PDF True "Breast Cancer Awareness":

Informing Women of the Abortion-Breast Cancer Link

 

By Danielle Huntley

AUL 2007 Summer Fellow

 

In the spring of 2001, a fifteen-year-old girl with a family history of breast cancer doubled her risk of developing the deadly disease in an abortion that lasted less than twenty minutes.1 This Oregon teenager filed suit against the abortion clinic that failed to warn her of the increased risk of breast cancer. The suit was settled before going to trial, even though the teen had yet to develop breast cancer.2

 

If an abortion clinic takes such a lawsuit seriously enough to settle a medical malpractice case, it is perplexing that women are not systematically informed of the link between abortion and breast cancer (ABC link). Yet, this disconnect between scientific evidence and what the established medical community accepts and disseminates to the general public is not new. The controversy surrounding the ABC link is not anything new to the medical and scientific community. In 1847 Dr. Ignaz Semmelweiss postulated that simple hand washing between examinations could reduce the number of infections in a labor and delivery ward. He observed that midwifes who washed their hands between examinations had a lower rate of mortality than midwives or doctors who did not. Today this conclusion is laughably obvious. But Sammelweiss' assertions cost him his job and his credibility within the medical community.3 The same treatment greets doctors and scientists who demonstrate that there is a link between abortion and breast cancer.4

 

The Science

 

In order to understand the controversy surrounding the ABC link it is vital to understand what biological mechanisms cause breast cancer. Scientific and medical experts agree that there are three primary biological factors that can cause a woman to develop breast cancer: genetics, lifetime exposure to estrogen, and breast tissue maturation.5

 

A woman develops breast cancer through genetics by inheriting a faulty gene from one of her parents.6 Genetics only cause between eight to ten percent of breast cancer cases, whereas lifetime exposure to estrogen and breast tissue maturation make up the remaining 90 percent of breast cancer in women.7

 

Lifetime exposure to estrogen plays a role in the development of breast cancer in two ways. First, estrogen can act as a carcinogen directly damaging DNA to the point that cancerous cells can form.8 Second, estrogen is one of the hormones that causes breast cells to divide and multiply.9 When a cell divides, the DNA of the breast cell replicates itself.10 Sometimes during this process errors occur. If the errors are grave enough, a cancer cell can be created.11 A woman's level of estrogen increases at the end of her menstrual cycle -- thus the more menstrual cycles a woman has in her life the greater her exposure to estrogen.12 Thus, if a woman is very young at the age of first menstruation (menarche) and has late menopause, then her risk of breast cancer is greater than a woman with later menarche and earlier menopause.13

 

In addition to family history of breast cancer and exposure to estrogen, the maturity of breast tissue also impacts a woman's risk of breast cancer.14 It is scientifically undisputed that full-term pregnancy reduces a woman's risk of breast cancer.15 It is also undisputed that the earlier a woman has a full-term pregnancy, the lower her risk of breast cancer becomes, because the breast tissue that is exposed to estrogen through the menstrual cycle is more mature and cancer resistant.16 In fact, for each year that a woman's first full-term pregnancy is delayed, her risk of breast cancer rises 3.5%.17

 

A woman's first full-term pregnancy changes the breast tissue from immature tissue more likely to develop breast cancer to mature cancer- resistant breast tissue.18 During the first and second trimesters of pregnancy the breasts develop merely by duplicating the immature tissues. Once a woman passes the thirty-second week of pregnancy (third trimester) then the immature cells develop into mature cancer resistant cells.19 It is acknowledged by mainstream medical science that premature deliveries that occur before thirty-two weeks increase a woman's risk of breast cancer because she has more immature breast tissue and the level of estrogen is much higher -- by the end of the first trimester a woman has 2000 percent more estrogen in her body.20

 

This is where abortion fits into the complex scientific puzzle. When an abortion ends a normal pregnancy, the woman is left with more immature breast tissue than before she was pregnant.21 This is the primary scientific basis for an independent ABC link.22 In short, the amount of immature breast tissue is increased and this tissue is exposed to significantly greater amounts of estrogen because of pregnancy and subsequent menstrual cycles.23 Additionally, a woman who procures an abortion loses the protection of matured breast tissue that develops during a completed full-term pregnancy. 24 Abortion also increases the likelihood of a woman not being able to carry a pregnancy to full-term in subsequent pregnancies, which in turn increases her risk of breast cancer.25

 

The Studies

 

The controversy around the ABC link turns on whose studies are more accurate and comprehensive. Yet, the studies in their totality point towards the legitimacy of the ABC link. Before diving into the most relevant studies, it is good to know the basic terminology thrown about by the scientists and researchers involved in proving or attempting to debunk the ABC link.

