Metastatic cancer and multiple myeloma: One ancient, the other a disease of modernity?

Background: Diagnostic caveats have often been incorporated in publications suggesting possible multiple myeloma in archeological sites, noting difficulty distinguishing it from metastatic cancer. It seems appropriate to assess whether suggested cases in the archeological record differ from what modern medicine recognizes/diagnoses. Methods: The published literature and archives were surveyed for reports of multiple myeloma in archeological sites. Descriptions were examined for fulfilment of diagnostic anatomic criteria (sharply defined, spherical defects, expansion without regard for the density of surrounding bone in the absence of bone reaction or residual internal structures and contained structures). Lytic areas were examined for shape homogeneity, sharp or graded edges, relative expansion through adjacent trabecular and cortical bone and for presence of new bone formation either bordering the lesion or as periosteal reaction. Results: None of the 49 reported accessible cases described/illustrated individuals had appearances consistent with what today is recognized as multiple myeloma. The mean age of reported cases of 44 was significantly less than that of 69 in clinically diagnosed cases (t test 4.62123, p = 0.00028). Descriptions of bone lesions in many actually were often at variance with that recognized on review of their images. The significance of subtle peri-lesional density variation was often overlooked and oval lesions were often mischaracterized as "punched out." Most cases likely represent metastatic cancer. A previously unreported alteration, rosette formation, was noted in a female subgroup. Discussion: Macroscopic, radiologic and epidemiologic comparison of clinically-diagnosed cases with purported archeologic cases evidences that they represent very different diseases. Since multiple myeloma has yet to be confidently diagnosed/recognized in the archeologic record, the possibility must considered is that it is a disease of the modern epoch. A further observation is that the newly recognized finding of peri-lesional rosettes might be a marker for the breast cancer origination of observed metastases.