Racial Health Disparity and Risk of Multiple Myeloma: Implications for Energy Balance Interventions

Abstract

Established risk factors for multiple myeloma including obesity and sedentary lifestyles are associated with well-known racial/ethnic disparities in disease risk. This review examines established risk determinants for multiple myeloma in Black adults, summarizes evidence linking lifestyle factors including obesity, physical inactivity, and diet to disease risk, and discusses energy balance interventions, including culturally tailoring, to mitigate multiple myeloma risk.

We summarize current evidence for racial/ethnic disparities in risk factors for multiple myeloma including unmodifiable heritable factors, modifiable contributors to obesity including diet and physical activity, and barriers to meeting physical activity and healthful diet guidelines. With this evidence, we present considerations to research lifestyle interventions directed towards risk factors for multiple myeloma.

Current foundational scientific evidence in energy balance interventions for cancer risk management are primarily supported in non-Hispanic White populations. Evidence for preventative exercise, diet, or lifestyle interventions for multiple myeloma among underrepresented populations are scarce. Research considerations are proposed to provide strategies utilizing community engagement, primary care education, and importantly, availability of exercise and dietary resources. The importance of tailoring exercise and dietary interventions is also underscored, in addition to generating clinical trial-based evidence to be equitable and beneficial for all populations.

INTRODUCTION

Across racial and ethnic backgrounds, Black adults experience an increased risk of multiple myeloma. Indeed, recent data from the Surveillance, Epidemiology and End Results Program estimate that per 100,000 individuals, new diagnoses of multiple myeloma would be 15.8 among Black individuals and 6.9 among White individuals.^1,2 The complexity of interactions between social, economic, biologic, epidemiologic, and clinical factors may contribute to the racial and ethnic differences in multiple myeloma risk.³ The heritable or genetic factors underpinning the biological differences in race and ancestry may contribute to an unmodifiable aspect of the racial and ethnic disparity.³ However, increasing evidence also suggests that physiological factors such as increased weight and obesity, which are well-established risk factors for multiple myeloma and are more common among Black adults than non-Hispanic White adults, may place the Black population at a heightened risk for multiple myeloma.⁴

Physical activity and diet are two modifiable lifestyle behaviors that may be used to successfully manage the risk of a number of obesity-related cancers, including multiple myeloma.⁵ Therefore, identifying preventative measures that target energy balance may be critical to developing interventions to reduce multiple myeloma risk in high-risk populations, including Black adults who are overweight or obese. Considering that non-Hispanic Black adults face a higher risk of multiple myeloma compared to White adults, addressing cultural needs in physical activity and dietary-related cancer prevention measures across all groups may enhance efficacy. Thus, the purpose of this review is 1) provide a brief overview of established determinants of risk for multiple myeloma among Black adults, 2) summarize evidence regarding lifestyle factors including obesity, physical inactivity, and dietary factors and the risk of multiple myeloma, and 3) to discuss energy balance strategies/interventions, including cultural tailoring to mitigate risk of disease.

1. BRIEF OVERVIEW OF DETERMINANTS OF RISK FOR MULTIPLE MYELOMA

Multiple myeloma, a malignant neoplasm of permanently differentiated plasma cells, lacks a well-established etiology. Racial disparities in the risk of multiple myeloma, which have been well documented, arise from a complex interplay of biological factors, genetic ancestry, and socioeconomic determinants.⁶ Alongside inherited factors like family history of multiple myeloma or other plasma cell disorders, risks include age 50 years or older, male sex, being Black or of African descent, and the presence of a precursor condition such as monoclonal gammopathy of undetermined significance (MGUS). In addition, emerging epidemiologic studies indicate potential associations with physical inactivity, body composition, and diet.^5,7

1.1. Non-modifiable risk factors

Non-modifiable risk factors such as age, sex, and race are significant risk factors for multiple myeloma. Black patients have an earlier median age of onset at diagnosis of 65.8 years compared to 69.8 years for White patients, whereby the influence of genetic backgrounds is poorly understood.⁸ A family history of multiple myeloma increases disease risk, likely due to shared genetic and environmental factors, with evidence suggesting that genetic inheritance may contribute to the higher incidence of multiple myeloma and its precursor conditions in the Black population.⁹ Genome-wide association studies have identified 23 susceptibility loci that may contribute to multiple myeloma risk, predominantly in populations with European ancestry, with several also identified in populations with African ancestry.^10,11 Although understanding of multiple myeloma susceptibility in persons who are Black is developing in regard to heritable factors, preliminary data indicate that at least some of the risk is due to a genetic predisposition.

