Sports Medicine Controversies

This topic is of particular importance to Central Oregon, one of North America's most sports/fitness/athleticsm-oriented areas.

Synthetic Turf & Lymphoma Risk

Incidence of malignant lymphoma in adolescents and young adults in the 58 counties of California with varying synthetic turf field density
Archie Bleyer, MD, Theresa Keegan, MD, MPH
Oregon Health and Science University and University of California Davis

To be published in Cancer Epidemiology in March 2018, for COMS members only.

Background: Case reports of cancer among soccer players raised concerns that the crumb rubber infill in synthetic turf fields may cause malignant lymphoma. One prior epidemiologic study on the topic found no association.
Methods: An ecologic evaluation of county-level incidence of lymphomas by race/ethnicity and socioeconomic status for the state of California with data obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results Program. Synthetic turf field density by county was obtained from the Synthetic Turf Council. During 2000–2013, 7214 14- to 30-year-old Californians were diagnosed with malignant lymphoma.
Results: Annual lymphoma county incidence trends were not associated with the county-level synthetic turf field density. None of 20 sub-analyses by race/ethnicity, sex and county median household income indicated a correlation of lymphoma incidence with synthetic turf field density. In California, there was no evidence at the county-level that synthetic turf fields are associated with an increased incidence of lymphoma in adolescents and young adults.
Conclusion: Our findings in the state with the greatest number of such fields and a large, diverse patient population are consistent with those of a prior study observing no association between individual-level exposures to turf fields and cancer incidence. Avoidance of synthetic turf fields for fear of increased cancer risk is not warranted.

For the full report, click here; do not distribute.

Synthetic Turf Crumb Rubber Controversy Commentary

Citation:  Bleyer A. Synthetic turf fields, crumb rubber, and alleged cancer risk.
Sports Med 2017. DOI 10.1007/s40279-017-0735-x.  Published May 11, 2017

Abstract: Most synthetic turf fields have crumb rubber interspersed among the simulated grass fibers to reduce athletic injuries by allowing users to turn and slide more readily as they play sports or exercise on the fields. Recently, the crumbs have been implicated in causing cancer in adolescents and young adults who use the fields, particularly lymphoma and primarily in soccer goalkeepers. This concern has led to the initiation of large scale studies by local and federal governments that are expected to take years to complete. Meanwhile, should the existing synthetic turf fields with crumb rubber be avoided? What should parents, players, coaches, school administrators, and playground developers do? What should sports medicine specialists and other health professionals recommend?  Use grass fields when weather and field conditions permit? Exercise indoor? Three basic premises regarding the nature of the reported cancers, the latency of exposure to environmental causes of cancer to the development of clinically-detectable cancer, and the rarity of environmental causation of cancer in children, adolescents and young adults, suggest otherwise.

Epidemiologic Evidence Argues Against Cancer from Synthetic Turf Fields

A pediatric oncologist (and prior president of the Central Oregon Medical Society) and a pediatric cancer epidemiologist at the University of California at Davis present national and California evidence that explains the higher incidence of lymphoma in adolescents and young adults who played soccer.  This results are consistent with the cause not being the synthetic field on which they may have played or practiced.   A manuscript summarizing the results has been submitted to the American Journal of Sports Medicine. Additional analyses of lymphoma incidence trends in the counties with the greatest density of synthetic turf fields (number of fields per 100,000 population of 14 to 30 year-olds during 2000-2013) are provided here.

Study Finds No Increased Rate of Cancer Among Soccer Players

By Markian Hawryluk | The Bulletin  |  February 2, 2017

An investigation into a suspected cancer cluster among soccer players in Washington state found fewer than expected cases in the 5 to 24 age group, casting doubt on a theory that playing on artificial turf fields could increase the risk for cancer. ...
“We found that the number of cancers among all soccer players reported by the coach was less than expected, given rates of cancer in Washington residents of similar age,” said Dr. Cathy Wasserman, state epidemiologist for non-infectious conditions and lead investigator for the study.

Click here or the title for full report

Rubber in Artificial Turf Causes Health Concerns

Summit High’s turf has Bend-La Pine watching for study results
The Bulletin  | 

From an athletic facilities maintenance perspective, the synthetic turf field at Summit High School in Bend is an enviable asset. The recycled rubber infill absorbs players’ falls, and it never turns to mud. It remains to be seen, however, whether the field and thousands like it will be deemed an environmental health hazard and financial liability because of the pulverized vehicle tires sprinkled between blades of artificial grass. Studies have shown so-called crumb rubber to be safe, but they have not ended the decade-long debate.

