THE FACTS

The Age - February 17 2003
http://www.theage.com.au/articles/2003/02/16/1045330466585.html
Breast cancer and abortion: the facts

It is not fear-mongering to give women the knowledge they need to make informed choices, writes Angela Lanfranchi.

When I first heard of the link between abortion and breast cancer, in 1993, I thought it was a pro-life fantasy. "That's crazy," was my initial response. However, out of curiosity I changed the history form I used in my work as a breast surgeon, asking each woman the order and outcome of all pregnancies. The results surprised me. In the first six months I had two patients in their 30s with breast cancer; one had had seven pregnancies and six abortions, the other five pregnancies and three abortions. I continued to see more and more young women with a history of abortion, developing breast cancer. Of course, I may have been witnessing a statistical fluke.

But then, in 1996, City University of New York Professor Joel Brind published his meta-analysis, which revealed 23 of 28 studies showing a link between abortion and breast cancer. The uproar that study caused in Britain, where it was published in the Journal of Epidemiology and Community Health, prompted the editor to write: "I believe that if you take a view (as I do) which is pro-choice, you need at the same time to have a view which might be called pro-information without excessive paternalistic censorship (or interpretation) of the data." Paternalistic censorship is what I experience every time I try to speak on the science supporting the abortion-breast cancer link.

About 85% of cigarette smokers do not get lung cancer. Doctors who tell their patients of the risk of lung cancer are not labelled fear-mongers. Similarly, not all women who have had an abortion will get breast cancer; only 5% will develop the disease. And 95% of breast cancer patients will not have a history of abortion. But some women are at especially high risk. And 5% still adds up to a lot of women. The 1994 Daling study published in the Journal of the National Cancer Institute showed that teenagers younger than 18 who had abortions between nine and 24 weeks had nearly a 30% chance of getting breast cancer in their lifetimes. The US National Cancer Institute's web page on reproductive risk informs women there are studies that show this link.

Many people ask me about first trimester miscarriage. This is quite different, in its effect on the woman's breasts, from induced abortion of a normal pregnancy. Miscarriages do not increase breast cancer risk, since they are associated with low oestrogen levels that do not cause breast growth. However, when pregnancy is terminated before the breast cells reach full maturity, a woman is left with more immature type 1 and 2 breast lobules (milk glands) than before her pregnancy started, and therefore is at increased risk. Her breasts never mature to type 3 and 4 lobules, which would have occurred in the third trimester and would have lowered her risk.

Ideology should not prevent the dissemination of this information. Australia's breast cancer organisations are not helping women exercise informed consent when they deny them this knowledge. There are three legal actions in the US by women who were not told of the link before having an abortion.

As Dr Janet Daling, who identifies herself as being pro-choice, says: "If politics gets involved in science, it will really hold back the progress we make. I have three sisters with breast cancer, and I resent people messing with the scientific data to further their own agenda, be they pro-choice or pro-life. I would have loved to have found no association between breast cancer and abortion, but our research is rock solid, and our data is accurate. It's not a matter of believing. It's a matter of what is."

Information only empowers women to make informed choices. Women who choose abortions need to be aware that they are at higher risk, so they will have mammograms earlier and more regularly. Cancers found on mammograms are more likely to be stage 1 and curable. No woman should die of breast cancer because she was not warned.

I watched my mother die of metastatic breast cancer. In my practice, I see young women with small children die of breast cancer. If the information I give patients can prevent a single death from a completely avoidable risk, I will gladly pay the price of being labelled a fear-monger.

Dr Angela Lanfranchi is a breast cancer surgeon, a fellow of the American College of Surgeons and clinical assistant professor of surgery at the Robert Wood Johnson Medical School in New Jersey. She is on a speaking tour of Australia, which is sponsored by, among others, several pro-life organisations.