Four cases of testicular cancer within a few months have not only brought the disease into focus in the Bundesliga. A look at possible causes and footballers as role models for more awareness.
Usually, when you think of typical soccer injuries, the first thing that springs to mind is pulled muscles, torn lateral ligaments, or a ruptured cruciate ligament. In the past few months, however, it has been an illness that has shaped the conversations about the Bundesliga, far removed from anything sporty: testicular cancer.
Within less than six months, four Bundesliga professionals were diagnosed with a malignant tumor. After Union’s Timo Baumgartl, Hertha’s Marco Richter and Dortmund’s Sébastien Haller, Jean-Paul Boëtius met another Hertha player last week. Testicular cancer has not really been a topic in public discourse or in sports circles to date, but it is currently being talked about more frequently.
The most influential question here: Is it simply a coincidence that four Bundesliga professionals contract testicular cancer in one year – or are footballers particularly susceptible to the disease? The fact that this question is asked so often is mainly due to the four professionals affected and their handling of the disease.
Tumor surgery at Hertha’s Jean-Paul Boetius “went well”
The incidence of testicular cancer
In order to be able to classify the four current testicular cancer cases in the Bundesliga, you first need an overview of the disease. Of the approximately 500,000 people who are diagnosed with cancer each year in Germany, around 268,000 men were affected in 2019, according to the “Center for Cancer Registry Data” from the Robert Koch Institute (RKI). With around 4,150 cases, testicular cancer accounted for only 1.6 percent of cancers in men, so it affects only relatively few people in this country. By way of comparison, there were over 68,000 cases of prostate cancer and more than 35,000 cases of lung cancer in men.
However, if you sort the data from the Cancer Center of the RKI according to the age of those affected, a different picture emerges. It is noticeable that between the ages of 20 and 39 – i.e. exactly the age at which most professional footballers are – testicular cancer is the most widespread cancer variant among men at around 35 percent and by a wide margin. The head of the center for germ cell and testicular tumors at the Berlin Charite, Dr. Mandy Hubatsch, says rbb | 24: “It is quite normal for us that young patients of this age are affected – we also see that in the frequency.” However, Hubatsch also admits: “The fact that there are so many football players at the same time is also new for us.”
Four cases of testicular cancer in the Bundesliga within a few months are not normal from the point of view of the expert. This assessment can also be proven mathematically: Baumgartl, Richter, Haller and Boëtius are four of around 500 current Bundesliga professionals. In the past few months, around 0.8 percent of top-flight players have developed testicular cancer. What sounds like little has a lot if you consider that since 2015 only around 0.2 percent of 20- to 39-year-old men in Germany have been diagnosed with testicular cancer. In other words: Statistically speaking, an average of one such case of illness per year in the Bundesliga would be normal – four, on the other hand, is obviously an exceptionally large number.
Sport as a promoter of testicular cancer risk?
In recent months, the question has been asked again and again as to whether footballers like Baumgartl and Co. have an increased risk of testicular cancer due to their sport. The Hamburg urologist Prof. Dr. Frank Sommer in July: “International studies show that boys who do extremely strenuous competitive sports before puberty have an increased risk of testicular cancer, regardless of genetic factors.”
In an interview with Südwestrundfunk (SWR), Sommer emphasized: “Normally someone who does sports is tumor-protective, so has a lower risk of cancer than someone who doesn’t exercise and eats poorly.” According to Sommer, however, testicular cancer could be the exception – for example due to its sensitivity (e.g. to changes in body temperature) in the prepubertal phase. It is a possibility that the President of the German Society for Men and Health is currently investigating in more depth in his own study.
No proven connection
For the moment, however, Sommer remains in the subjunctive in his remarks. “No, you can’t say that so clearly,” he also answers the question of a proven connection between sport and the risk of testicular cancer. The Charite doctor Hubatsch assesses this in a similar way: “There is no scientific evidence that there is a connection.”
