Royal College Advises Abortion Practitioners that Link between Abortion and Breast Cancer "Could Not Be Disregarded"

By Joel Brind, Ph.D.

At an important press conference held at its offices in London, England, the United Kingdom's prestigious Royal College of Obstetricians and Gynecologists (RCOG) addressed the issue of the link between abortion and breast cancer in its new "Evidence-based Guideline No. 7: The Care of Women Requesting Induced Abortion."

Although the actual summary recommendation released March 15 is that "available evidence on an association between induced abortion and breast cancer is inconclusive," the section that summarizes the evidence showing that there is a link includes (between denials) a clear warning.

Part of the reason the review is so useful is that it briefly summarizes the two most thorough reviews of the literature investigating the link between abortion and breast cancer (ABC). One is the 1997 review by Wingo et al. and the other is "A Comprehensive Review and Meta-analysis," a 1996 paper prepared by myself and several colleagues. (A meta-analysis is a study which pools the results of several studies in order to achieve greater statistical accuracy.)

The Wingo review, a rather exhaustive review of the ABC literature, was written by a team of American Cancer Society epidemiologists. Although asserting that the conclusions of the ABC literature were "inconsistent" and that "definitive conclusions" were not yet possible, the authors presented the data in a clear fashion. The overall trend of the data in the direction of an increased risk is unmistakable.

In fact, I used the Wingo paper's graphic depictions of the data to help make the case for an ABC bill during a 1998 public hearing in New Hampshire.

In 1986, Dr. Wingo was with the Centers for Disease Control (CDC), a federal agency based in Atlanta, Georgia. During the 1980s, the CDC acted responsibly in sounding a precautionary warning about an elective surgical procedure-abortion.

At the time, she co-authored a letter published in the prestigious British journal The Lancet. The letter included the unequivocal statement: "Induced abortion before first term pregnancy increases the risk of breast cancer." This statement was based on the only two then-existing studies published on American women.

In 1982, the CDC's Dr. Willard Cates (by no means a man sympathetic to the pro-life position) published a review of the safety record of induced abortion in the high-profile journal Science. The final conclusion of the Cates paper is well worth repeating:

There is some concern about possibly higher risks of breast cancer in certain women. Accurate information will help policy-makers, medical practitioners, and those most directly concerned-women of childbearing age-to make rational decisions about this subject.

Keeping in mind that this 1986 clear warning was published when there was only one, preliminary study done in the United States, let's return to the 1997 conclusion of Dr. Wingo et al. that the ABC link was "inconsistent." In the intervening years, an additional 11 American studies were published which had examined the ABC link. Of the total of 12 studies, 11 showed increased risk of breast cancer.

Thus, it is disheartening that the RCOG (which includes abortion specialists), should embrace a vague conclusion similar to Dr. Wingo's in 1997. But it is encouraging that the RCOG report gives a fair representation of the 1996 meta-analysis.

To quote, "The conflicting review by Brind has examined the same studies and concluded that induced abortion is a significant, independent risk factor for breast cancer-with an odds ratio [i.e., relative risk] of 1.3...[i.e., 30% average higher risk]."

The RCOG report continues: "These two meta-analysis were independently assessed for the RCOG Group. The assessor concluded that both were carefully conducted reviews and that the Brind paper had no major methodological shortcomings and could not be disregarded." So far, so good.

However, next comes an unfortunate argument that so often is offered as a way to discount evidence clearly indicating an ABC link: so-called "response bias." This is the notion that women who have had breast cancer are more willing "to reveal whether or not they have had an abortion," thus misleadingly inflating the risk of breast cancer for women who have induced abortions. To support that inaccurate assumption, the RCOG booklet offers the familiar, flawed cohort studies done on Swedish and Danish women. Unfortunately, the RCOG report omits the 1989 study by Howe et al.-the one U.S. study conducted in a manner that made it immune to even the possibility of response bias. The Howe study reported a 90% risk increase in women who'd had an induced abortion.

Moreover, the Swedish group which had-back in 1991-claimed to have found evidence of response bias has since retracted-in 1998-the basis of that claim. (They had originally concluded that breast cancer patients "overreport" their history of induced abortion!)

On balance, it is encouraging that RCOG is at least willing to put a decent slab of truth in their denial sandwich. That is a lot further than U.S. public health authorities have been willing to come.

It is even more heartening to consider that RCOG is the agency that sets the standards of care for the actual abortion practitioners in the United Kingdom. Hence it is hard to imagine that admissions to the truth about the abortion-breast cancer connection by other high authorities can be far behind.