Could Performance Drugs Cause Testicular Cancer?

Whoopi Goldberg asked a question that is likely on many people's minds this week: Did Lance Armstrong's doping contribute to his testicular cancer?

Speaking to Barbara Walters on The View, Goldberg raised the issue like this, according to The Huffington Post:

"...the question really is: Do the steroids cause cancer? That's the question. Did he get the cancer because of the steroids? That's what we need to know," Whoopi Goldberg said.

"I have not read that," Walters said quickly. "I think that's scary to put out."

"Well I think it's a really great question," Goldberg shot back. "If he was doing it for the thousand years that they say he was doing it, it's quite possible."

"You have to be careful to suggest that steroids cause cancer," Walters said, warning Goldberg about her previous comment.

So what's the answer? Who knows?

First of all, it's unclear whether Lance Armstrong's reported doping "admission" to Oprah, soon to be broadcast around the planet, answers the critical chicken-and-egg question: Which came first, the cancer or the drugs? Second, we don't know what drugs he did or didn't take. (Although former Sports Illustrated writer E.M. Swift posed this question in a Cognoscenti piece yesterday: “Did any of your doctors believe that your cancer could have been brought on by the steroids, testosterone, human growth hormones, corticosteroids, and EPO that, according to two friends, you told your doctors you had taken in your career?”)

With all of those key facts unknown, I asked Dr. Philip Kantoff, Chief of the Division of Solid Tumor Oncology at Dana-Farber Cancer Institute in Boston, whether there could possibly be any link between taking performance-enhancing drugs and developing testicular cancer. Of course Dr. Kantoff has no personal knowledge of Armstrong's history and our conversation was purely speculative. Here, slightly edited is what he said:

"There are no studies that prospectively look at testicular cancer with any of these drugs...Theoretically, of the drugs under consideration — I'm not sure he took human growth hormone — but of the potential performance enhancing drugs he may have taken, it's conceivable that growth hormone could, theoretically, be linked to cancer but there is no study to support that...

[On the question of testosterone, Dr. Kantoff said the most common context for treatment with testosterone is this]...the guy that comes in, he's a middle-aged man, a little depressed, his libido is down and his testosterone is slightly low. They give him enough to normalize his testosterone levels, but this is not in the category of enhancing, it's normalizing levels. And again, there aren't any definitive studies on this...there's belief and then there are studies...

With performance enhancement, you take people with normal levels and gve them super high levels. It's a whole understudied field. Nobody's ever taken a look at 20-to-30-year-olds with normal testosterone levels and giving them super high levels and the side effects from that...

With human growth hormone, it's conceivable — you can enhance the growth of cells — but there's no data."

About 5,000-10,000 men a year develop testicular cancer, Kantoff said. But it's the most common cancer in men between 20 and 40 in the U.S. So what's the bottom line in Armstrong's case?

"Any conclusion that there's a link would be a big leap here," Kantoff said. "All of these things could cause harm when taken at super high levels, but nobody's ever studied it."