The dates are embedded in McKenzie Hicks' memory.
First diagnosed with cancer: Feb. 14, 2011.
Declared in remission: Aug. 10, 2011.
Diagnosed with lymphoma a second time: July 10, 2013.
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Bone marrow transplant from twin sister Molly: Nov. 8, 2013.
In remission a second time: June 26, 2014.
If only determining the cause of her cancer were so simple.
A soccer defender in high school and a former midfielder for Morehead State University, Hicks can only wonder.
A report last fall by NBC News piqued her interest. Could the cause of her cancer be those little black crumbs of rubber that fill in many artificial turf surfaces, just like ones she had been playing on?
"I don't know," Hicks said. "I don't really want to jump to conclusions and assume that's the reason because ... I feel like I was born with this gene or whatever to have this. But I do think that — I've played soccer my whole life, so maybe being exposed environmentally to the crumb rubber has maybe triggered that gene to mutate for me to get the cancer. So I don't think it necessarily caused it, but I do think it played a role, maybe, in me getting it twice."
The NBC report cited the case of Amy Griffin, a college soccer coach in Washington (state), who in 2009 was looking in on two goalkeepers diagnosed with non-Hodgkin's lymphoma.
That day a nurse told Griffin that she had treated two other goalies that same week. Since then, Griffin has compiled a list of about 40 American soccer players, most of them goalies, who have been diagnosed with cancer. One worry is that goalies are especially vulnerable because they are in contact with the turf more often than other players.
Blood cancers like lymphoma and leukemia are dominant.
Crumb rubber became a suspected cause, although no research has linked cancer to artificial turf.
But the little black shreds can contain carcinogens and chemicals. Benzene, carbon black and lead can be contained in synthetic fibers and scrap tire.
NBC said its investigation did not find any agreement over whether crumb rubber had ill effects on young athletes, or even whether the product had been sufficiently tested.
But an alarm was sounded.
Few worries here
All of Lexington's public high schools, along with Lexington Catholic, have artificial turf fields. All have crumb rubber except for Lafayette, which has finely granulated sand.
Donnie Adkins, athletics director of Fayette County schools, said sand was used in place of rubber to see if there was a significant difference in heat retention. (There was not.)
The University of Kentucky is installing a new football field for this coming season that will use sand and crumb rubber. UK already has artificial turf fields at its indoor and outdoor practice facilities.
As for questions raised by the NBC News report, "Certainly the health of our student athletes is a priority and we're aware of the question," Russ Pear, UK senior associate athletic director for facilities and operations, said through UK spokesman Tony Neely. "There is existing research on the subject and, according to what we've seen, there's no research linking crumb rubber and negative health effects."
Soccer coaches around the city said they were aware of the NBC report, but that it had generated little or no talk from players and parents. And there have been no reports of cancer associated with turf in Lexington.
A spokesman for the University of Kentucky's Markey Cancer Center said there had been no cases there that were linked to crumb rubber.
"I think there needs to be more research done and more conclusive evidence than what I've seen," said Todd Bretz, coach of the Paul Laurence Dunbar soccer boys. "I don't have a concern. I'm not worried about breathing out there. I just don't know that there's enough evidence to show that there's any relationship between the field (and cancer). I'd rather see more evidence before I would jump to any conclusions."
That's the consensus around the city: Few fears for now, but let's see more research.
Jonathan Kincheloe, coach of the Lexington Catholic boys, often has his 2-year-old daughter at the field.
"So the more we can find out, I think it will help everybody. But ... there's risks, there's dangers with everything, and this is just another one we're faced with," Kincheloe said. "I don't feel like I know enough to have an educated fear. ... I have enough fears in this crazy world we live in. But until I know more, this is not going to be one of them."
The Kentucky High School Athletic Association sent information to member schools on Oct. 21, citing an advisory from the American Sport Builders Association, a centralized source for information on surfaces that use crumb rubber. That said that the ASBA relies on research from manufacturers.
"What we've just tried to do is make sure our schools had information because the NBC story, they were still researching whether or not there was a true connection, coincidence, etcetera, etcetera," KHSAA Commissioner Julian Tackett said. "But it was worth everybody's interest to take a look and make sure your situation was good.
"We don't build facilities, so it's not anything we would have expertise in, so when we get stuff like this we refer it out to our schools so they can make informed decisions. ... It's just not in our wheelhouse."
Benefits of turf
Artificial turf has obvious benefits.
