Lance Armstrong’s Self-Inflicted Cancer?

Did the use of performance-enhancing drugs cause seven-time Tour de France winner Lance Armstrong’s testicular cancer? That’s what a Sports Illustrated columnist suggested this week. It’s a provocative comment that warrants scrutiny from a scientific perspective.

In E.M. Swift’s article entitled, “The truth is out there: Smoking gun may finally be catching up with Lance,” Swift described testimony given by former Armstrong teammate Frankie Andreu and Andreu's wife in a lawsuit between Armstrong and a sponsor that refused to pay Armstrong a $5 million bonus because of doping allegations.

Andreu testified that while visiting Armstrong in the hospital for treatment of testicular cancer in 1996, Andreu overheard Armstrong tell his oncologist that he had used “steroids, testosterone, cortisone, growth hormone and EPO [an illegal performance-enhancing drug].”

Although both Armstrong and the physician disputed the testimony and the case was settled out of court in Armstrong’s favor, Swift nonetheless commented, “Which testimony is more credible? The Andreus’ or Armstrong’s? Ask yourself which party had the most to gain by lying. And why is that particular testimony significant? Because one of the possible side effects of prolonged steroid use is testicular cancer.”

Swift continued, “It’s impossible to prove, but if what the Andreus testified to under oath is true, that Lance Armstrong, role model and hero to so many cancer survivors, may very well have helped bring about his own cancer through his use of performance-enhancing drugs. Young athletes tempted to go down that road need to know if that's the case.”

Certainly Swift’s sensational charge that alleged steroid use by Armstrong may have caused his testicular cancer has a certain intuitive feel. After all, both endogenous and exogenous hormones are known to be involved in the development of various cancers. Science, however, is based on systematic observation of events, not a sports columnists’ “makes sense to me” mode of thinking.

A recent review published in the journal Current Sports Medicine Reports associated steroid use with liver and kidney cancers. Some studies have linked steroid use with prostate cancer. But no published study links steroids use with testicular cancer in humans or laboratory animals. I couldn’t find a study that even suggested such a linkage. It’s not clear where Swift got the notion for his claim that “one of the possible side effects of prolonged steroid use is testicular cancer” – he cited no expert or study.

Keep in mind that steroids have been used and abused, particularly by bodybuilders and other strength athletes, for more than 30 years. If they caused testicular cancer, that association would likely have been documented, or at least hinted at, in the scientific literature by now.

Further, no published studies link the other performance enhancing drugs mentioned by Swift – that is, testosterone, cortisone, human growth hormone, and EPO – with testicular cancer. Exogenous testosterone may increase the risk of prostate cancer in older men and growth hormone has been associated with increased risk of colorectal cancer in patients with acromegaly, but none of these associations supports Swift’s supposition about Armstrong.

The fact is that no one knows what causes testicular cancer. A number of potential risk factors have been identified – including undescended testicles, family history of testicular cancer, age, race, and body size – but the origins of the disease are unknown. The good news, however, is that testicular cancer can be treated and, very often, cured.

None of this is said to justify the use of steroids or other performance enhancing drugs. Aside from the ethical questions surrounding their use, the abuse of steroids, growth hormone and testosterone by athletes is associated with a number of serious adverse health effects – not testicular cancer, however.

It’s been a rough time for cycling. The second- through fifth-place finishers of the 2005 Tour de France were excluded from the 2006 race under a cloud of suspected drug use. Floyd Landis, the winner of the 2006 race, has had his title stripped because he failed a drug test administered immediately following one of the most amazing one-day performances in the Tour’s history. Just this week, former Armstrong friend Andreu and another former Armstrong teammate admitted they used EPO in 1999 – the year Armstrong won his first Tour title.

Swift may very well be correct that “the truth” may catch up to Lance Armstrong. Only time will tell. In the meantime, he ought to stay focused on the facts rather than fueling the creation of sensational, but junk science-based myths.