A more detailed look at the studies of past decades on the subject gives the same picture: On the one hand, there are actually the studies mentioned by Sommer with indications of an increased risk of testicular cancer as a result of early competitive sports. On the other hand, the majority of studies either come to the conclusion that there is no connection between exercise and the risk of developing testicular cancer or that exercise even reduces this risk – as with other types of cancer. According to Hubatsch, the many trips and the sometimes stressful everyday life of a football professional are not risk factors – unlike, for example, the genetic requirements of a man.
Hubatsch therefore speaks of “a coincidence” with regard to the four current testicular cancer cases and explains: “This means that different events occur at the same time, but this is pure coincidence.” In addition, in recent years, neither in the Bundesliga nor among professional athletes in other sports in this country have more than a handful of testicular cancer diseases become public. Instead of being particularly susceptible to testicular tumors, according to Hubatsch, soccer players and professional athletes in general would simply “fit into the patient clientele that we see again and again in the clinic.”
Exemplary openness and enlightenment
Of course, the general risk of testicular cancer remains – especially in younger men. Although testicular cancer is generally so treatable that over 95 percent of those affected can be completely cured, Hubatsch also advocates more education and awareness-raising. “Most young men don’t realize they’re the age group that gets testicular tumors,” she says. A circumstance that is currently beginning to change, above all thanks to the open handling of the footballers with their illness.
Unions Baumgartl made his illness impressively openly public in the spring. While testicular cancer is still an uncomfortable topic for many men, Baumgartl showed no shame about his diagnosis, surgery and chemotherapy. He also served as a role model for Marco Richter. When Richter returned to the Hertha training ground a few weeks after his diagnosis at the beginning of August, he also said about the subject of testicular cancer: “It’s already a taboo subject among men. But I really hope that there’s a rethink in the meantime.” Richter added about his own role on the way to this rethinking: “I believe that with our reach we have already persuaded many to take the step to become a doctor.”
In fact, it is obvious that the senses of the people in professional football and those who follow it have been sharpened when it comes to testicular cancer since Baumgartl was diagnosed, but at the latest since the three other cases in the summer. Union Berlin, for example, recently offered a check-up for the entire professional team – an offer that all players took advantage of without exception. There is also a discussion as to whether such examinations should also be mandatory in the annual medical check-ups for professionals, and a generally larger platform for exchange. “We are pleased that the public is finally talking about the subject of testicular tumors,” Mandy Hubatsch also observes changes.
(Not) a question of masculinity
It is a joy that the doctor shares with former soccer professional Marco Russ. The 37-year-old was playing for Eintracht Frankfurt when he was diagnosed with testicular cancer in May 2015. Russ also made his illness public, speaking and still speaking about the stigma that went with it and possible ways to reduce it. “The problem is that many people associate testicular cancer with the loss of masculinity,” says Russ, before he vehemently contradicts this prejudice: “There is a wrong view of the disease. With one testicle less you are just as male as with two testicles have intercourse as well.”
It is not uncommon for professional athletes to be viewed as particularly male – sometimes they radiate a kind of “physical inviolability”. The fact that these athletes are now showing themselves to be vulnerable and revealing the most intimate health problems is very valuable. “This shows that the disease does not stop at anyone, but above all that you can deal with it openly and don’t have to be ashamed,” says Russ. also dr Hubatsch is impressed “that these four young men are walking ahead and saying: ‘Look, we have this disease, we are talking about it and we are like you. Why don’t you also examine yourself.'”
Safety thanks to precaution
Marco Russ, who is now an analyst for Eintracht, has noticed a change in the way he deals with testicular cancer in his personal and professional environment. “With the four cases of Timo, Marco and Co., a lot has happened in many clubs and many players,” he says.
A lot, but not enough. Russ is also in favor of including a preventive check-up in the medical checks mentioned: “You examine the heart, do a stress ECG and all the other stuff to be fit for the Bundesliga. You should include that. It’s no effort, It’ll only take a few minutes, but you’re safe for now.”
Broadcast: rbb24, September 27th, 2022, 6 p.m