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was pleased. Sure, Armstrong was loud and obnoxious, full of himself and full of it most of the time. But it wasn’t like she was going to marry him.

      On September 14, 1996, at the 50-yard line of the University of Michigan’s football stadium, Andreu told Kramar that he loved her, and proposed. She cried and said yes.

      The wedding was set for New Year’s Eve.

      Two weeks after their engagement in the fall of 1996, the couple learned that Armstrong had been diagnosed with cancer. Neither of them had ever imagined he would be anything less than a powerhouse. Now the thought of him wasting away sickened them.

      Two days after Armstrong had tumors removed from his brain, Kramar and Andreu flew to Indianapolis and walked into a conference room in the downtown Indiana University Cancer Center to visit their friend.

      Always nosy, she took inventory of her surroundings. To the left, a bathroom. To the right, a long, rectangular table. Beyond that, a sofa and a television against the far wall. Armstrong was seated at the table with an IV attached to his arm. To Kramar, Armstrong looked like a ghost of himself, nothing like the indefatigable Texan she had come to know so well.

      Cancer had stolen his bravado. He was frail and bald with a long scar that bisected his scalp where doctors had opened his head for the surgery. She smiled and said he looked good. In truth, she was startled to see so much life drained out of him.

      Kramar and Andreu gathered with Armstrong and four of his other friends in the conference room because his hospital room had been too small. A Dallas Cowboys football game was on TV. Everyone strained to make small talk.

      Armstrong had received a juice machine as a gift, and Kramar started there. “Do you like carrot juice?” she asked him, preparing to extol the virtues of what she called “the power of juicing.”

      “How about apple? You like apple juice? You know, I have a juicer and I make all kinds of juice with it. You can even put vegetables in it. It’s so good for you.”

      “Thanks, I didn’t know that,” Armstrong said.

      The conversation ended abruptly when two men in white coats walked in. They were there to ask Armstrong about his medical background.

      “I think we should leave and give him his privacy,” Kramar said, nudging Andreu.

      “No, you can stay,” Armstrong said.

      Kramar motioned again to Andreu, trying to get him to leave. She tapped him with her foot.

      “No, Lance said we can stay,” he said.

      One of the doctors asked Armstrong if he had ever used performance-enhancing drugs. Betsy’s pulse quickened. What did he say? She snapped her head to look at Armstrong. She saw him scanning the room, looking at the people there.

      There was Coach Carmichael, and Carmichael’s future wife, Paige. There was Lisa Shiels, a blond premed student from the University of Texas who’d been Armstrong’s latest live-in love. Also in the room was Stephanie McIlvain, Armstrong’s personal representative at Oakley, the sunglasses company.

      These people were in Armstrong’s closest circle. With his glance around the room, he decided he could trust them. One hand on his IV, Armstrong answered the question calmly, as if reading a grocery list.

      He said, “Growth hormone, cortisone, EPO, steroids and testosterone.”

      At that point, sensing Kramar’s slack-jawed surprise, Andreu pulled her out of the room and into a hallway. Away from the hospital room’s door, near the elevators, Kramar addressed Andreu in a raised voice.

      “God, that’s how he got cancer, isn’t it?” she said. “I’m not marrying you if you’re doing all that stuff. The wedding’s off!”

      “I swear to God. I swear to God. I swear to God,” Andreu said. He motioned the sign of the cross. “Please, I promise you, I’m not doing all that stuff.”

      All Kramar knew about steroids was that Ben Johnson, the Canadian sprinter, had been busted for them at the 1988 Seoul Games after winning the 100-meter dash. But she knew enough to know steroids were unhealthy. And illegal. Worst of all, by her measure, using steroids was an immoral act. It was against the rules of competition. It was cheating.

      “Is that what cycling is all about?” she said.

      Andreu begged her to keep her voice down. “Betsy, please, I’ve never taken steroids. I’ve never taken any of that stuff.” He told her not to worry: He was clean. “I’m not involved in any of that doping shit.”

      She stormed off to the hotel, and he followed. The situation was so tense that they didn’t go back to see Armstrong that day. While she wanted to know more, he didn’t want to talk about it.

      Kramar had no idea that her fiancé had just lied to her face about his drug use. Several of his former teammates said Andreu had taken EPO starting, if not before, the 1995 season. Armstrong and the fellow Motorola rider Stephen Swart said the entire team, including Andreu, had used the drug for the 1995 Tour, though this was disputed by others on the team.

      In Andreu’s little corner of the world, everyone seemed aware that riders were relying on EPO to race.

      It’s just that Betsy Kramar was the last to know.

      Over the next few weeks, Kramar called four friends and two family members to talk about Armstrong’s drug admission. One was Dawn Polay, Kramar’s college roommate, who had known Andreu since grade school. “You never know what the truth is,” Polay said. “Just listen to what he has to say before you decide anything. Just because one person is doing it, it doesn’t mean Frankie is doing it, too.”

      Polay thought it all was one big, complex mess that Armstrong had created. Why had he trusted Kramar? If he paid any attention to her over the years, he knew she was opposed to smoking and drinking, let alone drug use. Polay thought Armstrong had made a monumental mistake—admitting to something so obviously “against the rules” to Betsy Kramar, an unflinchingly judgmental moralist.

      For weeks, Kramar and friends dissected what Armstrong’s admission might mean for her impending marriage. If Andreu had doped, would their children have three arms? They wondered if Armstrong had caused his own cancer. Kramar even asked her doctor as much.

      Most oncological experts say it is impossible to definitively say Armstrong’s use of PEDs caused his cancer or exacerbated a preexisting cancer. While testosterone has been shown to cause prostate cancer, there is no proof that PEDs cause testicular cancer, one of the most uncommon types of the disease. Men have a 1-in-270 chance of getting it. At twenty-five, Armstrong was in the age group—twenty to forty—with the highest incidence for testicular cancer.

      Though it is still unproven, some experts say that EPO and growth hormone use could hasten the development of tumors and cause cancer cells to replicate at a faster pace. Growth hormone stimulates the liver and other tissues to secrete insulin-like growth factor (IGF-1)—according to Dr. Arjun Vasant Balar, an oncologist at NYU Langone Medical Center in New York—and IGF-1 has been shown to increase the growth of cancer.

      Lucio Tentori, a cancer researcher at the University of Rome Tor Vergata, produced a research paper in 2007 that explored whether doping with HGH, IGF-1, anabolic steroids or EPO increases the risk for cancer. He was aware of only one described case of a cyclist’s getting cancer after using growth hormone, and that cyclist was diagnosed with Hodgkin’s lymphoma, not testicular cancer.

      After all his studies and analysis, Tentori would only go as far as to say that “athletes should be made aware that long-term treatment with doping agents might increase the risk of developing cancer.”

       CHAPTER 7

      In the picture they are a team. J.T. Neal and Lance Armstrong: two smiling, bald-headed cancer patients. Neal cherished the photo. It was

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