Follow major League Baseball and you expect to read about a lot of guys suffering physical problems — blown elbows, torn rotator cuffs, wrecked knees. What you don’t expect to read about are brain tumors.
But tumors, sadly, have been part of the game too. This week, numerous news outlets have been reporting that Hall of Fame catcher Gary Carter, who played principally for the Montreal Expos and the World Series-winning New York Mets, is suffering from an inoperable case of glioblastoma — a rare but extremely savage form of brain tumor, with an average survival rate of just over 14 months.
There was more than a whiff of tragic deja vu in the report, since a number of other baseball greats — managers Dick Howser and Johnny Oates, pitchers Dan Quisenberry and Tug McGraw, and outfielder Bobby Murcer — all suffered from the same rare disease and all succumbed to it quickly. And yet, Carter’s doctors — Henry Friedman and Allen Friedman, the deputy co-directors of Preston Robert Tisch Brain Tumor Center, associated with Duke University — sound sunnier than you’d think when talking about their famous patient’s prospects.
“The gestalt is that when you get this disease it’s a terminal illness,” says Harry Friedman. “But we’re going to be positive. With newer programs and interventions, we have some patients who go for 15 years or more. Others survive for nine, 10, 11 years. It’s a small minority to be sure, but I have to believe that you do have a cohort of patients who are cured.”
All this raises two questions: What in the world could the Tisch Center be doing to produce even a few cases that so defy the normal glioblastoma prognosis? And what in the world is going on in Major League Baseball that is causing so many big names to be claimed by so uncommon a cancer?
The baseball part is easiest to address because the answer is: There’s probably nothing going on at all. Steroids, which were endemic in the sport for years, have long been linked with brain cancer in the public mind, at least since the death of NFL defensive lineman Lyle Alzado, who died of the disease in 1992 after a career of anabolic steroid use. He went to his grave blaming his doping for his illness. But while Alzado was a tragic authority on the multiple deadly effects of steroids, he wasn’t a doctor.
“Alzado had a brain lymphoma, he did not have a glioblastoma,” says Dr. Gary Green, medical director of Major League Baseball. What’s more, Carter and the other baseball figures who have contracted the disease played the game in the pre-steroid era, and they all got sick long after they retired from playing. Neurosurgeon Alex Valadka, Major League Baseball’s medical consultant on brain trauma, even points out that in some cases steroids are actually used to treat brain tumors. “When the brain is injured, it swells,” he says, “and steroids help bring that down.”
Concussions have been mentioned as a possible cause too, since they are increasingly being revealed to do all manner of previously unsuspected damage to brain tissue. What’s more, both Carter and Oates were catchers — which is easily the most physical, high-impact position in the game. But here too, the docs turn a thumbs down.
“There is no data that relates concussions to brain tumors in any way shape or form,” says Friedman, and Green agrees: “No association,” he says flatly. Nor is there a credible link between brain tumors and chewing tobacco, despite the fact that the stuff is ferociously carcinogenic and widely popular in Major League Baseball. “Yes, it leads to cancer of the mouth and jaw,” says Friedman. “But even with some getting into the stomach and then into the bloodstream, it wouldn’t be in sufficient quantities to affect brain tissue.”
What’s really at work in the apparent cluster of glioblastoma cases in the Major Leagues is probably just a statistical illusion. Up to 18,000 Americans per year are diagnosed with the disease, and while that number seems huge, it’s just .00006 of the 300 million U.S. population.
Baseball, clearly, is a smaller community. Still, about 1,600 men wear a Major League uniform in any one season and over the course of 25 years —with some players leaving the sport after just a few seasons and others sticking around much longer — that adds up to about 5,200. Against that, six players jibes pretty closely with the glioblastoma incidence in the general population. What’s more, says Valadka, “Baseball players are all male, and men have a higher incidence of glioblastoma than women. All of them were older when they were diagnosed, which is when the disease hits.”
None of that makes it easier when one of those players does get sick, and of the six who have been diagnosed, five did go quickly. That raises the second question: what makes the doctors at Tisch think Carter can do better? Part of it is the two-pronged approach they take to glioblastoma. Treatment begins conventionally, which means surgery, followed by radiation and chemotherapy. But as many patients as possible are then enrolled in clinical trials of newer, potentially more effective drugs. Most patients readily agree because the prognosis can be so bleak otherwise. “Everyone is trying to conduct clinical trials to push the field forward,” says Friedman. “We try to help our patients participate in them.”
For those patients who don’t — either because they’re afraid of the experimental meds or because their insurance won’t cover them — existing drugs are given, but in new ways. The most common chemo agent used to treat new cases of glioblastoma is temozolomide, with other drugs held in reserve to be used in the event of relapse or if the first round of treatment doesn’t help. Tisch’s approach is to bring multiple guns to the fight at once.
“There are a lot of people who don’t believe you add recurrence drugs to newly diagnosed patients until you have randomized trials showing it works,” says Friedman. “We’re taking a leap of faith that it might.”
That’s a leap a few other brain cancer centers around the country are taking as well, and like Tisch, they’re getting some surprisingly good results — all of which they share among themselves. No one knows for the moment what distinguishes the few patients who succeed with the new treatment from the overwhelming share who still don’t — whether it’s something in the genome of their cancer, in their own genome, in the robustness of their immune systems. What is certain is that they do get extra years, stealing them back from a disease that is stingy even with its months.
The goal among scientists is to learn as much as they can about that small cohort of lucky patients and then use it to help the less lucky others. Baseball fans — particularly Mets fans — are simply hoping that Carter is one of the few who has a lot of opening days ahead of him.
[Clarification: An earlier version of this post put the number of people who have worn Major League uniforms in the past couple of decades as “tens of thousands,” per an estimate from MLB. Later information from the MLB offices revised that down to 5,200 over 25 years.]