A group of former athletes battling cancer has questioned whether crumb rubber caused their illnesses, and now three federal agencies intend to conduct a joint study and weigh in with a report by year’s end.

Results of Washington State Study of Cancer Rate in Soccer Players

The results, released in January 2017 by the Washington State Department of Health, not only do not support an association between use of the synthetic turf fields in Washington State and cancer, but suggest that the cancer incidence was lower than expected among youth soccer players, including goalkeepers.  The latter is feasible in that physical activity is a known cancer preventative and persons how are in good physical condition have a lower rate of developing cancer.

Click the title to review the full report, FAQs and recommendations from the State Department

Click here to view data supporting a lower cancer incidence among youth soccer players

The Truth about Artificial Turf & Crumb Rubber

On February 1, 2016, the Recycled Rubber Council and Safe Fields Alliance* released an educational video that has addressed the concerns parents and government agencies have voiced over the past 16 months. "The Truth about Artificial Turf and Crumb Rubber" includes compelling interviews from parents, coaches, and scientists who have examined the available studies.  The seven-minute video provides answers to the frequently asked questions parents and officials have regarding health and human safety considerations of crumb rubber infill in synthetic turf sports fields.

To view the video, click the title above.

*SFA is a coalition dedicated to educating stakeholders around the safety of synthetic turf fields and crumb rubber. FieldTurf, Sprinturf, and AstroTurf, 3 of leading manufacturers of synthetic turf fields, are associated with SFA

Physicians and Youth Tackle Football

An expert on chronic traumatic encephalopathy (CTE) at Columbia University Mailman School of Public Health advises physicians to minimize harms of tackle football. The NEJM Perspective is available free of charge.  There is also a audio interview on the NEJM website with Dr. Steven DeKosky on youth football, head injuries, and a recent American Academy of Pediatrics policy statement. 

Does Synthetic Turf Cause Lymphoma in Adolescents and Young Adults?

On February 8, the California Office of Environmental Health Hazard Assessment (COEHHA) reviewed evidence for and against cancer risk of synthetic turf fields alleged to be linked to the crum rubber in the field materials  The study will assess the potential health impacts associated with the use of synthetic turf and playground mats made of crumb rubber. OEHHA will focus on identifying chemicals that may be released from synthetic turf from indoor and outdoor fields throughout California, and estimating exposures to users of synthetic turf fields. OEHHA will also explore the feasibility of a future biomonitoring or personal monitoring study of people using synthetic turf fields to more directly measure exposure to chemicals that may be released from synthetic turf and playground mats. A Scientific Advisory panel of 7 international experts will be convening for the entire day with the COEHHA.

To review the agenda, supporting documents including a 190 page review and biographies of the experts, click the title above

To follow the proceedings live, on day of the event, click here

Update from OEHHA - August 2016

The California Office of Environmental Health Hazard Assessment (OEHHA) has expanded the scope of its synthetic turf field investigation based on input received from the Scientific Advisory Panel (SAP) and the public.  Under a recently modified four-year contract with the California Department of Resources Recycling and Recovery (CalRecycle), OEHHA is conducting a study of the potential health effects associated with the chemicals that can be released from synthetic turf and playground mats containing recycled waste tires.  The study will be completed by mid-2019.  CalRecycle regulates the use of waste tires in California.  The following are frequently asked questions about the current study of synthetic turf being conducted by OEHHA.  The fact sheet discusses an update of the study’s scope and is also available in pdf form in the downloads section on their website.

Artificial Turf and Lymphoma in Soccer Players, Especially Goalkeepers?

During the Fall of 2014, an assistant soccer coach at the University of Washington reported that a survey she had done of young adult soccer players diagnosed with lymphoma implicated artificial turf as an etiologic factor. Two news reports, one by NBC and a follow-up by ESPN, covered her report and raised considerable controversy. 
Central Oregon has one synthetic turf field, located at Summit High School, but is planning to create others since the demand on athletic fields by schools, clubs, and other organizations supporting soccer, football, rugby, field hockey and a number of other team/group activities are in need of such fields. The weather of central Oregon, increasing youth population, and success in team sports are driving the urgency.

To view the NBC report, click the title above
To review the ESPN report, by a former women's U.S. team team member, click here.