Abstract
The phenomenon of stage migration in cancers leads to apparent survival improvement in both lower and higher stages. This is due to an upward migration of patients with adverse biology from lower to higher stages, as well as newcomers in higher stages who are not as clinically advanced as the original cohort in that stage. This epidemiological paradox is called ‘Will Rogers phenomenon’ after the comedian Will Rogers, who, during the large-scale geographic migration of 1930s, had putatively said, ‘When the Okies left Oklahoma and moved to California, they raised the average intelligence level in both states’ [ [1] Feinstein A.R. Sosin D.M. Wells C.K. The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med. 1985; 312: 1604-1608 Crossref PubMed Google Scholar ]. Till date, the Will Rogers phenomenon has been mostly described in solid tumours. However, it is plausible that haematological malignancies are also susceptible to this phenomenon given advances in molecular diagnostics, bone marrow imaging, and modification of diagnostic criteria over the years. In this perspective, the author describes why the field of multiple myeloma and smouldering/asymptomatic myeloma is witnessing a Will Rogers phenomenon and its clinical implications?
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