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Correspondence re: G. G. Schwartz, Multiple Myeloma: Clusters, Clues, and Dioxins. Cancer Epidemiol. Biomark. Prev., 6: 49-56, 1997.

We read with interest the paper entitled "Multiple Myeloma: Clusters, Clues, and Dioxins" by Dr. Gary G. Schwartz (1). Dr. Schwartz has constructed an interesting hypothesis in regard to a possible association between dioxin exposure and the subsequent risk of developing multiple myeloma. Dr. Schwartz has gathered a number of apparent clusters of multiple myeloma from the literature, together with studies assessing dioxin levels in various parts of the world, to suggest such an association. However, we are concerned about the manner in which this information has been presented to support his hypothesis, particularly as it pertains to multiple myeloma in southeast Alaska Indians and the consumption of food items contaminated with dioxins. We would like to take this opportunity to respond to the proposed hypothesis with regard to multiple myeloma in Alaska Natives. Alaska Natives include Eskimos, Aleuts, and Indians. There are four Eskimo linguistic groups and at least four groups of Indians (Athabascans of central Alaska and Tlingit, Haida, and Tsimpsian of southeast Alaska). As we previously reported, multiple myeloma appears to occur at a high rate in southeast Alaska Indian males (2). This increased incidence has been reconfirmed in subsequent reviews of cancer incidence in Alaska Natives covering the period 1969-1993 (3, 4). However, multiple myeloma in the remainder of the Alaska Native community occurs at a low rate compared to the incidence of multiple myeloma for the general United States population (2-4). In particular, multiple myeloma rates are low for the Eskimos (Inupiat and Yupik) of Alaska. Yet, Eskimos have traditionally consumed marine biota as a major part of their diet, including marine mammals (5, 6). The incidence of multiple myeloma is also low in the circumpolar Inuit (7). It is particularly important to note that no cases of multiple myeloma have ever been reported in the Inuit of Canada. Dr. Schwartz has correctly cited the study by Dewailly et al. (8) showing increased concentrations of organochlorines among the Inuit of the eastern Arctic in Canada. Increased levels of dioxins in fish, marine mammals, and polar bears, as well as in the Inuit, have been well documented (8, 9). However, it is difficult to understand how Dr. Schwartz can make an association between data collected on the levels of organochlofines from the eastern Arctic of Canada and multiple myeloma in the Indians of southeast Alaska. We are aware of no studies that have assessed the levels of organochlorines in Alaska Natives residing in southeast Alaska or in foods uniquely used by that population. Thus, we do not feel that the epidemiology of multiple myeloma in Alaska Natives or in the Inuit across the Arctic support Dr. Schwartz's hypothesis. The apparent high incidence of multiple myeloma in southeast Alaska Indian males is of concern. However, it must be noted that this incidence is based on nine cases of multiple myeloma over a 25-year period (4). As we previously stated in our paper (2), incidence rates derived from such small numbers must be interpreted with caution. It is important that the incidence of multiple myeloma among Alaska Natives continues to be monitored and that possible etiologies of this disease are investigated.