1.2. Modifiable risk factors: Emphasis on obesity

Social determinants of health, such as access to nutritious food, housing, healthcare, and education, play a critical role in shaping health outcomes across all populations. However, Black communities are disproportionately disadvantaged due to systemic racism, which perpetuates socioeconomic deprivation, residential segregation, discrimination, and limited access to essential resources, contributing to persistent health disparities in the United States.¹² Studies suggest that race-related disparities in multiple myeloma outcomes may be driven by socioeconomic factors, including education, income level, and health insurance status, emphasizing the necessity for focused interventions to address these disparities.¹³ Furthermore, lower socioeconomic status, whether measured by occupation, income, or education, has been reported to be associated with increased multiple myeloma risk. Indeed, among Black adults, low education and income contribute 17% and 28% to the excess incidence observed, suggesting socioeconomic status as a factor in understanding the disparity in multiple myeloma incidence.¹⁴

Obesity, a well-established risk factor for multiple myeloma, is 13.6% more prevalent in Black adults compared to White adults and is a contributor to rising incidence of multiple myeloma among Black Americans.^1,2 NHANES data indicate that approximately 48% of non-Hispanic Blacks have an obese BMI compared to 34.5% of non-Hispanic Whites, contributing to the disproportionate effects of obesity-related disorders that include metabolic syndrome, diabetes mellitus, and cardiovascular disease.¹⁵ These findings highlight the need for increased awareness of multiple myeloma risk among Black individuals who are obese and underscore the importance of prospective studies to determine if weight reduction can mitigate multiple myeloma risk.

Racial disparities in obesity are also influenced by factors affecting access to physical activity that are impacted by built environment characteristics, such as ‘walkability’ indices, land use mix, and transportation variety, along with accessibility to diverse food options and availability of healthy foods.¹⁶ Inequitable access to food mirrors disparities in income, poverty, and neighborhood conditions, with the Black American population facing food insecurity at three times the rate of the White population.¹⁷ Furthermore, socioeconomic status may impact diet quality, in that individuals with higher socioeconomic status may more likely consume healthy foods including whole grains, lean meats, fish, and fresh vegetables, and fruits.¹⁸ Adiposity is linked with consumption of energy dense foods that include refined grains and added fats, along with a possible link with lower socioeconomic status.¹⁹ Additionally, Vitamin D deficiency, associated with increased inflammation, is present in up to 75% of patients with multiple myeloma and possibly impacts the initial stage that patients present with.²⁰ Given the increase in obesity prevalence among Black adults, and that excess body weight contributes to elevated risk of multiple myeloma,^21,22 this population may benefit from obesity prevention strategies.

2. ENERGY BALANCE STRATEGIES TO REDUCE RISK OF MULTIPLE MYELOMA

2.1. Benefits of a Healthy Diet

According to the World Cancer Research Fund International and the American Institute for Cancer Research, amongst the 13 most common cancers, an approximated one in three cases were preventable if a healthy lifestyle was incorporated, including not smoking, regular physical activity, balanced dietary intake and maintenance of healthy weight.²³ While multiple myeloma is not among these common cancers, it is widely accepted that a healthy dietary pattern may be a strategy to reduce cancer risk; this includes regular consumption of a variety of vegetables and legumes, fruits and whole grains, whilst limiting red or processed meats, sugar sweetened beverages, along with highly processed foods, refined grains, and alcohol.²⁴

Dietary interventions related to decreasing multiple myeloma risk are scarce. However, several observational studies have identified foods, nutrients, and lifestyle behaviors that may impact risk for multiple myeloma. For example, adopting fruit-rich dietary patterns in adolescence may reduce the risk of MGUS and when incorporated post MGUS diagnosis, may lower the likelihood of progression to multiple myeloma.²⁵ Food groups can be ranked across a spectrum of inflammatory markers using the empirical dietary inflammatory pattern (EDIP) index, ranging from more anti-inflammatory potential (i.e. coffee, carrots, squash, tea, green leafy vegetables) to pro-inflammatory (i.e. processed meats, red meats, sugary beverages and refined grains). Broadly, men with high EDIP have a 16% increased risk in developing multiple myeloma.²⁶ Evidence in overall dietary patterns suggest multiple myeloma risk is lower with plant-based diets compared to meat-eating diets.²⁷ Additionally, lowered risk of multiple myeloma may be connected with individual dietary components including consumption of fruits, vegetables (especially cruciferous), whole grains, and seafood, and modifications through vitamin supplements.^20,28,29 Finally, early evidence indicates diet modification or nutrition targeting the gut microbiome may yield protective results within the bone marrow microenvironment, aiding in control of progression from MGUS to multiple myeloma.³⁰ Considerations for addressing gut microbiome nutrition needs earlier on, may be of interest to study in multiple myeloma risk management. The findings of these observational studies should be considered within the context of their limitations, including reduced generalizability to racially and ethnically diverse populations. Conflicting results across studies may arise from factors such as small sample sizes and residual confounding, emphasizing the need for cautious interpretation.

