“CTE Diagnosis” Debuts in Women’s Sports: Heather Anderson Becomes the First Female Professional Athlete to be Diagnosed with Chronic Traumatic Encephalopathy

Types : Alerts

By: Dylan F. Henry, Esq and Tara Hessenthaler, J.D. Candidate

Researchers claim that they have made the first Chronic Traumatic Encephalopathy (CTE) diagnosis in a female professional athlete. A report published by the Australian Sports Brain Bank on June 30, 2023, revealed that Heather Anderson, a former Australian Football League (AFL) player, had low-stage CTE and three lesions in her brain. Though CTE has a long history dating back to the 1920s (e.g., “punch drunk syndrome”), Anderson’s CTE diagnosis comes almost 18 years after the first published diagnosis of CTE in an American NFL player, former Pittsburgh Steeler “IRON” Mike Webster, and the hundreds of claimed CTE diagnoses – and related lawsuits – that followed in male athletes across a broad range of professional sports.

Heather Anderson started playing football when she was five years old, playing for both the AFL and rugby league. Australian football is similar to rugby in that players do not wear helmets. She also served in the Australian military for nine years and participated in amateur martial arts for three years. Her professional career included eight games over the 2017 season with AFL Club the Adelaide Crows before she suffered a shoulder injury that ended her sporting career. Throughout her 18 years of playing contact sports, Anderson only suffered one diagnosed concussion; however, her family suspected that she also suffered four additional concussions that were not formally diagnosed.

Currently, CTE can only be diagnosed in a post-mortem autopsy. Anderson tragically died in November 2022, at the age of 28. Reports of her death indicate that she committed suicide. She had no known history of alcohol or non-prescription drug abuse and had not exhibited any signs of depression or unusual behavior in the months before her death. Suicide deaths are not uncommon in cohorts where CTE is sought at autopsy, which is exactly what Anderson’s family did. Her family donated her brain to the Australian Sports Brain Bank in hopes of learning whether a lifetime of exposure to repetitive head trauma (concussive and sub-concussive blows) contributed to Anderson’s death.

Despite the overwhelming media attention that CTE has received, much is still unknown about the disease, including its incidence, prevalence, natural history, and risk factors. On June 15, 2023, the Concussion in Sport Group (CISG) published the 2022 Amsterdam consensus statement, admitting that there is still much research to be conducted on CTE. The CISG warned that previous studies of former athletes are not cohort studies that can examine causation or quantify risk. Questions remain as to whether CTE causes specific neurological or psychiatric problems, the extent to which CTE can be clearly identified within the presence of Alzheimer’s disease neuropathology, and whether CTE is inevitably progressive.

Even among this uncertainty, Heather Anderson’s diagnosis further demonstrates the need for organizations to continue to implement state-of-the-art concussion management plans, which include reducing a player’s exposure to repetitive and cumulative concussive and sub-concussive blows (regardless of gender). The athletic community, including governing bodies, sports organizations, and medical professionals, must reassess current concussion protocols, implement enhanced player safety measures, and prioritize the long-term well-being of athletes of all genders. In that same vein, the CISG 2022 Amsterdam consensus statement announced the gold standard for sport-related concussion identification, treatment, management, and prevention. The statement recommends that healthcare professionals, coaches and staff, risk managers, athletic departments, and any individual or entity that deals with sport-related concussion should update their management policies and practices to include up-to-date assessment tools and provide greater individualized care that is both sport- and athlete-specific.

Anderson is the first female professional athlete diagnosed with CTE, but she likely will not be the last. Contact sports in which head injuries commonly occur were historically male-dominated, which led to a strong male bias in CTE prevalence to date. Nonetheless, popularity and participation in women’s contact sports, particularly among those aged 15-34 years old, have increased over the past two decades. Further, research suggests that women have an equal or greater susceptibility to sports-related concussions than men.

CTE is a growing concern among American female athletes. In 2019, the Boston University CTE Center announced the launch of its Soccer, Head, Impact and Neurological Effect (“SHINE”) study. SHINE is the first of its kind and is aimed at recruiting 20 former soccer players to donate their brains and create the first all-female study cohort dedicated to understanding CTE. Athletes such as Brandi Chastain, Michelle Akers, Abby Wambach, Megan Rapinoe, and Briana Scurry have already pledged to donate their brains to the SHINE study upon death. Two-time Olympic gold medalist and 1999 World Cup Champion, Briana Scurry—who suffered three concussions during her professional career—has claimed that she expects CTE to be found in her brain. Such speculative self-diagnosis can prove to be detrimental to the patient. They may avoid seeking treatment for a variety of other conditions that cause the same symptoms. “Many doctors consider CTE a rare disorder and believe widespread fear of it is unjustified. They say the same symptoms could be caused by a curable condition, such as a vitamin deficiency, a hormone imbalance, depression or even normal aging.”

Gaps remain in understanding CTE, but the research is clear that repetitive exposure to sub-concussive blows is detrimental to long-term brain health. Researchers and advocates continue to urge that reducing exposure to this type of head trauma is critical. For example, with regard to ice hockey, the CISG 2022 Amsterdam consensus statement panel unanimously proposed that mouthguards and policies disallowing body checking should be supported in youth and adolescent leagues. Research found that mouthguards were associated with a 28% reduced concussion rate in ice hockey across all age groups, supporting the position that they should be mandated for child and adolescent players. Moreover, the policy disallowing body checking in child or adolescent ice hockey reduced the rate of concussions in games by 58%.

We will continue to provide updates as more information regarding Heather Anderson’s case and its implications on CTE minimization plans in women’s sports becomes available.