Friday, January 21, 2022

My wife Elie’s nephew, Dov Rabinowitz, lives in Jerusalem and is the commissioner of the Jerusalem Softball League. OK, it is not exactly the MLB, but we are very proud. And so I promised Dovi that I would write something regarding baseball, a shared love, and cancer.

It is worth bearing in mind that baseball players, as athletes, generally have a life expectancy that exceeds the general public by, on average, about seven years. This is a variation on something referred to as the healthy worker effect. But when it comes to cancer, baseball players are at particular risk for two malignancies. One is cancer of the oral cavity, secondary to the widespread use of chewing tobacco. The other is skin cancer from extensive sun exposure.

Two anecdotes regarding baseball and cancer come to mind. The first is the story of one of my childhood heroes, Mickey Mantle, No. 7 for the New York Yankees. Mantle won the triple crown in 1956, had that glorious 1961 season with Roger Maris chasing the home-run record, and is considered the greatest switch hitter in baseball history.

But his personal life was tragic. He regularly hung out with Billy Martin and Roger Maris in night clubs and was given free liquor and other free perks. (I leave that to your imagination.) Thus, his alcohol consumption over the course even of his playing years was enormous. In 1995, he was diagnosed with hepatocellular carcinoma (HCC) in the setting of hepatic cirrhosis that was attributed both to alcohol consumption and to hepatitis C. It is believed that the hepatitis C was acquired from his infidelities.

At the time, Mantle was living in Dallas and was treated at Baylor. He was placed on the liver transplant list, something that was generally not done for alcohol-related HCC. But what made this truly controversial was that Mantle received a donor liver literally the next day after being placed on the transplant list, in essence jumping the line because of his 536 homers. His doctors asserted that it was legitimate, but no one truly believed them. Despite this, the transplant was unavailing, and he died two months later at age 64.

Another interesting tale from the world of baseball involved the Philadelphia Phillies. In 2013, the Philadelphia Inquirer did a review of the 33 years that the Phillies played at Veterans Stadium in Philadelphia. Apparently, over the course of those years, four players (Tug McGraw, John Vukovich, Johnny Oates and Darren Daulton) were diagnosed with and died from glioblastomas. One other player, Ken Brett, also died of a brain tumor that may have been a glioblastoma, but he only played for one season at Veterans Stadium. According to the analysis conducted by the Inquirer, this represented three times the rate of the general population.

In speculating as to a potential etiology, Veterans Stadium was one of the first stadiums to switch to artificial turf, which utilizes questionable chemicals for its maintenance, but this seems awfully far-fetched. It is also the case that the Philadelphia Eagles football team shared the same stadium/field and there were no brain tumor cases reported among them.

As you can imagine, this was widely discussed among cancer and brain tumor epidemiologists, many of whom I know, and none were willing to consider this more than a random cluster or a chance occurrence without further evidence. This seems to me to be a wise position for now.

As we have noted previously, clusters (of which this is one) are very common. This one happened to occur in a group that is in the public eye and so triggered more than the usual concern and investigation.

Finally, on a personal note, I would add that Columbia University Irving Medical Center, where I work. has a strong connection to baseball as well. On the site where the hospital is now, in the early part of the 20th century, was Hilltop Park, the home of the New York Highlanders until 1912. In 1913 they changed their name to the New York Yankees and began playing at the Polo Grounds, and when they acquired Babe Ruth from Boston in 1919, they began construction of Yankee Stadium in the Bronx. At that time, northern Manhattan and Washington Heights were less developed and more suburban. Columbia’s medical school was previously located at Roosevelt Hospital near Columbus Circle, and now part of Mt. Sinai. Columbia acquired the property in 1928. In the middle of the medical center sits a home plate on the site of the original home plate of Hilltop Stadium.

In the end, fortunately, cancer is not a major problem in the world of baseball, and I hope we can continue to enjoy it without undue concerns.

Alfred I. Neugut, MD, PhD, is a medical oncologist and cancer epidemiologist at Columbia University Irving Medical Center/New York Presbyterian and Mailman School of Public Health in New York.

This article is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Always seek the advice of your qualified health provider with any questions you may have regarding a medical condition or treatment.

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