Dear Lance 
The Race of His Life
As an intensely fit 25-year-old world-class cyclist, Austin’s Lance Armstrong never imagined he might be susceptible to testicular cancer. But then, no man ever does—and that’s precisely the problem.
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What’s worse is that even successful chemotherapy has its price. (Armstrong is being treated with chemotherapy rather than radiation because the latter is effective only when the cancer hasn’t spread to other areas.) Like many chemo regimens, Armstrong’s will be delivered in four cycles, each lasting three weeks. Generally, a patient receives the chemo treatment—three chemicals specifically designed to kill living cells—through a catheter inserted in a vein under his collarbone. The medication is given during the first week or two of each cycle, and the remaining time is left for the patient’s system to recuperate: The highly toxic drugs not only kill hair follicles but can also induce extreme nausea and even damage bone marrow, a side effect that in turn inhibits the body’s ability to form blood clots and fight infections. And in about half of all testicular cancer patients, the chemo treatment also causes fertility problems. As a consequence, patients who may want to have children are urged to preserve specimens of their sperm at a sperm bank before beginning their therapy.
As much as we know about curing the disease, the causes of testicular cancer have yet to be pinned down. In the wake of Armstrong’s astonishing announcement, it was perhaps natural to speculate that the extraordinary irritation and pressure endured by a professional cyclist’s groin area might have precipitated or at least encouraged the tumor. But both Youman and Craig Hall, a urologist at the University of Texas Southwestern Medical Center in Dallas, argue that there is no scientific foundation for such a hypothesis. “We do frequently see the presence of some antecedent trauma to that body area in men diagnosed with cancer of the testis,” Hall says. “But I see no basis for making the call that it causes or encourages the cancer. Rather, I think some sort of impact to the groin usually draws the sufferer’s attention to his testes, after which cancer is detected.”
But some experts believe that the brutalizing physical regimen endurance athletes follow—Armstrong customarily trained six hours a day—is in fact part of the problem. Dallas’ Dr. Kenneth Cooper, for instance, has suggested that “distress exercise,” such as running marathons or cycling for hours on end, actually has a deleterious effect on health (see “Walk, Don’t Run,” June 1995). Cooper, who was the father of the aerobics movement of the sixties and seventies and a longtime proselytizer for improved health through exercise, changed his tune somewhat in the late eighties, when he began looking into the incidence of cancer in otherwise healthy professional athletes, including American runner Steve Scott, who was diagnosed with testicular cancer.
Cooper contends that excessive exercise—running more than fifteen miles a week, for instance—enhances the production of free radicals, oxygen molecules that have been damaged by stress. As unstable molecules, the free radicals become scavengers in search of an additional electron to secure themselves; frequently they will filch one from nearby healthy cells, a process that can eventually damage muscles, the liver, blood, and other tissues. Interestingly, Cooper’s theory is in part supported by research performed as far back as 1928 on long-distance cyclists. In studies of the amount of pentane, a chemical by-product of free-radical activity, in the cyclists’ breath after exercising, researchers discovered that as exercise became more strenuous, pentane and free-radical activity picked up—and hence, body tissues became more vulnerable to degeneration.
Could Armstrong have cycled himself into a potentially deadly illness? It’s impossible to know. Cooper’s theories are provocative, and Armstrong himself once confessed that he has frequently thought, “I will not live as long because of the conditions we have to race in.” But oncologist Youman, for one, thinks that so-called exercising to death was not a factor in Armstrong’s case. “The body is fine as long as you replenish it well,” he says, “and Lance does.”
Barring the possibility of overexercise, there are no handy ways to predict who will be struck with the disease. Cryptorchidism—the failure of one or both testicles to descend from the abdominal area into the scrotum shortly after birth—can be an indication that a man is susceptible, but it is by no means conclusive. Today only vigilant self-examination can ensure timely detection. Though that idea is likely to elicit nervous guffaws or jeers among many men, Armstrong made a poignant argument in its favor: “…if I had done it five years ago, I wouldn’t be in this position.”
Doctors recommend more than a cursory visual inspection; each testis should be examined gently by hand for suspicious growths or obvious asymmetries. While it is fairly common for one testicle to be somewhat larger than the other, if the deviation in size is a recent and sudden development, you should consult a physician. Naturally, persistent pain in either or both testes should also prompt a call to the doctor.
Though Armstrong’s chance to advocate such exams has been delayed, his foray as a victim-spokesman wasn’t wasted. Apparently he prompted at least one young fellow Austinite who had been feeling soreness in his groin to call his doctor. The young man, it turned out, had cancer. In October he underwent successful surgery and a few days afterward sent his thanks to Armstrong through the athlete’s representatives. That news no doubt lifted Armstrong’s spirits, though they were soon battered once again when he learned that the cancer had spread to his brain. Now, Stacy Pounds says, Armstrong has begun a radically more aggressive chemo regimen.
There’s a lesson in Armstrong’s plight for all men, even those of us who are long past 25 and are not professional athletes. In recent years the medical establishment has become increasingly concerned that men are too indifferent about their health; that we, because of a perceived cultural mandate to be the “tougher” gender, visit the doctor too infrequently and that, when we do go, we tend to ignore the advice we get. Research performed by Men’s Health magazine, in fact, recently revealed that women visit a doctor up to two and half times more frequently than men do. All too often, it takes a cruel glimpse of our own mortality—a heart attack or a stroke—to remind us that, while our bodies may be physically stronger than women’s, they are just as susceptible to life-threatening diseases and deterioration. No degree of muscle mass or macho bravado can stand up to a single strand of mutant DNA. Unfortunately, Lance Armstrong had to learn that the hard way.
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