 

Epidemiology: "the study of disease trends in large populations."26

 

Meta-analysis: "a study that polls together the data from the studies in an area of medicine . . . and comes up with an overall risk for a particular risk factor."27

 

Recall bias: woman with breast cancer is more likely to report prior abortions than a healthy woman who has had an abortion in the past.28

 

The first study examining the ABC link was published in 1957 and found that a woman who had procured an abortion increased her risk of breast cancer by 160 percent.29 Since then "seventy epidemiological studies have been conducted," and of those studies "eighty percent . . . report risk increases for women who have abortions."30

 

In 1994, pro-choice researcher Dr. Janet Daling published a study of women in Washington State which found that "among women who had been pregnant at least once, the risk of breast cancer in those who had experienced an induced abortion was 50 percent higher than among other women."31 Her findings are particularly alarming for teenagers under the age of eighteen and older women over the age of twenty-nine; when these populations procure an abortion their risk of breast cancer increases by 100 percent. 32 Most alarming was her finding that the women in her study who procured abortions as teenagers and had a family history of breast cancer were all diagnosed with breast cancer by age forty-five.33 Daling also specifically controlled for "recall bias" and found that it did not impact her results.34

 

In 1996 Dr. Joel Brind and colleagues conducted a meta-analysis of all of the studies that examined a connection between induced abortions and breast cancer.35 His analysis showed a 30 percent increased risk of breast cancer among women who procured an abortion after their first full-term pregnancy and a 50 percent increased risk of breast cancer among women who procured an abortion before their first full-term pregnancy.36

 

The other side of the debate is not without their studies. Those who claim that the ABC link does not exist rely heavily on a study published in 1997 by Danish researcher, Dr. Mads Melbye and her colleagues. Their study claims that an induced abortion does not increase a woman's risk of abortion.37 However, this study was deeply flawed because the researchers misclassified and miscounted cases such that the study masked the ABC link, as Dr. Brind pointed out in a letter to the New England Journal of Medicine. 38 Interestingly, in a study published by the same team of researchers in 1999, the team corrected for the errors pointed out in Dr. Brind's letter.39

 

In 2007 a group of Harvard researchers claimed that there was no link between abortion and breast cancer.40 However, this study, touted as unequivocal proof that the ABC link is pro-life fear mongering, is not without its own grave errors. Dr. Brind points out that patients included in the data were not followed for an adequate period of time.41 Additionally, the authors of the Harvard study did not adjust their findings for statistically significant factors that would have a striking impact on the study's results.42 Most recently, the Journal of American Physicians and Surgeons published a study using national cancer registration data from eight European countries.43 The study considered seven reproductive risk factors, concluding that "breast cancer incidence appears to be best explained by an increase in abortion rates . . . and lower fertility."44 Countries with higher abortion rates can expect a substantial increase in breast cancer incidence; countries with low abortion rates can expect a smaller increase; countries with declining abortion rates can anticipate a decline in breast cancer.

 

Myths and Facts

 

Myth:

Recall bias invalidates the findings of studies that have shown a link between abortion and breast cancer.

Fact:

Recall bias has never been shown to make a statistically significant effect in "groups even when explicitly tested."45

 

Myth:

If miscarriages do not increase a woman's chance of breast cancer, abortion should not either, because they both end a pregnancy before term.

Fact:

Miscarriages most often occur in pregnancies that have low levels of the needed hormones. Since abortion most often occurs in normal pregnancies with normal hormonal levels it makes sense that a woman's risk increases because she has more breast tissue exposed to higher levels of estrogen than if she miscarried with low hormonal levels.

 

Myth:

A new Harvard study disproved the ABC link unequivocally.

Fact:

The study was so methodologically flawed that it hides the positive association between induced abortion and breast cancer.

