IMS 2023 | Screening for MGUS: clinical and practical considerations
Karthik Ramasamy, MBBS, MRCP, FRCPath, PhD, Oxford University Hospitals NHS Foundation Trust, Oxford, UK, discusses potential strategies for screening for monoclonal gammopathy of undetermined significance (MGUS). Dr Ramasamy highlights findings from the ongoing iStopMM study (NCT03327597) which aims to assess the benefits and harms of screening for MGUS at a population level, and concludes by discussing possible alternative strategies, such as risk-adapted screening. This interview took place at the 20th International Myeloma Society (IMS) Annual Meeting, held in Athens, Greece.
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Transcript (edited for clarity)
Screening for MGUS has been addressed in a major study, within Iceland, called the iStopMM. The initial observations do show that screening and taking an intensive approach to seeing these patients in secondary care, unearths a large number of myeloma patients and smoldering patients. Whether these earlier encounters through screening improve survival is left to be observed. But taking those screening trials, what we have observed consistently, certainly in the UK, is that patients are being diagnosed in a delayed fashion, because of more vague symptomatology in older folks, with a median age of myeloma diagnosis being 70...
Screening for MGUS has been addressed in a major study, within Iceland, called the iStopMM. The initial observations do show that screening and taking an intensive approach to seeing these patients in secondary care, unearths a large number of myeloma patients and smoldering patients. Whether these earlier encounters through screening improve survival is left to be observed. But taking those screening trials, what we have observed consistently, certainly in the UK, is that patients are being diagnosed in a delayed fashion, because of more vague symptomatology in older folks, with a median age of myeloma diagnosis being 70. More and more work will have to be done in this space. Population-level screening is one approach, which Iceland has taken, but there are other approaches in the form of risk-adapted screening – you could screen when people have their first fracture, or you could screen when patients have their first abnormal kidney test. There are different ways to approach the whole screening topic. Certainly, in the UK, we are collecting some data in this space and we look forward to contributing to the screening debate.
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