Exploring a Common Drug's Potential Against a Rare Cancer in Black Women
Black women face twice the multiple myeloma risk compared to white women
Potential survival improvement with post-diagnosis aspirin use
Studies specifically targeting racial disparities in cancer outcomes
Imagine a common household medication—found in nearly every medicine cabinet across America—holding untapped potential against a deadly blood cancer that disproportionately affects certain populations.
This isn't science fiction; it's the promising frontier of cancer prevention research that examines whether aspirin, taken for decades to prevent heart attacks, might also protect against multiple myeloma. This cancer shows a striking health disparity, being twice as common in Black Americans compared to white Americans, yet the reasons remain largely unexplained 4 8 . For Black women, who experience both the gender and racial burden of this disease, understanding whether something as accessible as aspirin could modify their risk represents an urgent scientific question with profound implications for public health.
The exploration of aspirin's potential anticancer properties has accelerated in recent years, with studies showing regular use is associated with reduced risks of several gastrointestinal cancers and possibly other malignancies 7 . However, the specific relationship between aspirin and multiple myeloma remains both complex and controversial, with different studies yielding apparently conflicting results.
Aspirin's accessibility makes it a particularly promising candidate for addressing health disparities, as it could provide an affordable intervention for high-risk populations.
Multiple myeloma is a cancer of plasma cells, which are white blood cells normally responsible for producing antibodies to fight infections. In multiple myeloma, these cells become cancerous and multiply uncontrollably, accumulating in the bone marrow and crowding out healthy blood cells.
This leads to a range of symptoms including bone pain, fatigue, frequent infections, and kidney problems. Unlike many cancers that form discrete tumors, multiple myeloma typically spreads throughout the bone marrow, affecting multiple sites—hence the name "multiple" myeloma.
Virtually all cases of multiple myeloma are preceded by a precursor condition called monoclonal gammopathy of undetermined significance (MGUS) 4 . MGUS is typically discovered incidentally during blood tests done for other reasons and affects approximately 3% of adults aged 50 and older.
One of the most consistent findings in multiple myeloma research is the stark difference in incidence across racial and ethnic groups. Black Americans develop multiple myeloma at approximately twice the rate of white Americans, while Asian populations tend to have lower rates 4 .
| Population Group | MGUS Prevalence | Multiple Myeloma Incidence | Key Findings |
|---|---|---|---|
| Black Americans | ~2x higher than whites | ~2x higher than whites | Higher MGUS prevalence explains disparity |
| White Americans | Baseline | Baseline | Most extensively studied population |
| Asian Americans | Lower than whites | Lower than whites | Genetic and/or environmental protective factors |
| Men vs. Women | Higher in men | Higher in men | Biological factors contribute to gender disparity |
Research has demonstrated that this disparity stems primarily from differential MGUS development rather than differences in how often MGUS progresses to multiple myeloma 8 . A comprehensive modeling study published in Nature Communications in 2023 analyzed nationally representative data and found that the rate of developing MGUS is about twice as high in non-Hispanic Black populations compared to non-Hispanic white populations, while the progression rate from MGUS to multiple myeloma showed no significant difference by race 8 .
Aspirin potently inhibits the cyclooxygenase-2 (COX-2) enzyme, which is frequently expressed in multiple myeloma cells and has been shown to predict poor outcomes in patients 1 .
Aspirin suppresses nuclear factor kappa B (NF-κB), a family of transcription factors that mediate normal B-cell development and are upregulated in multiple myeloma cell lines 1 6 .
Aspirin may suppress interleukin-6 (IL-6), a pleiotropic pro-inflammatory cytokine that serves as an important growth factor for multiple myeloma cells 6 .
Aspirin's antiplatelet effects might also interfere with the bidirectional signaling between platelets and cancer cells that facilitates tumor growth and metastasis.
The epidemiological evidence regarding aspirin and multiple myeloma risk has been mixed, reflecting the complexity of cancer epidemiology:
While most research has focused on prevention, a groundbreaking 2022 study published in Cancer Epidemiology, Biomarkers & Prevention took a different approach—investigating whether regular aspirin use after multiple myeloma diagnosis might improve survival 1 .
