TY - JOUR T1 - Diagnosing myeloma in general practice: how might earlier diagnosis be achieved? JF - British Journal of General Practice JO - Br J Gen Pract SP - 462 LP - 463 DO - 10.3399/bjgp22X720737 VL - 72 IS - 723 AU - Lesley Smith AU - Jonathan Carmichael AU - Gordon Cook AU - Bethany Shinkins AU - Richard D Neal Y1 - 2022/10/01 UR - http://bjgp.org/content/72/723/462.abstract N2 - Multiple myeloma, the third most common blood cancer, is often discovered following multiple prediagnostic consultations, with delays in diagnosis resulting from the ubiquitous nature of presenting symptoms.1 Delays result in high disease burden, greater end-organ damage, and emergency presentation, all of which are associated with poorer outcomes.2 Improving the early diagnosis of myeloma remains an area of unmet clinical need. In this editorial, we describe the issues with the current diagnostic process, explore the potential impact of the COVID-19 pandemic, and identify alternative strategies that may improve the early diagnosis of myeloma.Myeloma has one of the longest diagnostic intervals of all cancers. Around half of myeloma patients have three or more pre-referral consultations and around one-third are diagnosed through emergency presentation.1,2 There are various reasons for this. It is a relatively rare cancer; an average GP will see one new case every 8–10 years. Patients present with a range of non-specific symptoms, including back pain, bone pain, fatigue, and blood test abnormalities (hypercalcaemia, renal impairment, anaemia, and raised CRP), which are all common in an ageing population and often attributable to concurrent conditions. Early diagnosis of myeloma is crucial in limiting disease-related complications, such as lytic bone disease, pathological fractures, kidney injury, and severe infection, all of which may impact long-term quality of life, eligibility for routine or experimental therapy, treatment tolerance, response rates, and survival.The COVID-19 pandemic resulted in a substantial decrease in myeloma referrals and diagnoses, in parallel with an increase in emergency presentations.3 Reductions in overall urgent referrals for suspected cancer were mainly … ER -