Op-Ed: Screening Athletes Could Save Lives
August 2nd, 2008
By Susanne Haga, PhD
This Op-Ed appeared in the August 2, 2008 edition of The Herald-Sun (Durham, NC).
Last March, Ereck Plancher, a 19-year-old freshman on the University of Central Florida football team, died following a conditioning workout. The autopsy report released this month concluded that his death was due to an inherited genetic condition that causes red blood cells to deform and block blood vessels, particularly under strenuous conditions.
As summer camps across the country open in preparation for the upcoming football season, it is worth remembering that simple screening tests, when combined with education and monitoring, could prevent deaths like Plancher's.
Sudden death can strike amateurs and professionals alike of any sport. While sudden death due to heart-related conditions in athletes is relatively rare, occurring in about 1 in 200,000 student athletes per year, the condition that killed Plancher is extremely common in African-Americans, putting as many as 1 in 12 individuals at risk.
Plancher didn't have a "disease." Rather, he was a "carrier" for a disease. Sickle cell anemia occurs in individuals with two abnormal copies of a gene that forms part of the oxygen-carrying hemoglobin molecule. Individuals with one mutated copy and one normal copy, like Plancher, have sickle cell trait, a condition that typically comes without symptoms.
Yet during strenuous physical activity or in places where the oxygen level is low (such as high altitudes or underwater), the red blood cells in individuals with sickle cell trait can deform, blocking blood vessels and transforming this non-disease into sudden death.
Almost all newborn babies born in the United States are screened for a panel of genetic diseases, a fact many parents may not even be aware of since consent isn't always required. Since 1986, almost all states screen for sickle cell anemia. However, the physician or parents are usually notified only when the result is positive for sickle cell anemia, not sickle cell trait, even though the test reveals both conditions. That's because children with sickle cell anemia are given antibiotics to prevent serious life-threatening infections while those with sickle cell trait require no medical intervention.
Some wonder if knowing whether someone has sickle cell trait would create more harm than good, causing the child to be labeled as "ill," leading to stigmatization and limiting his ability to participate in physical activities. But given the frequency of sickle cell trait and the possible devastating outcomes for athletes, state health departments should review their notification policies and at least give parents the option of learning their newborn's carrier status.
Parents who opted for the results would then be aware of the risks that physical activity might bring and could more closely monitor the child's condition, whether they chose to share the information with the child or not. With proper education and awareness, individuals with sickle cell trait can safely participate in sports, even reaching the professional level as Kansas City Chiefs receiver Devard Darling has. (Devard's twin brother Devaughn also had sickle cell trait and died in 2001 after a team workout at Florida State. After his brother's death, Devard was banned from playing at the school and transferred to Washington State in order to continue.)
If public health departments find that the harms (or costs) of reporting the results of a sickle cell trait diagnosis outweigh the benefits, the burden to screen athletes then falls upon the schools or professional organizations. About two-thirds of NCAA Division 1 schools require screening for sickle cell trait. Given the number of athletes and schools, that leaves some 6,500 student athletes untested.
But waiting until college to provide this information seems an unnecessary risk as students planning to play at the collegiate level will surely have participated through high school and earlier.
Newborn screening results for sickle cell trait should be made available to physicians and parents who want them, and parents should be educated about appropriate precautions. As is the case with other diseases, screening can save lives.
The writer is an assistant research professor of the Institute for Genome Sciences Policy and Public Policy Studies at Duke University.