Investigations testing the degree to which energy balance interventions reduce the risk of multiple myeloma are growing but currently remain limited. A recent pilot clinical trial indicated that a plant-based diet is feasible in overweight patients diagnosed with multiple myeloma precursor diseases (MGUS or smoldering multiple myeloma; n=23) with a case series (n=2) of patients who experienced BMI reduction by the end of the one year intervention, implicating the importance of investigating a plant-based diet as a means to delay progression to multiple myeloma development.³¹ Similarly, PROFAST is an ongoing clinical trial (NCT05565638) investigating prolonged fasting, a type of dietary intervention, as a possible strategy in preventing multiple myeloma development in overweight and obese individuals diagnosed with precursor diseases.³² The degree to which these interventional studies are applicable to diverse patient profiles is unclear, although there is evidence for successful integration of dietary change through culturally tailored dietary interventions, such as the Eat for Life trial and Body & Soul intervention, demonstrate their potential, as supported by the National Cancer Institute’s Evidence-Based Cancer Control Programs.^33,34 Though not specific to multiple myeloma, the authors of the study (Harvesting Health Program) demonstrate the effectiveness of culturally tailored programs in fostering healthy lifestyle habits, including weight loss.³⁵ The limited number of studies from culturally tailored dietary interventions in Black or African descent populations emphasizes the importance of developing and clinically testing similar dietary strategies benefitting all ethnic and racial groups.³⁶

2.2. Benefits of Regular Exercise Participation

Exercise, a structured component of physical activity, reduces inflammation, improves immune system function and can play a role in preventing obesity through increased muscle mass and reductions in adipose tissue^37,38. However, the response to exercise varies across individuals, due to differing genomic expression and impact of environmental stressors. Due to the difference in genetic make-up across ethnicities, slight differences in response to exercise training occur, therefore the need to tailor a specific training program based on the identification of their genotype and environment may be an avenue to explore across all populations.³⁹

Current literature indicates, across 10 cancer types including multiple myeloma, there is an association between lowered cancer risk and individuals that incorporate leisure-time physical activity.⁴⁰ Additionally, in a screening cohort of 2,628 individuals throughout the United States, high levels of physical activity were inversely associated with plasma cell disorders such as MGUS.⁴¹ Furthermore, there is a compelling link between lowered cancer risk and incorporating physical activity at an early stage in life.⁴² Based on this, it is necessary to determine how to effectively prescribe exercise interventions as a cancer prevention strategy given the lack of adequately powered randomized controlled trials that target multiple myeloma prevention among racially and ethnically diverse populations.

Efforts to reduce health inequities in Black communities, stemming from systemic racism and unequal healthcare, include the exploration of community-based culturally tailored education (CBCTE) programs across diseases like diabetes and cardiovascular disease.⁴³ Culturally tailored exercise interventions, which account for social and community factors, have also shown success in minimizing health disparities among underrepresented racial and ethnic groups.⁴⁴ CBCTE programs designed to improve health outcomes, with obesity as a primary focus, in Black adults, are limited in number but indicate community interaction as a critical factor to include along with consideration for age and gender.⁴⁵ More specifically, of 74 studies reviewed, the CBCTE programs designed education programs to take into account socio-cultural, community and familial factors to provide resources on diabetes (65%), hypertension (30%), cardiovascular disease (3%), and stroke (1%).⁴⁶ Benefits include patient physical activity, overall health, medication use, and literacy. Additional support is shown in a study designed to increase physical activity through the use of a smartphone and associated app in Black adult women, preliminary data suggests this as a feasible approach with enhancing social support as a primary focus for larger-scale interventions.⁴⁷ In summary, there is a lack of evidence for interventions that provide culturally appropriate options to tailor exercise programs to target obesity management in Black/African American patients to reduce the risk of developing multiple myeloma.

