IN OCTOBER I WAS TO MEET INTERNATIONAL CYCLING STAR Lance Armstrong at his posh West Austin home around three o’clock for a most uncomfortable interview. He would be answering questions not in his role as America’s most celebrated road racer but in his newer, less familiar persona: as a victim-spokesman for cancer awareness.
Just two weeks before, one of Armstrong’s testes had been removed after doctors discovered that he had advanced testicular cancer. The disease was in the “third stage”—meaning it had metastasized, or spread, from the testicle to his abdomen and lungs—so after the surgery, doctors had placed him on an aggressive chemotherapy treatment. They had given him a 65 to 85 percent chance of full recovery. Armstrong, displaying the stoicism and grit that had made him a world-class athlete, immediately announced that he would become a spokesman for awareness of the disease. As has become public ritual with suddenly stricken celebrities, Armstrong’s fans were first stunned that a 25-year-old at the apogee of physical conditioning could have cancer, then they were reassured, even buoyed by his resolute promise to lick the disease and help other young men do the same.
But when Stacy Pounds, an assistant to Armstrong’s lawyer, met me at the door, bad news was written all over her face. Apologizing profusely, she said Lance would be unable to do any interviews—now or in the foreseeable future—because some “troubling” news had arrived just an hour before from the M. D. Anderson Cancer Center in Houston. She wouldn’t go into detail, but it was clear that oncologists had recommended some changes in Armstrong’s treatment, which meant that something unexpected must have turned up in his blood work. For the time being, the would-be spokesman had to take orders from his disease, and simply wait. “It has thrown everything up in the air,” Pounds concluded, her voice taut with concern.
As it turned out, the cancer had spread farther than first believed, and later that month he underwent surgery at Indiana University Hospital in Indianapolis to have two lesions removed from his brain. The operation was successful, but for Armstrong, it was one more savage bump in the steep downhill course he had been on since the diagnosis. Earlier this year, he was riding high as professional bicycling’s brightest rising star. The young rider, who grew up in Plano, had begun to make his name in 1991, when he won the U.S. amateur championship, and continued the next year, when he had a strong showing in the Olympics. In 1993 he turned pro, racing internationally with the Motorola team, and quickly came into his own, winning that year’s world championship in men’s professional road racing, the Tour DuPont in 1995 and 1996 (the most prominent American cycling event), and stages of the Tour de France in 1993 and 1995. This past summer, one poll ranked him first in the world, even though he had dropped out of the 1996 Tour de France because of a respiratory ailment and had finished a disappointing twelfth in the summer Olympics. He had just signed an endorsement deal with Nike and a two-year, $2.5 million contract with a new French cycling team, Cofidis, and he had just moved into a new $1 million Mediterranean-style home on Lake Austin. Though in the States Armstrong is known almost exclusively by serious followers of his sport, he is extremely popular in Europe, where cycling, like track and field, has a much larger and more established fan base. He was, by all accounts, at the top of his game, an odds-on favorite to win the 1997 Tour de France.
But in September, Armstrong began to notice pain in one of his testicles. Such discomfort wasn’t in and of itself extraordinary for a man who makes his living riding a bike. Spitting up blood was, though; so in early October he visited his doctor and, for the first time he could remember, had his testicles checked. Thus began the roller coaster ride that has once again turned Lance Armstrong’s life upside down. It’s hard to imagine a psyche that could be more shocked by the idea of a life-threatening illness than that of a youthful, vigorous athlete. If cancer is difficult for most of us to contemplate, it must be an impossible abstraction for a man like Armstrong, whose entire life has centered on the fine-tuning of his body, on the acute awareness of its every ache and pain and weakness. Like most athletes, he had learned to live with a certain level of constant pain, and yet he had also continued to push his body harder. Each time he found out that he could take greater strain, it perhaps re-inforced a belief that his body would never let him down.
Certainly he never imagined that he might have testicular cancer. Though the disease is relatively rare, afflicting fewer than 4 out of every 100,000 men and accounting for 1 to 2 percent of all male cancers, it has quietly become the second most common cancer, behind leukemia, among males between ages 18 and 35. It has remained in the shadows because, as Armstrong’s Austin oncologist, J. Dudley Youman, puts it, “a twenty-five-year-old isn’t going to think of getting cancer.” Perhaps more important, it involves a region of the anatomy so private and sacred that most men feel uncomfortable inspecting themselves there or even entertaining the thought that something might be wrong with it. Armstrong, for example, said publicly that he believes he has had one enlarged testicle “ever since I can remember.” But until the enlargement became painful, he apparently never gave it a second thought.
The good news about testicular cancer is that, stealthy as it is, it responds well to chemotherapy. Its malignancies are among the fastest-growing cancers, and cells that replicate quickly are much more susceptible to chemical assault than slow-growing ones, such as colon cancer cells. (This is why chemotherapy patients commonly lose their hair during treatment: Hair cells grow faster than nearly all others, and chemotherapy makes no distinction between healthy cells and cancerous ones.) Indeed, in some oncological circles, the improvements in the treatment of testicular cancer over the past twenty years are considered something of a success story. “As late as 1970 or so, ninety percent of our efforts were unsuccessful with this cancer,” Youman says. “Nowadays, we have a success rate of nearly ninety percent overall because of improved chemical therapies.” But those odds mainly apply if the cancer is discovered in its early stages; they begin to sink to as low as 60 percent as the disease progresses and metastasizes. And testicular cancer, like most cancers, can relapse suddenly, without warning.
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.