Abortion and Breast Cancer:

Truth loses first round in North Dakota

By Joel Brind, Ph.D.

Having originally been set for September 11, 2001, the trial of Amy Jo Kjelsrud v. Red River Women's Clinic took place the last week of March (see April NRL News, page 30). At issue was the abortion clinic's advertising brochure--typically distributed to prospective clients by referring physicians--that severely minimized when it did not dismiss outright the possibility of an abortion-breast cancer link (ABC link).

Over most of the three and a half day trial experts (including myself) presented extensive testimony on the science that underlies the link. So how could it be that before the week was out, Cass County District Court Judge Michael McGuire ruled that the clinic's brochure was "not false or misleading in any way"?

A large part of the answer is that the clinic got big-time help from the National Cancer Institute (NCI), including an extremely timely new fact sheet issued just before the trial began.

The NCI is the huge federal agency within the Department of Health and Human Services which funds most of the cancer research in the United States. The agency also spends a fair amount of its budget on the publication of information on cancer risks. It publishes a number of "cancer facts" fact sheets on its Internet web site, including one on the ABC link.

While the NCI's fact sheet has undergone some changes since it first appeared in 1996, it has been consistent in misrepresenting the scientific literature on the subject, concluding that evidence for the link was equivocal at best. In fact, not only does the ABC link show up statistically in most studies, but it also makes biological sense as well.

The first two trimesters of a normal pregnancy expose a woman's breasts to huge amounts of estrogen, which makes breast cells multiply. Cells, previously dormant, rapidly grow into a system of branching ducts and gland cells capable of producing milk. Once this growth, change, and maturation is completed, the chance of developing cancer is much less. However, if pregnancy isn't completed, the immature cells are still capable of being stimulated to grow - - and therefore have much more potential to become cancerous.

Getting back to the fact sheet, the pressure of congressional oversight had forced the NCI to retract its most egregious misstatements. One flagrant falsehood was, "There is no evidence of a direct relationship between breast cancer and either induced or spontaneous abortion." [emphasis added]

In the face of studies that by a three to one margin show evidence that there is a link between an induced abortion and an increased risk of future breast cancer, that's rather beyond the pale. The statement was modified in 1996, with the insertion of the qualifier "convincing," as in "there is no convincing evidence" of a direct relationship. The fact sheet went on to say, "Available data are inconsistent and inconclusive." This is still misleading, of course, but hardly as demonstrably false as the stark claim of "no evidence."

The abortion clinic's brochure which was at issue in the North Dakota case, however, relied on the obsolete and false wording of the old NCI fact sheet which claimed "no evidence." This language was actually put into the clinic's brochure in 1999--in fact, after the suit was filed. This wording remains in the clinic's brochure today, and it was the major bone of contention at the trial.

But just three weeks before the trial--what a coincidence--the NCI's fact sheet on the ABC link went from bad to worse. Between 1999 and March 4 of this year, the wording morphed from "data are inconsistent," to "results were inconsistent," to the latest and most dismissive characterization: "The current body of scientific evidence suggests that women who have had either induced or spontaneous abortions have the same risk as other women for developing breast cancer."

Predictably, the clinic's defense attorneys wasted no time in using the NCI's more explicit denial. And to underscore just how successful the NCI has been in misleading the public, it was clear from his ruling that Judge McGuire was thoroughly confused even about one aspect of the ABC link that was not even in dispute!

Even the NCI fact sheet acknowledges that the age of first full- term pregnancy is a "well established risk factor" for breast cancer. That is to say, the younger the woman is when she delivers her first baby, the greater her protection against subsequently contracting breast cancer. When a childless woman aborts, by definition she raises the age at which she'll complete her first full-term pregnancy. This risk-lowering (protective) effect of full-term pregnancy is universally acknowledged to be a long-term boon.

But somehow, Judge McGuire became convinced that this lifelong protective effect only lasts a few years after the completed pregnancy. No doubt the fact that the judge (legally, the fact finder in the case) was confused about some essential facts will figure strongly in an appeal of his decision.

Meanwhile, the new NCI fact sheet remains posted on the Internet. It is misleading in several ways:

First of all, it confuses the most fundamental fact, namely, what an abortion is. Over and over again, the fact sheet talks about "spontaneous or induced abortion," as if these terms are equivalent. They are not!

Never does the article note that spontaneous abortion is synonymous with miscarriage something many women do not know. In fact, the word "miscarriage" never appears at all!

Miscarriages generally do not increase breast cancer risk because estrogen production is low in such pregnancies. Thus, if spontaneous and induced abortions are lumped together in summarizing research data, no significant link emerges.

Second, there is the material omission of the most important and convincing studies published on the ABC link. For example, the 1994 study (commissioned by the NCI, no less) by Dr. Janet Daling et al., and published in the NCI's own journal, is no longer mentioned in the fact sheet.

That study found an overall increased risk of 50% among women who had any induced abortions. Daling's study also found more than 100% risk increases for women with abortions either before age 18 or after age 30. Women with any family history of breast cancer and an abortion before age 18 experienced vastly higher risks. These latter ominous findings of the Daling study never made it onto the NCI fact sheet.

Neither did the 1989 study by Holly Howe et al. of the New York State Department of Health. The Howe study found a 90% increased risk of breast cancer among women with any abortions.

Importantly, it was based entirely on medical records of abortion, rather than on women's recall of the event. The NCI's fact sheet makes a very big deal about such studies as being more reliable, but the Howe study reported a politically incorrect result.

Regarding the putative unreliability of studies based on women's recall of their abortion history, the NCI fact sheet claims that self-reports of abortion history "have been shown to differ between breast cancer patients and other women." Supposedly, women who have breast cancer are more "honest" about having had an abortion.

But not only is this untrue, the study cited on the fact sheet to back it up--the 2000 study by Tang et al.--concludes exactly the opposite: "The authors' data do not suggest that controls are more reluctant to report a history of induced abortion than are women with breast cancer."

Finally, the NCI fact sheet continues to rely heavily on the fatally flawed 1997 study by Melbye et al. that supposedly debunked the link between induced abortion and breast cancer. However, this study, although based on medical records, misclassified 60,000 Danish women who'd had abortions as not having had any. How? By ignoring all the legal abortions that occurred in Denmark before 1973.

The Melbye study also suffered from other gross violations of scientific procedure, such as padding the database with over 350,000 women under age 25--too young to get breast cancer, but old enough to have plenty of abortions, to name one.

Not surprisingly, then, bad science translates into bad public policy and bad law.