Abortion & Breast Cancer

Higher Risk for All, Astronomically High Risk for Some Women

By Joel Brind, Ph.D.

For almost five years, NRL News has kept you abreast of research investigating the link between induced abortion and an increased risk of breast cancer. Pro-lifers should be greatly encouraged that ever so gradually, the knowledge that abortion increases a woman's risk of contracting breast cancer is making its way into the mainstream in ways both obvious and oblique.

The first real breakthrough came in November 1994, with the publication of a study in the Journal of the National Cancer Institute by a team led by Dr. Janet Daling of the Fred Hutchinson Cancer Research Institute in Seattle. She and her colleagues concluded that there was an overall 50% increased risk for breast cancer among women who had chosen abortion.

Not surprisingly, an accompanying editorial called this finding "small in epidemiological terms." Others have characterized this finding as "a weak association" - - technical jargon for an increased risk that is of relatively small magnitude. But the fact that someone not identified as pro-life agreed there was a link was very significant.

Then, in 1996, I and my colleagues at the Pennsylvania State College of Medicine addressed the issue with a "comprehensive review and meta- analysis" that appeared in the British Medical Association's prestigious Journal of Epidemi-ology and Community Health. We found that the summary consensus of worldwide data indicates an overall average increase in the range of between 20% and 50%.

Because both breast cancer (180,000 new cases per year) and abortion (well over a million per year) are very common in the U.S., this heightened risk translates to about 5,000 cases of breast cancer in the United States each year. These are attributable to induced abortion, as opposed to spontaneous abortion (miscarriage), which does not increase the risk.

It would seem prudent that any reasonable standard of informed consent would require women undergoing elective abortion to be informed of this significantly increased risk. Alas, except for four states (Louisiana, Mississippi, Montana, and Kansas), no such warnings are required. Moreover, the medical professional associations (whose members include the abortion practitioners) have thus far shown no interest in adopting such warnings.

Fortunately, this reluctance may be beginning to change. In a program entitled "Uncertainties in informed consent" at the spring session of the American Academy of Pediatrics in Chicago this year, I gave a lecture on the abortion-breast cancer issue. Naturally, I focused on the role of the pediatrician since he or she so often is in the position of referring their adolescent patients for abortions.

However, instead of concentrating on overall risk figures, I decided to focus on a hypothetical, what some might describe as a "hard case" but actually one that occurs thousands of times each year.

I asked the pediatricians to consider the case of a 45-year-old woman, herself in remission after treatment for breast cancer, who brings in her healthy, 15-year-old daughter for an office visit with the family pediatrician. The pediatrician confirms that the daughter is eight weeks pregnant, and mother and daughter request a referral for induced abortion.

In my hypothetical, although he considers himself "pro-choice," the pediatrician declines his patient's request, citing the enormous increase in the girl's risk of future breast cancer if she aborts, compared to the risk-lowering effect of early childbirth.

What I suggested to the pediatricians in Chicago was that for a teenager with a family history of breast cancer, referral for abortion was beyond the limits of an informed consent issue. It is unethical itself, purely because of the unacceptably high health risk it would present to the pregnant woman. On what scientific and medical basis did I come to that conclusion?

Backtrack to the 1994 Daling study, to a finding in the study which received no mention in the accompanying editorial or the mainstream media. One of the "subgroups" of women which Daling et al. studied were those women who had an abortion before age 18, and who also had a family history of breast cancer (mother, grandmother, sister, or aunt).

Of the approximately 1,800 women in the whole study - - 900 cancer patients and 900 healthy "control" subjects - - there were 12 who fell in this subgroup. The shocking finding here is that all 12 had breast cancer!

This made the calculation of relative risk come out to infinity, i.e., incalculably high. Importantly, data from other studies support the finding of a deadly synergy between family history of breast cancer and induced abortion.

More evidence of such synergy was reported in 1994 in a study in France by Nadine Andrieu and colleagues. Women in general showed only a 10% risk increase if they had one or more induced abortions. However, for those women with a family history of breast cancer, there was a 30% risk increase when they had one induced abortion but a 610% increase with two or more induced abortions!

The following year, Andrieu et al. published another study which was a reanalysis of data from six previous studies (including her own) from women in France, Australia, and Russia. Some had been published, but none had previously shown data on abortion and family history of breast cancer.

The results were that women without a family history of breast cancer showed a 20% risk increase with one or more induced abortions. By contrast those women with family history showed a 50% increase with one abortion, and a 140% increase with two or more abortions.

The authors concluded, "Our findings suggest a synergism between familial factors and abortion."

The most recent American study provides further evidence of this deadly synergy, although as so often is the case, the authors say one thing, the data another. The abstract of the paper was published in the November 1997 issue of the journal Cancer Causes and Control, and was written by Julie Palmer and Lynn Rosenberg of Boston University School of Medicine and their colleagues from Memorial Sloane-Kettering and Cornell in New York and the University of Pennsylvania in Philadelphia.

The term "family history" isn't even mentioned until well into the body of the paper. Moreover, the bottom line of the abstract argues, "These findings provide little support for the hypothesis that induced abortion increases breast cancer risk overall or in particular subgroups."

But the impression completely changes if one scratches deep below the surface of this study. There one finds further confirmation of the lethal synergy between induced abortion and family history as risk factors for breast cancer.

With regard to the extraordinarily heightened risk that accompanies a family history of breast cancer and induced abortion(s), Palmer et al. actually confirmed Daling et al.'s findings. Among women in general, the Palmer study found only a 20% increased risk attri-butable to induced abortion.

But when compared to women with a family history of breast cancer but no abortions, women with a family history and any abortions were found to be not at a 20% increased risk but an 80% increased risk of breast cancer.

My recommendation to the pediatricians at the American Academy of Pediatrics meeting that even a "pro-choice" pediatrician should decline an abortion referral for a teenager whose mother had had breast cancer, not surprisingly, was provocative.

One pediatrician labeled this "patriarchal." He argued that the doctor is obliged to give the patient "all the facts and help her make the decision." Breast cancer, he said, is just "one bit of risk in a decision where there are many other factors involved," factors such as "whether she will get a good job and a good education," and the like.

In my reply, I suggested that the good doctor would decline to give a patient a non-prescription medication such as aspirin for a headache, if the cause of the headache was head trauma, and there was risk of bleeding in the brain.

Another pediatrician suggested that it is the doctor's duty "to present the data and allow them [the patients] to make an informed choice, no matter how bad you think that choice might be." I asked whether the doctor would always grant a prescription to any patient who, despite being advised that it was contraindicated, insisted on having it anyway.

It was certainly a useful and sincere dialogue. I believe these doctors were beginning to see how their own thinking had been shaped by the pervasive pro-abortion culture and how they may have allowed the rhetoric of "choice" to trump sound medical advice and practice.

The abortion culture has had over three decades to pervade every nook and cranny of modern life, and it will surely be a long road back. That the doctors are beginning to show a willingness to examine honestly the effect of abortion on their own profession is indeed a hopeful sign.

Joel Brind, Ph.D., is the editor and publisher of the Abortion-Breast Cancer Quarterly Update and founder and president of the new Breast Cancer Prevention Institute in Poughkeepsie, New York.