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None of the facts make sense.

They were fit. They ran, jumped and beat opponents. Family and coaches say there were no signs. They were so young.

In the past week, three young athletes have died mysteriously: Mickey Renaud, the 19-year-old Windsor Spitfires captain who died at home on Monday; 17-year-old Shannon Veal, a high-school basketball star from Louisiana who died during a Monday night game; and Rene Ayangma, a 20-year-old University of Prince Edward Island student who collapsed after a mixed martial arts sparring session on Tuesday night. All three deaths, their official causes still undetermined, have raised a troubling question for those left behind: What could kill a youth so seemingly healthy?

Health experts say they highlight a controversy that flares up with each sudden death on a playing field. If mandatory physical tests for young athletes had been in place - as they are in Italy and some parts of the U.S. - could the deaths have been prevented?

"The question that people are asking is, is mass screening of everybody justified?" said Winne Meeuwisse, a sports medicine doctor and professor of kinesiology at the University of Calgary. "The answer is, if you're the person that [is at risk of dying] - yes."

Sudden death among young athletes is rare. Studies show only about one to two out of every 200,000 youth participating in sport will die suddenly, Dr. Meeuwisse said.

Most cases result from a pre-existing heart defect or abnormality. Sometimes the first symptom can be death itself.

Specific causes include hypertrophic cardiomyopathy, in which the heart becomes unusually thick, making it harder to pump blood, and abnormalities of coronary arteries, which can become compressed during exercise and slow blood flow to the heart.

A genetic disorder known as Long QT syndrome, which affects the heart's electrical system, is another potential cause.

"These abnormalities exist because people are born with them, not because they're participating in sports," said Jack Goodman, associate professor in the faculty of physical education and health at the University of Toronto.

Still, sudden cardiac deaths among young athletes can be triggered by exercise, said Dr. Goodman, whose research examines the effect of prolonged exercise on heart function.

"You need to have a disease," he said. "But you also have to have a trigger. Exercise itself is a stressor. And it may, under the right circumstances, at the right time, provoke the heart to undergo arrhythmia."

While there are effective methods of screening for rare heart conditions, there is debate about cost-effectiveness, and "who's going to pay," Dr. Goodman said.

Researchers also need to refine screening procedures, said Dr. Meeuwisse.

Even though the use of an electrocardiogram [ECG or EKG] can accurately detect some conditions, when you screen vast populations you can still wind up with "a lot of false positives," meaning a lot of kids being banned from sports unnecessarily, he said.

In Canada, varsity and professional athletes undergo systematic physical exams in order to remain active, Dr. Meeuwisse said. But the country lags behind other jurisdictions when it comes to screening school-aged athletes.

Italian law mandates that prior to participating in a competitive sport, every athlete must undergo medical tests, including an ECG.

Some U.S. states require school-aged athletes to undergo a medical examination, including Louisiana, where basketball star Shannon Veal died on Tuesday.

But sudden death among athletes can be prevented without general screening, said Michael Ackerman, a pediatric cardiologist at Mayo Clinic in Rochester, Minn., who specializes in caring for young people at high risk of sudden cardiac death.

"We estimate that [with] half of the sudden deaths, there was a legitimate warning sign present in either that person or their family that should have raised a red flag," Dr. Ackerman said.

Those signs include collapsing, fainting or sudden chest pain during exercise, he said. Also, if a family member died before the age of 50 with no apparent reason, it could be a sign of a congenital heart defect. In those cases, athletes and non-athletes should go to their doctor for targeted screening, Dr. Ackerman said.