Curt Schillings’ Public Service Announcement Is a Major League Blooper

Major League Baseball is airing a public service announcement with retired pitcher Curt Schilling claiming “I have oral cancer” and linking that condition to his long-term use of chewing tobacco (here).  The 60-second spot, produced by MLB and the Professional Baseball Athletic Trainers Society, will be shown in baseball stadiums and on the MLB Network.

The PSA, however well-intentioned, is unsubstantiated and grossly misleading. Schilling and MLB squander a chance to impress adults and youths about the hazards of smoking, alcohol and human papillomaviruses (HPVs, sexually-transmitted viruses causing throat cancer and cervical cancer in women) and instead perpetuate smokeless tobacco myths.

Schilling has been blaming smokeless for his cancer for two years, but neither he nor his doctors have presented any evidence to support the claim and there is, in fact, good reason to question its accuracy. 

Mouth cancer is extremely rare.  The most common risk factor is smoking, which can increase chances ten-fold.  Smokers who drink alcohol are at even higher risk, and alcohol abuse alone raises the odds about four-fold.  Another significant cause of tongue and throat cancer is HPVs (here). 

While Schilling attributes his cancer to chewing tobacco, one’s odds of developing mouth cancer from this habit are about the same as those for a person who neither smokes, drinks nor has an HPV infection – roughly one or two in 100,000. 

One should ask: Did Schilling actually have mouth cancer?  It’s highly unlikely.  He says his cancer was discovered after he found a lump in his neck.  This indicates that it was almost certainly located in his throat and that it had already spread to a lymph node.    

Throat cancer is not associated with smokeless tobacco use.  It is, however, strongly linked to smoking, heavy alcohol use and infection with HPV. 

The MLB is irresponsible in airing a PSA based on the mere (and likely misguided) opinion of a layman.  Public health campaigns should be founded on verified medical and scientific information.

BBC Drops the Ball on Baseball & Smokeless Tobacco

It’s almost baseball season, which means it’s time for anti-tobacco extremists to start grabbing easy headlines.  One especially zealous state lawmaker wants to ban smokeless tobacco by players and fans in all California ballparks (here).  It’s all based on smoke and mirrors, as illustrated in a woefully inaccurate recent BBC story on smokeless tobacco and baseball.

The report includes an erroneous claim that baseball stars Tony Gwynn, Curt Schilling and Babe Ruth died from cancers caused by smokeless tobacco. 

Neither Gwynn’s nor Schilling’s cancer was related to smokeless products, as I have detailed before (here and here).   Reporter Nada Tawfik concedes that “doctors say a link between [Gwynn’s salivary] cancer and chewing tobacco cannot be proven.”  I have previously noted the absence of a scientific link between smokeless tobacco and this cancer type (here).  As for Schilling, he never said he had mouth cancer and not one of his doctors has supported his statement that smokeless tobacco caused his illness.

The BBC repeated the decades-old myth that Babe Ruth suffered from smokeless tobacco-induced mouth cancer.  In truth, Ruth had nasopharyngeal carcinoma, a rare disease caused by the Epstein-Barr virus.  Ruth was a prodigious consumer of cigars and alcohol, but neither are strongly associated with nasopharyngeal carcinoma (discussed here).  He also used smokeless tobacco, which has no link to this cancer type.

Included in the BBC story was a remarkable quote attributed to Dr. Jatin Shah, who runs the Head and Neck Service at New York’s Memorial Sloan Kettering Cancer Center.  Chewing tobacco, he is reported to have said, is “probably more harmful than smoking.”  I emailed Dr. Shah to ask if he had been misquoted.  He responded with a comment on South Asian products, but the BBC’s vast audience has been left with the grossly erroneous impression that American smokeless tobacco is more dangerous than cigarettes.

Thus are myths perpetuated and the public health undermined.     

Mouth Cancer Facts

Baseball star Curt Schilling says he has mouth cancer that was caused by chewing tobacco (here).  His announcement has generated considerable interest in mouth cancer, its frequency and causes.

What is mouth cancer?

Mouth cancer typically appears in the lining of the mouth; it may start as an ulcer or red area that is discovered in a dental or medical exam.  The phrase is often used incorrectly to include cancers of the throat.

Schilling did not disclose the location of his cancer, but he did say that he found a lump in his neck.  This indicates that the tumor had spread to a lymph node, a condition that more likely suggests a tumor of the throat, rather than the mouth. 

How common is mouth cancer?

It is very rare.  Mouth cancer occurs with higher frequency in people who have the risk factors I describe below, but it is possible for someone with no risk factors to develop this disease.  As I described previously (here), among 100,000 men age 40+ years, perhaps three or four with no risk factors will develop mouth/throat cancer each year; only one or two of those cases will be mouth cancer. 

What causes mouth cancer?

The most common cause of mouth cancer is smoking, which can increase risk 10-fold; smokers who drink alcohol have even higher odds.  Alcohol abuse raises the odds about four-fold.

Another recognized risk factor is infection with human papillomavirus (HPV), a sexually transmitted disease discussed previously (here).  HPV is considered by some experts to be a significant cause of mouth cancer, but precise estimates of risk elevation are not available.

Schilling attributes his cancer to chewing tobacco.  There are numerous studies of the risks related to smokeless tobacco (discussed here).  The odds of developing mouth cancer if you use chewing tobacco or moist snuff are about the same as if you didn’t smoke, drink or have HPV.  In other words, one or two users out of 100,000 will develop mouth cancer.   

Smoking and drinking can produce a cancer anywhere in the mouth, esophagus, voicebox and lungs.  HPV is generally linked to cancers of the throat.  In contrast, the most common location, by far, for mouth cancer in a smokeless tobacco user is at or very close to where the tobacco is placed, normally between the cheek and gum.

While rare, every case of mouth cancer is unfortunate, and potentially avoidable.  Have your dentist or physician perform a thorough head and neck exam every year.