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Doping with cancer may be a risky mix, experts say

The International Olympic Committee has just stripped former cyclist Lance Armstrong of his 2000 Olympic bronze medal, the latest sanction to follow a U.S. anti-doping report that he has used performance-enhancing drugs.

Before Lance Armstrong’s reported confession to Oprah Winfrey that he used performance-enhancing drugs, the former cycling champ had long deflected the relentless rumors by suggesting that, after his experience with near-fatal cancer, such drugs would be dangerous.

In 2007, he told an audience at the Aspen (Colo.) Ideas Festival, “I came out of a life-threatening disease. I was on my death bed. You think I'm going to come back into a sport and say, ‘OK, OK doctor, give me everything you’ve got, I just want to go fast?’ No way! I would never do that.”  

Armstrong may have used his cancer as a defense but questions about his use of performance enhancers have dogged him for years. This summer, the United States Anti-Doping Agency stripped him of his titles as part of the United States Postal Service cycling team going back to Aug. 1, 1998, the same year he began his comeback after his 1996 diagnosis and treatment of testicular cancer that had spread to his lungs and brain.

His teammates testified, according to USADA documents, that over the course of his cycling career, Armstrong used recombinant erythropoietin (EPO), an artificial hormone that stimulates red blood cell production and, some athletes believe, may fuel their muscles' ability to perform; androgen hormones (versions of the testosterone molecule); “blood doping,” the practice of infusing one’s own (or somebody else’s), stored blood into the body as a way to increase oxygen-carrying red blood cells; cortisone; and Actovegin, a product derived from calf’s blood that is thought by some athletes to increase endurance.

It's not known yet exactly what Armstrong himself has admitted to taking or how long he took them. But, if he used the performance-enhancing drugs (PEDs) that his teammates say he did, could they have affected his hard-fought recovery from cancer, or compromised the body he said he was trying so hard to protect?  

Research does suggest that EPO might possibly fuel some existing cancers, but so far there’s no specific research on testicular cancer cells. Certain types of cancer cells, like breast, renal and colon, are sensitive to the EPO hormone, explained Scott Drab, associate professor of pharmacy and therapeutics at the University of Pittsburgh School of Pharmacy. Drab, who advises doctors on how drugs affect the body and various disease states, said, “EPO does have properties that can proliferate cell tumor growth.”

EPO is used as part of cancer therapy because it combats sometimes life-threatening anemia, a common side effect of chemotherapy. Some studies have shown EPO is safe when used carefully while others have suggested a possible link to worse outcomes for cancer patients. Some studies seemed to indicate statistically significant lower survival rates following EPO use in cancer patients. Other studies appeared to contradict such results, but, out of caution, the FDA issued a “black box” warning in 2007 advising doctors to use the lowest possible dose. 

"The consensus is that we still don’t know” EPO’s full effect on cancer, said Dr. Bartosz Chmielowski, an oncologist at UCLA's Jonsson Comprehensive Cancer Center.

“It is generally a bad idea to take drugs you don’t need,” he said, in response to a question about PEDs effects on anyone, not just a cancer survivor like Armstrong.

Even in a person with cancer, he explained, EPO should be used “only in cases when somebody is undergoing chemotherapy and that’s causing anemia and there are not any other causes of anemia.” The only other time anybody who’s had cancer should be using the drug, he said, is if the disease is terminal and doctors want to improve quality of life and avoid transfusions.

Dr. Norman Fost, a pediatrics professor and director of the bioethics program at University of Wisconsin School of Medicine and Public Health, has written extensively for 20 years about performance-enhancing drugs.

He's known as an opponent of "steroid hysteria," but, he said that while “there’s just no scientific proof of any such association” showing steroid use triggers cancer, “I wouldn’t be surprised to see a rise in prostate cancers 30 years from now among people who used [androgenic, related to testosterone] steroids” since it’s known that prostate cancer can be fueled by androgens.

Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young Ph.D., of "The Chemistry Between Us: Love, Sex and the Science of Attraction," (www.TheChemistryBetweenUs.com), now on sale.

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