Are soccer players more at risk of cancer? There is a lack of statistical data and scientific evidence

«Should I be scared?». Especially after the deaths of Sinisa Mihajlovic and Gianluca Vialli, several players of the eighties and nineties have expressed their fears for a possible link between the substances taken to improve performance in the field and the onset of cancer. If the emotions of those who are frightened must certainly be respected, speaking of a link between ex-footballers and a greater chance of cancer, we are really very close to giving ano false alarm. In short, to use metaphors that remain in football: it is a very slippery field and there is a real risk of scoring an own goal, raising unfounded hypotheses. Because, to begin with, to understand if a substance causes cancer, it is necessary to study that precise substancebut the players themselves (almost all very young at the time) cannot say what was the content of vials, pills, drinks that were administered to them, as many of those directly involved have repeatedly stated.

So let’s start here: what is known about the “drugs” taken in those years by many players?

“Little or nothing. There has been talk of Micoren or simpaminaa sort of anti-asthmatic that a few years ago was prescribed to those suffering from asthma and low blood pressure – he replies Francis Massari, researcher in Oncology at the University of Bologna —. Basically, the medicine improved breathing, also presenting mainly cardiovascular side effects, but in the 1970s it was considered harmless and was given to football players because it improved respiratory performance. In 1985 it was eliminated by the anti-doping law and even today little is known about its long-term effects, there is no evidence that it is carcinogenic. In the 70s, then, for some sports injuries was prescribed the roentgen therapy (radiotherapy treatment that uses a beam of X-rays on the area to be treated, but at the time in unsuitable doses), subsequently “discontinued” because it was found that it increased the risk of neoplasms”.

Are there numbers that indicate an increase in tumors in football players compared to the rest of the population?

“To date, we do not have official data that could indicate an increase in the incidence of tumors in footballers compared to the general population,” he explains. Massari, oncologist responsible for neoplasms of the genitourinary tract at the Irccs Policlinico Sant’Orsola Malpighi of Bologna -. In theory, football players (like all athletes) are subjected to rules and “good practices” for food, sleep, medical visits and major checks compared to the general population. For example, they tend to eat more rich in anti-oxidantswhich we know is a protective factor for the development of tumors, which at this point could even have a lower incidence”.

And for other pathologies, such as ALS?
“As far as amyotrophic lateral sclerosis (ALS) is concerned, there has long been data that indicates a greater risk of contracting the disease among Italian professional players he replies Adriano Chiodirector of the regional expert center for amyotrophic lateral sclerosis at the «Rita Levi Montalcini» Department of Neuroscience at the Le Molinette Hospital of the City of Health and Science of Turin, as well as the first author of fundamental studies that have shown an epidemiological association between calcium and Sla —. The risk has been calculated equal to an increase of about six times and the Italian data is now confirmed by similar data from other countries (Spain, France). However in the studies performed the use or abuse of substances have never been identified as a specific cause, while the role played by traumas, in particular cranial ones, has emerged related to head shots, use of substances for the maintenance of soccer and training fields (herbicides) and, more generally, intensive physical activitynow considered a relevant risk factor for ALS».

Is there a list of substances used in sports that we know today are carcinogenic?
«Absolutely not – says Massari, who also plays for the San Donato Calcio 1948 club in Bologna, in the second category FIGC championship -. There are no legal substances used in sports with potential carcinogenic activity. The World Anti-Doping Agency (WADA) identifies a number of substances (anabolics, steroids) which are prohibited “in competition” (in the hours close to the competition) and “out competition” (regardless of the execution of a competition), but the prohibition is not linked to their carcinogenic potential, but toeffect on sports performance».

How does one scientifically establish that a substance is carcinogenic?

«Carcinogens are usually identified as external risk factors and are classified by the IARC (International Agency for Research on Cancer, the highest authority on the study of carcinogens which is part of the World Organization of Health) in different categories based on the carcinogenic risk for humans – Massari replies -. In order to scientifically demonstrate the carcinogenicity of a substance, it is first of all necessary to evaluate the exposure of guinea pigs in the laboratory in very high concentrations: in this way they are identified potential carcinogens (subdivided into certain, probable and possible) which, by inhalation, ingestion or contact, can cause neoplasms. Or you collect data from studies of large population samples. Thus it has come to include in the list of elements that certainly cause cancer, for example, some substances used in the workplace, as well as benzene, asbestos, air pollution, active and passive smoke, ultraviolet radiation, hepatitis B virus and C and Papillomavirus”.

So how can the different cases of cancer in former footballers be explained?

«According to the most recent estimates, one in three Italians will fall ill with cancer in the course of his life and the probabilities grow with age, especially from the age of 50 onwards (so much so that it is precisely from this threshold that we start with routines such as mammography or the Sof test, to look for fecal occult blood) — remember Massimo DiMaio, national secretary of the Italian Association of Medical Oncology (Aiom) —. Even if the cases of famous people cause much more sensation, considering that they are often “healthy” and fit people, there is no way to demonstrate that cancer numbers in footballers and formers are higher than in the rest of the population. Studies are missing, there are no statistics. We are in the field of pure hypotheses. In short, sportsmen and women can develop cancer like everyone else».

In conclusion, what can those who fear developing a tumor do?

What everyone should do, that is, follow the good rules of prevention – concludes Di Maio -. It has now been amply demonstrated by numerous studies conducted around the world that one case out of three is avoidable with healthy lifestyles: don’t smoke (or quitting with concrete benefits at any age), do regular physical activity, follow a balanced diet and not have extra pounds. And participate in the screeningthen undergo those checks that in Italy are offered free of charge to those most at risk of developing cancer and which, however, many compatriots refuse ».