3. Research Considerations for Risk Reduction

3.1. Proposed Framework for Risk Reduction

The goal is to develop culturally tailored programs for multiple myeloma awareness, education, and risk reduction initiatives promoting behavioral changes in at- risk groups based on known modifiable lifestyle factors. The strategies outlined (Figure 1) include community engagement, primary care education, and availability of exercise and dietary resources, emphasizing (1) cultural tailoring techniques and (2) healthcare system responsibilities.

Figure 1.

Proposed framework for multiple myeloma risk reduction including the following key areas for successful implementation: (1) community based patient support teams, (2) education that is culturally appropriate and (3) access to exercise and dietary resources.

Community Engaged Patient Support Teams

Establishing community-based patient navigation teams is essential for improving patient risk reduction outcomes. Programs like the International Myeloma Foundation’s M-Power platform, illustrate effective community engaged research at the national and local level, and includes collaborative efforts with both medical and non-medical experts, raising awareness of multiple myeloma, its presenting symptoms, its impact on the Black community, and strategies to overcome associated health disparities. Partnerships among primary care providers, certified exercise oncologists, and registered dieticians can enhance advocacy and prevention efforts. Expert teams – comprising patients, advocates, physicians, healthcare providers, leaders in the Black community, and industry representatives – can explore the benefits of preventative exercise and dietary interventions, aiming to standardize risk reduction strategies for patients nationwide.

Healthcare professionals integrated into local communities for specialized diseases like multiple myeloma begins with creating access to educational events in hospitals or community centers with strong Black community engagement. Initiatives like the MMRF and Acclinate’s NOWINCLUDED summit provide resources including educational hubs and mentorship. Primary care providers and hematologic oncologists can participate by delivering presentations, fostering open dialogue with patients and emphasizing the importance of patient advocacy. A national collaboration between oncology groups (e.g., the American Cancer Society), multiple myeloma organizations (e.g., IMF, MMRF), and major cancer centers would standardize access to these resources through both in-person and virtual seminars.

Local collaborations with faith-based groups, YMCAs, and health centers can enhance outreach and engagement, leveraging established infrastructures for health education, screening and lifestyle modifications. Expanding existing programs, such as M-POWER or the MMRF Annual Health Equity Summit⁴⁸ and Medical Student Scholars for Health Equity in Myeloma⁴⁹, along with delivering multiple myeloma education in accessible settings (e.g., churches, YMCAs) can improve awareness and diagnostic sensitivity in minority populations.

Metrics of success for Community Engaged Patient Support Teams:

1. Increased Participation in Educational Events: Annual growth in provider and community member attendance at multiple myeloma educational events hosted in hospitals, community centers, YMCAs, or churches. Track engagement through surveys on self-reported efficacy of the event and feedback for cultural-based development to advise future events.

2. Improved Patient Advocacy and Early Diagnosis: Monitor the number of patients diagnosed earlier (e.g. stage 1 or 2) as an indicator of improved awareness.

3. Expanded Community-Based Collaborations: Expand partnerships with community organizations (e.g., faith-based groups, local YMCAs, Black advocacy groups) across major cities to increase outreach annually.

4. Continuing Medical Education (CME): Track completion rates of multiple myeloma-specific CME among healthcare professionals, with year-over-year growth targets and actively participating in local M-POWER events or similar outreach programs.

Efforts to address engaging clinicians to help patients move through cancer have been identified through the Exercise is Medicine in Oncology roundtable.⁵⁰ Strategies such as Assess-Advise-Refer could be implemented prior to cancer diagnosis, within primary care settings to kickstart a patient’s journey in diet, nutrition and exercise lifestyle habits. Referrals to culturally tailored consultations with exercise physiologists and dieticians, integrated into community-engaged patient support teams, are vital for patients with higher BMI or a family history, focusing on education on risk reduction strategies.

Culturally Sensitive Education Resources

Culturally and linguistically accessible resources for different cultures and languages would benefit primary care setting standard practice.⁵¹ Primary care providers should establish transparent, emotionally supportive patient-provider relationships with Black patients and their families that are inclusive in decision-making,⁵² to promote adoption and maintenance of exercise and dietary habits. Considering the increased risk of multiple myeloma in Black patients, early education should be prioritized on: (1) risk of developing multiple myeloma, (2) comorbidities such as obesity, metabolic syndrome, diabetes mellitus, and cardiovascular disease, (3) benefits of healthy exercise and dietary lifestyle habits as preventative measures that reduce risk, (4) available resources in support of modifying lifestyle habits accordingly (outlined in the next section), and (5) follow-up support on the use of these resources during the course of patient being in the primary care setting.