 

Myth:

Women should just sue for medical malpractice; we do not need to require doctors to inform their patients. Fear of litigation will create enough of an impetus to inform women.

Fact:

Sadly, when it comes to abortion the political and social agenda behind abortion trumps giving women all of the information they need to make a truly informed "choice." Those who provide and profit from abortions cannot be entrusted to give women an accurate picture of the affect that abortion could have on their physical and psychological health.

 

Myth:

We do not need to be so concerned about the link of one physical ailment and abortion; it is just not that big of a deal.

Fact:

Approximately 240,510 women will be diagnosed with breast cancer in 2007.46 Breast cancer is the second deadliest cancer for women (only behind lung cancer). In 2007, an estimated 40,460 women will die in the U.S. from breast cancer.47 Women are not being informed of the risks that surround their decision to procure an abortion. The amount of information that women receive should not be dependent on the political and social agenda of healthcare professionals.

 

State of the States: Where Are We Now?

 

Currently women wishing to procure an abortion are informed of the ABC link in only six states. Mississippi, Texas and Minnesota explicitly require a doctor to inform a woman seeking an abortion of the ABC link.48 Alaska, Kansas and West Virginia do not mandate disclosure of the ABC link to a woman procuring an abortion, but do include information about the ABC link in the educational materials that a woman must review before the abortion can be performed.49

 

Interestingly, it is litigation that will probably bring the ABC link publicity.50 Lawsuits concerning the ABC link brought by abortion victims stem from women's lack of informed consent. In order for patients to give meaningful consent to a medical procedure, they must be informed of the risks inherent to the procedure, even the unlikely ones.51 In 2003 a Pennsylvania woman successfully settled a claim against the abortionist who failed to warn her of the ABC link when she had an abortion at age seventeen. 52 Similarly, in 2005 an abortion victim in Oregon sued the abortion clinic that did not disclose the ABC link to her when she had an abortion at the age of fifteen.53

 

Litigation has also occurred dealing with the information disseminated by both pro-life organizations and pro-abortion groups with differing outcomes. Pro-lifers were successful in Pennsylvania when the third circuit ruled that Southeast Pennsylvania Transit Authority (SEPTA) "acted as a censor" when it removed advertisements with the slogan "Women Who Choose Abortion Suffer More & Deadlier Breast Cancer."54 However, an abortion clinic was successful in knocking out a pro-life activist's claim against it for false advertising because of a pamphlet that read in part that "[a]nti-abortion activists claim that having an abortion increases the risk of developing breast cancer."55 The Supreme Court of North Dakota ruled that the pro-life activist plaintiff lacked standing to bring the claim.56

 

Looking Towards the Future

 

A woman's medical autonomy should not be predicated on the agenda of the abortion industry. States must work to statutorily mandate discussing the ABC link before a woman can procure an abortion. The ABC link is real and women have the right to know how their "choices" impact their bodies.

 

 

Endnotes

 

1. Brent Rooney, "Oregon Judge Dale Koch Dooms Abortion Industry to Bankruptcy," available at: http://www.abortionbreastcancer.com/news/051109/index.htm (last visited Sept. 27, 2007).

 

2. Andrew L. Schlafly, "Legal Implications of a Link Between Abortion and Breast Cancer," 10 J. of Am. Physicians & Surgeons 11 (2005) [hereinafter Schlafly, Legal].

 

3. Angela Lanfranchi, "The Science, Studies and Sociology of the Abortion Breast Cancer Link," 18 Research Bulletin 1, 7 (2005) [hereinafter Lanfranchi, Science].

 

4. See id.

 

5. Angela Lanfranchi, "The Breast Physiology and the Epidemiology of the Abortion Breast Cancer Link," 12 Imago HOminis 228, 229 (2005) [hereinafter Lanfranchi, Physiology].

 

6. Id.

 

7. Id.

 

8. Id. at 230.

 

9. Id. at 229.

 

10. Id.

 

11. Id. at 229-30.

 

12. Id.

 

13. Id.

 

14. Id. at 229.

 

15. The Coalition on Abortion Breast Cancer, "ABC Summary," available at: http://www.abortionbreastcancer.com/abcsummary.htm (last visited July 12, 2007).