Bo Lankster, girls' coach at Tates Creek, recalls that in the days of grass fields soccer practices were held at Veterans Park in an effort to save the game playing surface. Still, by September, the game pitch was hard and showed little grass. The field also was narrower (55 yards) than what is now the minimum requirement (65 yards) to host postseason play.
"The other big plus is the lines have already been put on for us, so you're not spending your time lining it," Henry Clay boys' coach Tim Bernardi said. "So that's a big plus for a soccer team as well."
Football and lacrosse share the playing field at Henry Clay, and the track team uses the surrounding oval.
What surface is best?
"I know most of us really enjoy the Bermuda (grass) as far as soccer goes, just purely playing," Dunbar girls' coach Tom Morgan said. "But from dollars and cents and just purely what's more reasonable for a high school setting, I think the turf is a better option just because I share the field with football, boys' soccer, middle-school football, and there just is no way that a grass field could sustain a season of those four sports. Once the rain hits, it just gets torn up."
"Schedule-wise and financially, it's a better option," said Manes Preptit, coach of the Bryan Station boys. "I like playing on grass, but it's easier to keep up when you have turf, where you don't have to cut it, you don't have to worry about clumps, you don't have to worry about weeds or having to re-seed every year. We have such a small budget, it's great to have the turf."
Paul Rains, football coach at Dunbar, said "we've never had any problem at all. We've never had kids with rashes or anything like that from playing turf. ... I think it's safer. No doubt that field's softer than some of the old hard-panned things that I played on and coached on in the early years. When you hit that, it's no big deal to get knocked down on that turf, and it wasn't that way 15, 20 years ago. There were some fields that were brutal; the collision with the ground was much tougher than the collision with the person."
Not everyone is enamored by artificial turf, though.
Take Jim Hicks, athletic director at Bellevue High School. He's also McKenzie Hicks' father.
"My perspective is as a father," he said. "With my daughter having Hodgkin's lymphoma twice growing up, playing soccer high school/college level."
Jim Hicks said he's "not one way or the other" in deciding that crumb rubber causes cancer.
"I think research needs to be done, questions need to be asked," he said. "Testing. Let's figure out if the crumb rubber is a cause of Hodgkin's lymphoma, which is an environmental cancer. ... The more people that ask questions, I think the quicker people will be able to respond and get this figured out."
Bellevue's soccer facility is grass, and Jim Hicks plans to keep it that way for now.
"From a financial standpoint, once the (artificial) field's down you can use it a lot more," he said. "A lot more teams, rental, whatever to increase the revenue for the school. But right now I'd definitely need to see a confirmation that crumb rubber is not a contributing factor to particular forms of cancer.
"Research needs to be done. From an athletic side, as well as the manufacturers need to step up and take some responsibility. If it isn't a contributing factor, then it shouldn't be a problem with them funding some of this research."
NBC contacted manufacturer FieldTurf and industry professionals such as the Synthetic Turf Council and the Rubber Manufacturers Association.
From Darren Gill, vice president of marketing for FieldTurf, NBC got this: "If you look at the ingredients that go into a car tire, some people take those ingredients and turn them into health concerns. But after the vulcanization process, those ingredients are inert."
Dr. Davis Lee, a Synthetic Turf Council board member, told NBC "we've got 14 studies on our website that says we can find no negative health effects." While those studies aren't "absolutely conclusive," he added, "there's certainly a preponderance of evidence to this point that says, in fact, it is safe."
Crumb rubber is an "environmental success story," Rubber Manufacturers Association spokesman Dan Zielinski told NBC.
There have been calls for the Environmental Protection Agency and the Consumer Product Safety Commission to look at the questions.
"While both the CSPC and the EPA performed studies over five years ago," NBC reported, "both agencies recently backtracked on their assurances the material was safe, calling their studies 'limited.' But while the EPA told NBC News in a statement that 'more testing needs to be done,' the agency also said it considered artificial turf to be a 'state and local decision,' and would not be commissioning further research."
As for McKenzie Hicks, who was a college sophomore when first diagnosed with cancer, she is graduating this weekend from nursing school at Morehead.
"I guess you can't really control if you get sick with cancer," she said. "You can't just stop doing the things you love, like playing soccer. I would never stop playing because I was scared that maybe I would get cancer.
"But what you can do, you can control your outlook on life. You can control how you handle news like that, when you are diagnosed. I think that the mental battle is even more important than the physical battle of cancer. So I just think it's important for everyone to know that no matter what happens, you always have to stay positive and optimistic."