This prospective analysis followed 436 men and women diagnosed with multiple myeloma between 1980 and 2016 who had reported their aspirin intake on biennial questionnaires in the Health Professionals Follow-up Study and Nurses' Health Study.
The findings revealed a substantial survival advantage for regular aspirin users after multiple myeloma diagnosis:
| Aspirin Use Status | Multiple Myeloma-Specific Mortality | Overall Mortality |
|---|---|---|
| Non-users | 1.00 (reference) | 1.00 (reference) |
| Post-diagnosis users | 0.61 (0.46-0.79) | 0.63 (0.49-0.80) |
| Pre-diagnosis use only | Not significant | Not significant |
| Weekly Aspirin Tablets (325 mg) | Multiple Myeloma Mortality | All-Cause Mortality |
|---|---|---|
| Non-users | 1.00 (reference) | 1.00 (reference) |
| 1 to <6 tablets | 0.64 (0.45-0.90) | 0.66 (0.48-0.90) |
| ≥6 tablets | 0.56 (0.37-0.85) | 0.58 (0.40-0.84) |
Conducting this type of sophisticated epidemiological research requires both specialized laboratory tools and carefully characterized population resources. The following table highlights some of the essential "research reagents" that enabled this investigation into aspirin and multiple myeloma:
| Research Tool | Function in Research | Specific Application in This Study |
|---|---|---|
| Cohort Populations (NHS, HPFS) | Large, well-characterized groups followed over time with repeated exposure assessments | Provided longitudinal data on aspirin use and health outcomes over decades 1 |
| Biennial Questionnaires | Repeatedly collect updated exposure and covariate data | Assessed aspirin use patterns, confounders, and identified cancer diagnoses 6 |
| Medical Record Review | Validates self-reported cancer diagnoses | Confirmed multiple myeloma diagnoses using hospital records and pathology reports 1 |
| National Death Index | Identifies deaths in study populations | Complete mortality follow-up supplemented with cause of death information 1 |
| Multivariable Cox Proportional Hazards Models | Statistical technique that estimates relationship between exposure and time-to-event outcome | Calculated hazard ratios for mortality associated with aspirin use while adjusting for confounders 1 |
| Immunofixation Electrophoresis | Laboratory technique to detect monoclonal proteins in serum | Used in related studies to identify MGUS cases |
The compelling evidence that post-diagnosis aspirin use may enhance multiple myeloma survival takes on special significance for Black women, who face a disproportionate burden from this disease. While the specific study discussed didn't separately report results for Black women, the potential implications are substantial given what we know about multiple myeloma disparities:
The finding that aspirin benefits were consistent across eras of treatment suggests it could work complementarily with existing therapies, potentially offering an accessible, low-cost adjunct to standard care.
Aspirin's anti-inflammatory mechanism of action might be particularly relevant if chronic inflammation contributes to the higher MGUS prevalence observed in Black populations .
The Determinants of the Racial/Ethnic Disparity in MGUS Risk study, which includes participants from four cohorts including the Black Women's Health Study, is explicitly examining whether anti-inflammatory medications including aspirin predict MGUS and help explain racial disparities .
The most definitive evidence would come from randomized controlled trials specifically testing aspirin as a complementary therapy for multiple myeloma patients.
Studies specifically designed to understand whether aspirin's effects differ by race and sex are essential, particularly given the established disparities.
Further laboratory research to clarify exactly how aspirin interacts with multiple myeloma cells could identify new therapeutic targets.
Comprehensive studies evaluating the balance between aspirin's potential anticancer benefits and its risks would help guide clinical decision-making.
The exploration of aspirin's potential against multiple myeloma represents a fascinating convergence of cancer epidemiology, disparities research, and drug repurposing science. While questions remain—particularly regarding its specific utility for Black women—the current evidence suggests that this common medication might offer uncommon benefits for multiple myeloma patients when used after diagnosis.
This article summarizes current research for educational purposes only and does not constitute medical advice. Consult your healthcare provider before making any changes to your medication regimen.