Many of the topics I write about start out as random things in my life that eventually grow into a column. Sometimes the seed is planted by a comment someone makes, or perhaps something I read, or in at least one case by a dream.

The idea for this month's column came to me when I recently heard the song "Once In A Lifetime" by the Talking Heads, which includes the line "You may ask yourself, well, how did I get here?"

Or in other words, "Why do I have multiple myeloma?"

I would venture this is another question most of us ask soon after our diagnosis. I think I asked the question at my next appointment after being diagnosed, and the doctor basically said "We don't know what causes multiple myeloma. It could be genetic, but given the evidence, it's more likely due to environmental causes."

I'm of two minds when it comes to finding out what caused my multiple myeloma. The practical, and admittedly cynical, part of me says “What difference does it make? You have it, so deal with it.” However, the inquisitive part of my mind can't quite let go of wondering what caused my cancer and whether it could have been avoided. I would also expect finding the cause would help with finding a cure.

Most of the information I've come across supporting a genetic cause, or at least a genetic connection, is based on the chromosomal abnormalities that tend to be present in patients with multiple myeloma. However, this almost appears to be a chicken-or-egg issue as to whether multiple myeloma causes the abnormalities, or whether the abnormalities cause the multiple myeloma.

For example, research presented at the 17th Congress of the European Hematology Association in 2012 indicated more than half of myeloma patients acquire additional chromosomal abnormalities over time (see related Beacon ^[1] news). Does this then indicate abnormalities are spawned by the multiple myeloma? Also, what about patients that don't exhibit any of the abnormalities (such as myself)? What causes our disease?

Conversely, findings published in November of 2011 from a study by British and German researchers comparing the human genome of people with and without multiple myeloma report that people with either of two particular genetic variations have a 30 percent to 40 percent greater chance of developing myeloma than people without the variations (see related Beacon ^[2] news). This would seem to indicate the variations may at least be a contributing factor to acquiring the disease.

On a related note, I have recently been reading the book "The Emperor of All Maladies: A Biography of Cancer" by Siddhartha Mukherjee, which among other things, explores the history and characteristics of cancer. One notable point that the author makes is that mutations are constantly taking place within our body, and it's a testament to our body's defense mechanisms that we aren't riddled with cancer.

So what causes the right conditions to occur, the right mutations to survive, that lead to multiple myeloma? Is this where environmental factors come in?

Consider all the substances we're exposed to over the course of our life. Perhaps one by one, they take up residence and hide in obscure places in our body unnoticed and benign until the right combination exists that leads to the mutation for multiple myeloma.

This is one area where I haven't been able to find much evidence of research. Are researchers collecting detailed environmental history from patients to look for common contributing factors?

In my case, no one has ever delved into my background for possible factors. I think back over my life and wonder about the things I've been exposed to. For example,

• Parents and friends that were smokers
• A few recreational drugs in my late teens and early twenties
• Working on a hot tar roofing crew for three summers (not only exposure to the tar, but also some of the crap we ripped off old roofs such as the thick green dust on a foundry roof)
• Paints, solvents, and other chemicals associated with home building, demolition, and repair
• Paints, solvents, lubricants, fillers, etc. associated with car maintenance and repair
• Fertilizers, herbicides, and insecticides used around the house

What combination of these may have contributed to getting this disease?

For a short time after being diagnosed, my wife and I dwelled on what the cause could be, but in the end, my practical and cynical side won out and we felt our time could be better spent looking forward rather than back.

I hope that researchers continue to try to find the cause, and when and if they do, that it would help towards finding a cure. For me, while I'll never completely let it go, my time is better spent on other topics.

Peace, and live for a cure.