Chest X-Rays Found Rare Disease Early But Not All Colleges Use Them

The early-stage Hodgkin’s disease that is slowly and silently attacking Pat Fresch’s lymph system might not have been detected if Fresch had decided to play football at a university other than Arizona State.

This is not to say, however, that the majority of the nation’s colleges lack comprehensive physical examination programs for athletes.

But the crucial procedure--the chest X-ray--that illuminated a widening compartment between Fresch’s lungs and suggested Hodgkin’s, is not used in sports physical exams at many Division I-A schools.

An informal poll indicates that the contents of such exams--and more important, whether chest X-rays are included--vary widely from school to school.

Fresch, an offensive lineman who graduated from Palos Verdes High, left for ASU last month but was sent back to Los Angeles for conclusive tests after his chest X-ray was examined.

Dr. Richard Lee, ASU team physician, and other universities’ doctors say Hodgkin’s often is detected in its early or secondary stages without chest X-rays but that the procedure makes early detection probable if the disease attacks lymph nodes in the chest, as it has with Fresch.

Lee stressed that the chest X-ray, though not a cost-effective procedure to use on all incoming athletes, was the key in Fresch’s case.

Hodgkin’s disease is one of a group of diseases known as lymphomas . Lee said: “You would not expect a lymphoma if you examined the entire freshman class, but every four of five years you find one.

“So, although the chest X-ray is a low-yield procedure, it was really fortuitous for Pat that it was started this year. It certainly wasn’t started just for Hodgkin’s disease, so this is really a godsend, finding it now, because it means it was there before and was not going to go away.”

Like Arizona State, USC also takes chest X-rays of all athletes, according to Medical Director Dr. Allan Ebbin.

UCLA, however, does not, said assistant trainer Mike Wells, who added that he had not heard of the procedure being used in routine physicals at any school. This is Wells’ 15th year at UCLA.

The varying use of chest X-rays in sports physical exams at these three Pacific 10 schools reflects the lack of conference rules governing what such tests must consist of, Pac-10 Assistant Commissioner Duane Lindberg said.

Lindberg noted that he had not heard of any movement toward standardizing physical exams within the conference.

Any such movement is also unheard of within the National Collegiate Athletic Assn., according to Rick Evrard, director of legislative services for the NCAA.

At Boston College in Chestnut Hill, Mass., team physician Dr. Randy Shrout said he had never heard of chest X-rays being used in sports physicals. Shrout and his staff did 110 football physicals this year but took only one chest X-ray, to learn more about a player’s medical history.

Dr. Bob Murphy, team physician at the Big 10 Conference’s Ohio State University, said chest X-rays are not a normal procedure at the Columbus school, either. “I think it’s incredible that they do them for everyone” at Arizona State, said Murphy, who does not use the procedure normally in his private practice.

“I’d rather take 10 doctors and have them do good physicals than do chest X-rays,” Murphy said, “because if you do chest X-rays, there really is no end to the number of tests you can do.”

Murphy added that he could not imagine a Hodgkin’s patient having no symptoms. Fresch, however, had no symptoms, not even fatigue, and he said doctors at ASU asked several times whether he felt unusually tired.

Murphy pointed to cost--he said chest X-rays would run about $50 per athlete--as a key reason for not using the procedure. Shrout at Boston College said costs would amount to about $90; Lee at Arizona State said about $25.

Varying X-ray and radiology fees account for the cost differences between schools, said Brigham Young University’s Dr. Marc Udall, who added that chest X-rays are also considered too expensive at BYU, a Western Athletic Conference school in Provo, Utah.

(Dr. Udall diagnosed a player with Hodgkin’s disease last year after discovering a lump in his back, and said the player returned to the team with no complications after being treated.)

Finally, at Louisiana State University, a Southeastern Conference school in Baton Rouge, head trainer John Anderson said he had never discovered a case of Hodgkin’s disease but that chest X-rays were taken of all athletes, scholarship or walk-on.

“When in doubt, we X-ray out,” said Anderson, entering his eighth year at LSU. “We have an X-ray machine right in our training room, so it’s easy. We don’t even bat an eye about chest X-rays.”

Though the combined opinions of doctors at Arizona State, USC, UCLA, Boston College, Ohio State, Brigham Young and LSU indicate that the use of chest X-rays in sports physicals is a debatable issue, there is no sense debating the value of the test at Arizona State, according to Fresch’s father, Gene Fresch.

“If it hadn’t been for Arizona State,” Gene Fresch said, “Pat’s problem probably wouldn’t have been detected until months from now, when he probably would have been really sick and not performing up to expectations.”

Dr. Lee asked the Arizona State athletic department to include chest X-rays and blood tests in its sports physical exams in an effort to develop a program that could identify what athletes might be risking unexplained sudden death while performing.