 

16. Id.

 

17. MacMahon et al., "Age of First Birth and Breast Cancer Risk," 43 Bull. World Health Organization 209 (1970).

 

18. Lanfranchi, Physiology, supra note 5, at 231.

 

19. Id.

 

20. Id. at 232.

 

21. Lanfranchi, Science, supra note 3, at 4.

 

22. Id.

 

23. Id.

 

24. Id.

 

25. Id.

 

26. Lanfranchi, Physiology, supra note 5, at 233.

 

27. ABC Summary, supra n.15.

 

28. Lanfranchi, Physiology, supra note 5, at 235.

 

29. M. Segi et al., "An Edpidemiological Study on Cancer in Japan," 48 GANN 1 (1957).

 

30. The Coalition on Abortion Breast Cancer, "Epidemiology," available at: http://www.abortionbreastcancer.com/epidemiology/index.htm (last visited Sept. 27, 2007).

 

31. Janet Daling et al., "Risk of Breast Cancer Among Young Women: Relationship to Induced Abortion," 86 J. of the Nat'L Cancer Inst. 1584-92 (1994).

 

32. Id.

 

33. Id.

 

34. Id.

 

35. Joel Brind et al., "Induced Abortion as an Independent Risk Factor for Breast Cancer: a Comprehensive Review and Meta- Analysis," 50 Brit. J. of Epidemiology & Community Health 481-96 (1996).

 

36. Id.

 

37. See Mads Melbye et al., "Induced Abortion and the Risk of Breast Cancer," 336 New Eng. J. Med. 81 (1997).

 

38. Joel Brind & Vernon Chinchilli, "Letter to the Editor, Induced Abortion and the Risk of Breast Cancer," 336 New Eng. J. Med. 1834 (1997).

 

39. Mads Melbye et al., "Preterm Delivery and Risk of Breast Cancer," 80 Brit. J. of Cancer 609 (1999).

 

40. KB Michels et al., "Induced and Spontaneous Abortion and Incidence of Breast Cancer Among Young Women: A Prospective Cohort Study," 167 Archives of Internal Med. 814 (2007).

 

41. Joel Brind, "Induced Abortion and Breast Cancer Risk: A Critical Analysis of the Report of the Harvard Nurses Study II," 12 J. Amer. Physicians & Surgeons 38 (2007).

 

42. Id.

 

43. Patrick S. Carroll, "The Breast Cancer Epidemic: Modeling and Forecasts Based on Abortion and Other Risk Factors," 12 J. Am. Physicians & Surgeons 72 (2007).

 

44. Id. at 77

 

45. Lanfranchi, Physiology, supra note 5, at 235

 

46. American Cancer Society, "What are the key statistics for breast cancer?," available at: http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_breast_ cancer_5.asp (last visited Sept. 27, 2007).

 

47. Id.

 

48. Minn. Stat. § 145.4242 (2007); Miss. Code Ann. § 41-41-33 (2007); Tex. Health & Safety Code Ann. § 171.012 (2007).

 

49. Alaska Stat. § 18.05.032 (2007) (requiring a woman to review information maintained by the state online); Kan. Stat. Ann. § 65-6709 to -6710 (2007) (requiring woman to review printed materials provided by the department of health and environment); W. Va. Code § 16-2I-2 to -4 (2007) (requiring women to be informed at least by telephone about the risks of abortion, and for the Secretary of the Department of Health and Human Resources to maintain a website with the same information).

 

50. See Schlafly, Legal, supra note 2.

 

51. Andrew L. Schlafly, "Had an abortion? Call an attorney," Celebrate Life, Sept.-Oct. 2005, at 31, 32. [hereinafter Schlafly, Attorney]

 

52. Press release, Women's Injury Network, "Abortion Doctor Settles Malpractice Suit, Failed to Inform Patient of Breast Cancer Risk from Abortion Procedure," October 22, 2003, available at: http://www.abortionbreastcancer.com/news/031022/index.htm (last visited Sept. 27, 2007).

 

53. Schlafly, Attorney, supra note 49, at 32.

 

54. Christ's Bride Ministries, Inc. v. Southeastern Pennsylvania Transportation Authority, 148 F.3d 242, 246 (3rd Cir. 1998).

 

55. Kjolsrud v. MKB Management Co., 669 N.W.2d 82, 83 (N.D. 2003).

 

56. Id. at 88.