hope National Medical Center; Duarte, CA; (Bernstein)

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To the Editor:

Epidemiologic studies of the association between anthropometric characteristics and multiple myeloma risk have yielded inconsistent results.1–4 In particular, limited attention has been paid to anthropometric characteristics during early adult life.2,3,5,6 Recent studies have suggested that height and body mass index (BMI) around 20 years of age play a role in the etiology of lymphatic malignancies, and that the association varies by specific subtype.2,3 We have analyzed data from the prospective California Teachers Study cohort to investigate the role of anthropometric factors in the etiology of multiple myeloma among women.

A detailed description of anthropometric data collection has been published elsewhere.7 For this analysis, we included 121,216 women (age, 22–84 years) who, at cohort entry in 1995–1996, provided information on height and weight, currently and at age 18 years, and who had no prior diagnosis of hematopoietic malignancy. In a 1997–1998 follow-up questionnaire, 89,324 of these women, with no prior hematopoietic malignancy diagnosis, provided waist and hip circumference measures. During an average follow-up of 11 years through 2007, 111 women were diagnosed with multiple myeloma (International Classification of Diseases for Oncology, Third Edition, morphology codes 9731, 9732, 9734). Of these cases, 78 were diagnosed after the 1997–1998 questionnaire. Age-stratified multivariable Cox proportional hazards regression models, with age as the time scale, provided hazard rate ratio (RR) and 95% confidence interval (CI) estimates.

The mean age at diagnosis was 72 years (range, 44–89). Risk was moderately elevated for women who were at least 64 inches tall relative to shorter women (for 64–65 inches, RR =1.66 [95% CI = 1.03–2.67], for ≥66 inches, 1.53 [0.92–2.55]) (Table). Although women in the second tertile of waist circumference had elevated risk (1.68 [0.86–3.27]), this risk was not increased for women in the highest tertile, nor was a trend effect observed across tertiles. No association was observed for other anthropometric measurements. Further analysis after exclusion of women with less than 2 years follow-up after each questionnaire did not fundamentally change risk estimates (data not shown).



The biologic mechanisms for a link between adult height and multiple myeloma are not yet established. Insulin-like growth factor-1 is positively associated with height in childhood, and may influence the development of multiple myeloma by influencing B-cell survival and proliferation.8 These findings of a moderate association with height, but no association with the other anthropometric variables assessed, are consistent with findings from a recent European cohort study.3 In contrast, results from the Iowa Women's Health Study demonstrated a positive association with BMI, weight, waist circumference, and hip circumference, but no association for height or waist-hip ratio.6 Finally, the Netherlands Cohort Study reported no increased risk for either taller or heavier women, although they found taller women had increased risk of all lymphatic malignancies combined.2

Depending on the average age of subjects, early adult BMI may represent lifetime body size status better than measurements at cohort entry or diagnosis, as the later measurements may be affected by later life events (eg, menopause, illness). The Netherlands Cohort Study is the only previous study that examined the association of BMI in early adult life with the risk of multiple myeloma.2 Although that study confirmed a positive association between BMI at age 20 and overall lymphatic malignancy risk, no association was detected for multiple myeloma. These results are consistent with those observed previously in the California Teachers Study for B-cell non-Hodgkin lymphoma7 and here for multiple myeloma. Despite the null associations observed in these 2 studies for multiple myeloma, the number of cases in each study was small, limiting the statistical power to detect associations.

Yani Lu

Jane Sullivan-Halley

Katherine D. Henderson

Huiyan Ma

Division of Cancer Etiology

Department of Population Science

City of Hope National Medical Center

Duarte, CA

Pamela L. Horn-Ross

Peggy Reynolds

Northern California Cancer Center Fremont, CA

Rosemary Cress

California Cancer Registry

Public Health Institute

Sacramento, CA

Leslie Bernstein

Division of Cancer Etiology

Department of Population Science

City of Hope National Medical Center

Duarte, CA

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