I think that when you are diag­nosed with a serious con­di­tion such as multiple myeloma, it’s probably quite natural to wonder why this has hap­pened.

The medical and popular media are con­stantly suggesting that we follow particular regi­mens in order to keep ourselves healthy and avoid getting cancer. Lots of 'un­healthy' behaviors are thought to in­crease our risk of getting a range of lifestyle-related cancers. But there is no evi­dence that multiple myeloma is a 'preventable' cancer. Nothing that we know of that we “did” caused us to get multiple myeloma or even in­creased our likelihood of getting it.

It was nobody’s fault.

I get some strange comfort from this notion. I am not sure exactly why, but perhaps it’s because, at least, I feel that I am not culpable!

Screening or even routine blood tests might have helped some of us, who were diag­nosed late, to discover that we were at risk of devel­op­ing the disease. However, even that discovery wouldn’t have prevented the myeloma from becoming estab­lish­ed. Knowing you have MGUS or smol­der­ing myeloma just puts you in the waiting room. People in this unenviable position know that they are at risk of devel­op­ing full blown multiple myeloma, but even then they cannot stop the pro­gres­sion nor predict if or when it will take place.

It’s nobody’s fault if their con­di­tion progresses.

It would appear that some forms of multiple myeloma may run in families, but there doesn’t seem to be any clear hereditary pattern. So knowing that multiple myeloma does or does not run in your family isn’t helpful. Parents are not responsible, in any way, if their chil­dren develop multiple myeloma.

It’s not their fault.

Sometimes friends ask me how I think I devel­oped multiple myeloma. In many cases, I think the person asking the question subconsciously is trying to work out if there’s any­thing they can do to make it less likely that they develop the disease themselves. I usually say that myeloma is caused by a catastrophic error in a blood cell. To the follow-up ‘why’ question, I just say that the reason is unknown. I often add that it was just bad luck. I can tell that my answer puts some people ill at ease.

In some cases, when I'm asked what I think cauased my multiple myeloma, I think the person really wants to know why I, in particular, got the disease. What is there in my life story that explains it? Is there a lot of cancer in my family? Was I exposed to chemicals in Indonesia? Could my pre­vi­ous infertility treat­ment have caused the myeloma to progress? If I had had more regular health checks, might I have been able to prevent it devel­op­ing?

But nobody was responsible, and nobody is to blame.

Going on from this, there’s the lucky or unlucky story of the type of multiple myeloma you have and how it responds to treat­ment. Again, it is not predictable; patterns exist, but the disease seems to have its own sneaky way of progressing.

I was reading one of Tabitha’s recent columns ^[1], which she finished by saying,‘it is what it is, nobody is to blame.’ After years of dealing with smol­der­ing myeloma and without any known deleterious genetics, her husband Daniel's myeloma went into orbit and did not respond well to many regular treat­ments. Tabitha's column brought tears to my eyes. They had done everything right in trying to prepare for this time. They had even moved so they could be close to a major cancer center, but it still went wrong.

It most certainly wasn't their fault.

Multiple myeloma doesn’t come with the sort of guilt those who smoke may have if they develop lung or throat cancer. It just comes with an unknown cause and an unknown pro­gres­sion. We have little control of our cancer; for the most part, we have to have the medical tests, wait, and hope. And that’s what I do, for the most part.