Culturally appropriate education can include health messages and interventions that are adapted to the values, beliefs, language, and social norms of the Black community. The PEARL guide was developed for African American and Immigrant African women to be used as a guide in putting together culturally sensitive cancer education materials, that highlights the following: Plain language and understandability, Explicit data, statistics and graphs, Affirmative framing, Representative content, and Local connection.⁵³ Although PEARL may not meet all community needs, it offers a peer-reviewed foundation that can be iteratively refined based on community feedback, helping primary care practices deliver relevant and effective health education.

Metrics of success for Culturally Sensitive Education Resources:

1. Community Feedback and Iterative Improvement: Measure the frequency and quality of community feedback on educational materials and develop a target metric to track retention and satisfaction rates among community members regarding the relevance, clarity, and cultural appropriateness of the materials, with periodic updates based on the feedback received.

2. National Program Development: Specific to multiple myeloma resources within the Black community that is nationally recognized or implemented would also serve as a long-term goal.

Availability of Exercise and Dietary Resources

Tailored exercise and dietary programs should address specific needs and barriers faced by Black patients and can leverage the community-based participatory approach (CBPR) to reduce health disparities in chronic diseases (i.e. diabetes, hypertension, cardiovascular disease, etc.), which involves faith-based social infrastructure characteristics of Black communities.⁵⁴ The Wholeness, Oneness, Righteousness, Deliverance (WORD) Trial, an adapted Diabetes Prevention Program, demonstrate the effectiveness of culturally tailored weight-loss strategies adapted for Black communities, supported by health professionals.⁵⁵

Implementing similar frameworks for multiple myeloma prevention across exercise and dietary interventions could focus on accessible technology platforms (e.g., mobile apps, text-based resources) and partnerships with local libraries, gyms, and faith-based organizations to bridge digital and physical access gaps. Studies indicate that holistic health promotion, delivered both in-person and through technology, caters to the values, perspectives, and preferences of older Black adults in low-income communities⁵⁶ To address digital access disparities: (1) platforms should be optimized for mobile use and provide resources via text messages, phone calls, and simple web-based interfaces; (2) collaborations with mobile service providers to offer low-cost data plans or free access to health websites can increase engagement; (3) establish partnerships with local libraries or community centers that offer free digital literacy programs and computer access would further enhance reach; (4) within research-based settings, take advantage of health equity grant offerings to provide further support.^57,58

Metrics of success are outlined below:

1. CBPR Program Development: Designed specific to multiple myeloma for digital accessibility and integration with primary healthcare systems to provide an additional platform for patients and primary care providers to interact in a preventative healthcare space.

2. Mobile Platform Engagement: Track mobile resource usage, aiming for annual increases in user engagement through text messages, phone calls, or mobile-optimized websites.

3. Digital Literacy Program Participation: Measure the number of patients with multiple myeloma diagnosis that completed digital literacy programs offered through libraries or community centers over a set period (e.g., one year).

Ensuring access to exercise and dietary resources requires building partnerships with community-based organizations such as local gyms, YMCAs, and parks to offer free or reduced-cost exercise programs.⁵⁹ Working with local government funding or faith-based community centers, to provide low-cost or free transportation opportunities to locations in safe environments for those that live in unsafe or non-walkable communities.⁶⁰ Government or non-profit funding could be directed to create wellness centers or support existing facilities in underserved areas.⁶¹ Shared-use agreements that allow for after-hours public access to existing facilities such as K-12 education centers could increase accessibility.⁶² Plans to coordinate with local workplace facilities and policies to encourage physical activity using workplace policies, management support and social support programs would benefit across all communities.⁶³ Additionally, integrating registered dietitians and exercise physiologists into local health clinics can provide direct support to patients, and include mobile health units to deliver services to rural or low-access communities.⁶⁴ This could be facilitated by a partnership with the Exercise is Medicine Underserved & Community Health Committee to efficiently use existing networks of physical activity resources to continue the promotion of culturally adapted opportunities.

