Six professional US baseball players have died from glioblastoma after playing on artificial turf. There may be a connection.
Artificial turf is made up of many chemicals, including Per-and polyfluoroalkyl substances (PFAS) and heavy metals—both of which pose potential health risks.
Potential links between PFAS and cancer have been made, prompting calls to ban and limit artificial turf. That said, researchers cannot say for certain that PFAS cause cancer due to their ubiquity in the environment.
According to a recent report in The Guardian, there may be a possible link between toxic chemicals in artificial turf and the deaths of six Philadelphia Phillies baseball players. The players all died of glioblastoma, a malignant tumor in the brain or spine, and they all played on a synthetic field, prompting the question, are synthetic sports fields a danger to human health?
The Inquirer reported, “The rate of brain cancer among Phillies who played at the [Veterans Stadium] between 1971 and 2003 is about three times the average rate among adult men.” According to CA: A Cancer Journal for Clinicians, glioblastoma accounts for 49 percent of all malignant brain cancers in the US, while it's rare in younger men. The rate of occurrence in men between the ages of 20 and 39 was less than 1 percent in 2021.
What is artificial turf made from—and what potential risks does it pose?
According to Kelly Johnson-Arbor, MD, FACEP, FUHM, FACMT, a medical toxicologist and interim executive director at the National Capital Poison Center, “Artificial turf is composed of multiple synthetic layers of material. The components of artificial turf can include plastic products, crushed concrete, and crumb rubber derived from recycled tires. Tire rubber contains multiple potentially harmful chemicals including heavy metals, volatile organic compounds, and phthalates. Per-and polyfluoroalkyl substances (PFAS) are also found in crumb rubber.”
In the case of the Philadelphia Phillies baseball players, The Philadelphia Inquirer decided to test the turf. They did so by purchasing souvenir turf (via eBay.com) from the team’s field between the years of 1977 and 1981. The findings, which came from tests conducted by Eurofins Lancaster Laboratories Environmental Testing as well as the University of Notre Dame, revealed several different types of PFAS.
According to the Environmental Working Group (EWG), PFAS are given the moniker “forever chemicals,” as they are toxic, fluorinated chemicals that “build up in our bodies and never break down in the environment.” There are more than 9,000 identified PFAS. Most people have been exposed to PFAS but repeated exposure over a longer period of time can increase levels, says the United States Environmental Protection Agency.
The National Institute of Environmental Health Sciences found that human exposure to PFAS is potentially linked to issues with metabolism, fertility, reduced fetal growth, increased risk of being overweight or obese, increased risk of some cancers, and reduced ability of the immune system to fight infections.
Very recent studies have shown a connection between cancer and PFAS.
In a 2022 study of a community in Merrimack, NH—where the public water was contaminated with PFAS—researchers found that subjects had blood serum levels of PFAS higher, in some cases up to two times higher, than the average American. The researchers concluded that the residents of Merrimack had a higher risk of four different types of cancer, but more research is needed to definitively link PFAS to the cancer rates.
Additionally, in a 2023 Journal of Hazardous Materials study specifically focused on gliomas, researchers concluded, “our findings suggested that exposure to PFAS might increase the probability to develop glioma.” The findings also showed this correlation was higher in men than women.
Due to these findings, there have been calls to both ban or limit artificial turf in several states, including Massachusetts, California, and Connecticut. 
There are doubts about whether PFAS are actually unsafe, however. The Synthetic Turf Council, whose mission is to “lead, educate and advocate for the synthetic turf industry,” issued a statement suggesting that PFAS testing can be faulty and subject to false positives.
What about heavy metals?
Although the majority of concern around artificial turf is around PFAS, heavy metals are also found in some artificial turf—and they pose a threat to human health as well. “These metals can be toxic to humans,” Johnson-Arbor says. “Lead exposure is associated with cognitive difficulties and developmental delays, while mercury poisoning can result in personality changes, rashes, and headaches. Chronic arsenic exposure is associated with the development of certain types of cancer. However, it’s unclear whether these metals are present in artificial turf in high enough amounts to cause any undesirable health conditions in humans who play on the turf.”
Talking to your patients about artificial turf
If your patients play on a turf field or if their kids have been playing on turf for years, they may come to you with concerns—especially after reading recent news reports.
Even though there are potential links between cancer and turf, there’s no true way to draw a clear line between the two. “Since PFAS are ubiquitous in the environment and are detectable in nearly all of our bodies, it’s difficult to definitively connect these chemicals to specific health conditions in humans. Because of this, the health effects of PFAS exposure remain poorly defined,” Johnson-Arbor says.
She says that patients with concerns can take preventive measures to reduce individual exposure to the chemicals in the turf. “Such measures include washing hands after using artificial turf fields, and avoidance of eating or drinking while playing on artificial turf.” According to the Massachusetts Department of Human Health, exposure to chemicals in artificial turf can occur when breathing in dust from the turf, touching skin to turf, or swallowing small amounts of crumb rubber if hands haven’t been washed. Parents should know that children may be at risk for even greater exposure to PFAS, so arming parents with the facts is key.
You already know that PFAS testing is not routine, but patients may request bloodwork to test their PFAS levels. But they should know that this information cannot be used to diagnose current or future health conditions, according to the US Department of Health & Human Services.