HAEMATOLOGY


Despite clear advantages, the adoption of sFLC assays for early diagnosis remains inconsistent, with many UK hospitals continuing to use these assays solely for monitoring disease progression


expense of implementing sFLC assays for diagnosis against the reduced costs of treating subsequent complications.


Barriers to early diagnosis Unfortunately, systemic barriers continue to hinder early diagnosis, and an over- arching factor contributing to this is the lack of awareness of diagnostic guidelines among GPs and non-haematologist specialists. As a result, initial symptoms such as back pain, fatigue and anaemia often go unrecognised as the warning signs of MM, and are instead misattributed to more common conditions, therefore delaying appropriate testing (including sFLC and serum protein electrophoresis) and subsequent referrals to specialists.24


Budgetary constraints further complicate efforts to improve early diagnosis; the budgeting system within the NHS often makes it harder for laboratories to adopt newer, more accurate diagnostic tests even though that might be a more cost-effective approach overall. The additional costs incurred by hospitals when implementing sFLC testing in this context are likely to be more than off-set by substantial savings from avoiding treating patients with renal complications resulting from delayed MM diagnosis.25


However, a misalignment


between laboratory budgets and clinical cost savings often delays the implementation of advanced diagnostic tools. In the case of sFLCs, many laboratories already have instruments in place and conduct the assays for treatment monitoring, but they still lack the funding and autonomy to implement the same tests in the context of early diagnosis.


These diagnostic challenges are compounded in certain populations by cultural and demographic disparities in disease risk and health literacy.26,27 For instance, MM is significantly more prevalent among Black and Asian populations, with incidence rates two to three times higher than in Caucasian groups.1,4


medical advice and diagnosis.27 This


highlights the urgent need to improve public awareness and education about MM, particularly in high-risk groups, to help ensure earlier and more equitable MM diagnosis.


Overcoming diagnostic challenges Overcoming the current obstacles to early MM diagnosis is a daunting task, but it is potentially achievable and essential for improving patient outcomes and reducing long-term healthcare costs.


n Education and awareness Improving education and awareness of MM across the board is essential.24 Organisations such as Myeloma UK and Blood Cancer UK play important roles in helping the understanding of MM symptoms and promoting the importance of timely diagnostics among the general population. They also actively develop resources and training material for clinicians, equipping them to recognise red flags like persistent back pain, fatigue and anaemia. Myeloma UK’s Early Diagnosis Programme,28


overcome this hurdle; but need to recognise the long-term savings and key patient benefits associated with early diagnosis and realign budgets accordingly. Reallocating funds to prioritise prompt diagnosis is a complex but necessary step toward creating a more effective and patient-centric healthcare system. Fortunately, many laboratories across


the UK already have the tools necessary to transform MM diagnosis. Freelite assays – performed on the Optilite automated analyser – are already widely used as an aid in monitoring MM patients, yet their potential as an aid in the diagnosis of MM remains largely untapped. These tests were introduced in 2001 as the first commercially available automated immunoassay of their kind, and they were purposely designed to enhance diagnostic precision and reduce delays. Expanding their application from use as an aid in monitoring to investigative purposes would therefore require minimal additional investment, as the necessary instruments are already integrated into the existing infrastructure. This simple adjustment could lead to substantial benefits; automation can enhance diagnostic accuracy, reduce manual errors and simplify workflows, improving the efficiency and accessibility of MM diagnostics and boosting early detection, while minimising the costs associated with advanced-stage complications.


for instance, plays


a vital role in educating GPs and clinical departments to ensure that they are better prepared to identify MM at earlier stages, promoting a proactive approach to care.


n Improving diagnostic pathways Streamlining diagnostic pathways is another key step to boosting accuracy and efficiency in MM diagnosis. Clinical scientists in several leading laboratories are able to proactively add sFLC assays to testing panels when MM is suspected, even in the absence of a specific request from a clinician. This shared approach can help to overcome system inefficiencies and ensures that diagnostic pathways are more patient focused.


are more likely to develop the condition at a younger age.27


Additionally, Black individuals Despite this


heightened risk, awareness of MM and its early symptoms remains low in these communities, leading to delays in seeking


50


n Managing budgets and optimising existing resources Frustratingly, budgetary constraints are still preventing laboratories from adopting sFLC assays for early diagnosis of MM, despite the best practice guidelines from 2016 and clear evidence from trusts across the UK that have gone down this path. Healthcare leaders and policymakers have the power to


A call for change in myeloma diagnostics


Despite advances in our understanding of MM, as well as significant strides in diagnostic technologies, healthcare systems have yet to consistently adopt best practices in MM diagnosis. The tools to transform its detection already exist; sFLC assays are widely used for monitoring MM patients, but their full potential as an aid in prompt diagnosis has been overlooked. This oversight is particularly costly, given the profound consequences of delayed diagnosis, both in terms of patient outcomes and financial implications. Early diagnosis consistently proves to be the most effective treatment strategy, reducing tumour burden, preventing severe complications and dramatically improving prognoses. For true change to occur, healthcare systems must prioritise timely detection as a cornerstone of MM care. Addressing healthcare inefficiencies, fostering cross-departmental collaboration and reallocating budgets toward prevention rather than reaction are vital steps. Companies like Binding Site, part of Thermo Fisher Scientific, play a crucial role in this transformation, offering not


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