Metrics of success are outlined below:

1. Participation in Community-Based Exercise Programs: Track the number of individuals participating in free or reduced-cost exercise programs offered through local gyms, YMCAs, or parks, with the goal to increase participation numbers within the first year of implementing the partnerships and programs.

2. Access to Registered Dietitians and Exercise Physiologists: Monitor the number of patients receiving support from registered dietitians and exercise physiologists in local health clinics or mobile health units. A target metric could be a set increase in patient consultations within underserved or rural communities in the first year of program implementation

Additionally, considerations in exercise prescription and progression plans must account for potential implicit racial biases, particularly in pain management, which is a well-documented disparity in health care settings.⁶⁵ Improving the availability of exercise and dietary resources for patients addresses barriers relating to trust, awareness, and access that can be delivered equitably across patients. Funding can be sourced from a combination of federal and state public health grants (e.g., CDC, NIH), private foundations focused on health equity, and partnerships with healthcare organizations and pharmaceutical companies with vested interests in multiple myeloma research and treatment. Additionally, community fundraising initiatives and grants from non-profit organizations may support local implementation efforts. Accountability can be maintained through continuous community engagement, transparency in reporting outcomes, and by establishing advisory boards that include community representatives. Regular feedback from participants and stakeholders should be solicited to adapt programs to community needs. Finally, conducting community-based participatory research ensures that investigators work in collaboration with community members, promoting shared decision-making and ensuring cultural relevance and trust.

3.2. Proposed Implementation Plan

To effectively implement these strategies, the following steps are proposed following a similar framework to Bhutani et. al.⁶, to address the increased risk of multiple myeloma in Black adults using energy balance-based interventions. The first stage would consist of developing a dedicated group of exercise oncologists and registered dieticians specialized in oncology, in collaboration with prevention-focused primary care providers and engaging high-quality care centers for multiple myeloma in advocacy efforts. Followed by developing collaborations with health networks, across cities with higher Black populations, to advocate for implementing partnerships with exercise oncology experts and registered dieticians specialized in oncology prevention. Ongoing research to identify and mitigate risk factors through comprehensive data collection, including genomic analyses by race and ethnicity, is critical to advance mechanistic understanding of multiple myeloma. These efforts can inform the development of targeted exercise and dietary interventions that focus on risk reduction, supported by initiatives such as the Charlotte African American MGUS Project and the PROMISE Study, which focus on screening and epidemiology in Black populations. Trust will be built through transparent communication, culturally appropriate education, and community-specific tools and outreach programs, leveraging partnerships with existing cancer, exercise, and dietary initiatives. As previously noted, a recent example of this was presented through the Multiple Myeloma Research Foundation (MMRF) and Acclinate’s NOWINCLUDED community which hosted four multiple myeloma summits in separate cities, providing key resources for individuals affected by the disease. Educational efforts would address cultural differences and communication gaps, ensuring inclusivity in risk reduction strategies within the exercise and dietary programming. Systemic changes promoting health equity, such as universal health insurance coverage and access to high-quality care would support mitigating persistent disparities. This comprehensive action plan aims to reduce multiple myeloma risk in at-risk populations through tailored interventions and healthcare reforms.

4.0. CONCLUSIONS AND FUTURE DIRECTIONS/CALL TO ACTION

Black individuals are at an increased risk of developing multiple myeloma due to possible heritable factors along with higher rates of obesity – a modifiable risk factor that can be addressed through various lifestyle interventions including diet and exercise. Dietary intervention strategies focusing on weight reduction, especially in individuals that are overweight or obese, may be one strategy in preventing the development of multiple myeloma. Additionally, exercise interventions that focus on adiposity reduction and muscle mass development may serve as a protective mechanism in the risk of multiple myeloma. The combination of dietary and exercise interventions may provide a more holistic approach in modifiable lifestyle management. Based on underlying racial/ethnic inequities in the Black population, including socioeconomic status and access to resources and support for healthy diet and physical activity regimens, there is a need for energy balance interventions that are culturally tailored to reduce risk of multiple myeloma development. Culturally tailored programs have demonstrated success in fostering healthy lifestyles in the Black population, though there is a lack of research specifically focused on multiple myeloma risk. The hereditary, dietary, and physical activity factors contributing to the health disparity in Black and/or of African descent vs. Non-Hispanic White Americans are moderately established for risk of developing multiple myeloma. The consideration to implement energy balance interventions may support effective care prevention strategies for populations at elevated risk of multiple myeloma, with a focus on efficient dissemination via multisite centers.