DEAR DR. ROACH: After a routine blood test raised suspicions, my husband was diagnosed with monoclonal gammopathy of undetermined significance (MGUS). At first, we thought this wasn’t a big deal, but further tests indicate that he’s in the “high risk” category, although he doesn’t have symptoms. The hematologist/oncologist has indicated that he has a 50% chance of developing a blood cancer called multiple myeloma in 20 years.

My husband is very upset and feels that a death sentence is hanging over him. The oncologist says he has to be monitored every three months. I’ve tried to be reassuring, but I don’t really understand what we’re facing either. Fifty percent does seem like a very high risk, but what does this mean on an annual basis? My husband’s in his early 70s. Is there anything he can do to better his odds? His weight is normal, and he tries to be active.

•L.C.

ANSWER: I understand that a 50% risk sounds scary. I wish there were treatments to prevent the progression of MGUS to myeloma, but there are no approved treatments, although there are several agents in clinical trials.

The usual next stage in MGUS is a condition called smoldering myeloma. If your husband developed this, then there are treatments to reduce the risk of this condition, which progresses to myeloma. However, a risk of about 50% over 20 years (58% is often quoted in the literature for high-risk MGUS) means that 97% to 98% of people will be fine each year. These are pretty good odds. If he makes it to 80 without problems, he’s still 97% to 98% likely to make it to 81 without developing myeloma.

I don’t mean to sound blunt and unfeeling, but all of us are living under a death sentence. Nobody lives forever. This new diagnosis does make things a bit worse — but only by a bit.

Almost 75% of people with high-risk MGUS haven’t progressed to myeloma in 20 years when considering the competing causes of mortality. Your husband would be in his early 90s by then.

His oncologist is quite right that careful follow-ups are necessary so that if he does go on to the next stage (smoldering myeloma), he can then consider treatment.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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