Thirty Years After Roe v. Wade:
The Abortion Breast Cancer Link

Call To Reason, by Dr. Angela Lanfranchi

Thirty years ago when Roe v. Wade was decided, I was right here, a third year medical student at Georgetown. The third year is when medical students leave the classroom and go into hospitals to do their clinical rotations. The ruling had an immediate effect on the practice and ethics of medicine. No longer would my obstetrics professor tell his students that his was a unique specialty, that he always had two patients to consider, mother and child. Now only when the mother wanted the child did we treat two patients. When the mother didn’t want the child, no consideration would be given to the unborn’s humanity. It was no longer a child but a blob of tissue, a “product of conception,” a parasitic entity or whatever the mother chose to call “it.” For the first time, every doctor in every state could legally kill another human being. On my pediatric rotation that year, I helped to resuscitate a child who was born four months prematurely crying aloud, struggling to breathe. She was the result of a failed abortion. She was wizened and burned from the hypertonic saline used to try to kill her on the hospital floor just below the nursery. I can still see her clearly in my mind’s eye.

One and a half years after Roe v. Wade, when I graduated, something else very profound had happened. The Hippocratic Oath we took, that had stood medicine in good stead for 2400 years, had been changed. The part about refusing to give a woman a pessary to induce an abortion had been deleted.

Ten years after Roe v. Wade I watched my mother fight and lose her battle with breast cancer. Added to her physical torment was her mental anguish at the thought of leaving my youngest brother before he was fully grown.

Twenty years after Roe v. Wade, I was settled into a surgical practice devoted to breast cancer. I found that breast cancer risk was no longer 1 out of 12 women, as I had learned in medical school, but had increased dramatically to 1 out of 8. Not only that, but all the women were no longer post-menopausal grandmothers but young 30-year-old mothers with toddlers. I knew from my own painful experience what they would face.

The Roe v. Wade ruling not only changed the oath I took at graduation, but also my practice. Each of you in this audience knows a person with breast cancer personally or through friends and family. Breast cancer is the only major cancer whose incidence has continued rising. Most of this increase has occurred in members of my own generation, those women who were 25 to 39 when Roe v. Wade was decided.

It is estimated that an additional 10,000 cases of breast cancer occur each year due to abortion. Abortion is a risk factor for breast cancer. I see it every day in my practice. Thirty percent of my breast cancer patients who are in their thirties do not have a family history of cancer, but have had an abortion.

I am going to explain to you how the abortion-breast cancer link, which I will refer to as the ABC link, is supported by the published epidemiological studies, the physiology of the breast, and the experimental studies done in mammals. Next, I will address the arguments used to refute the ABC link by demonstrating flaws in the studies and arguments pro-abortionists use. I will then attempt to explain why organized medicine has failed to acknowledge the ABC link and the social and political climate that causes the information to remain unknown by the public. Lastly, I will show the signs of hope that this life-saving information will become more widely known and accepted.

Epidemiological studies overwhelmingly support the ABC link. However, to put them into proper perspective, one must understand why some have referred to epidemiology as a “pseudo-science.”

Epidemiology can be defined as the study of disease in large populations. These studies can never be taken as proof positive that any risk found is causal. For example, large studies would probably show unequivocally that more people with lung cancer carry matches in their pockets than those without cancer. This would not mean that matches cause lung cancer, even though large studies were done well, and were statistically significant and reproducible. Biology has shown that it is the carcinogens in match-lit cigarette smoke that cause lung cancer. Similarly, without the support of the well-known breast physiology and experimental data, the studies would be inconclusive.

Epidemiologists have defined five criteria that should be largely satisfied before a risk factor can be considered a potential causal risk.

These are the five criteria:

1. The patient must be exposed to the risk before the cancer develops.

Now this appears to be so obvious that one would question why it needs to be mentioned. However, there is a well-known published study that violates this most basic criteria.

2. There must be similar findings in many studies.

One or two studies can never be taken to prove anything. In the case of the ABC link, 28 out of 35 worldwide studies show a link between abortion and breast cancer. 13 out of 15 studies done in the U.S. show a link.

3. There must be statistically significant increases.

Scientists need to show with 95 percent certainty that their results could have not occurred by chance alone. There are 17 statistically significant studies that show a link between abortion and breast cancer and eight were done in the U.S.

4. There should be a dose effect, that is, the risk should be higher with more exposure to the risk.

In the case of cigarettes and lung cancer, the more cigarettes one smokes, the greater the risk of lung cancer. In the case of abortion, the longer one is pregnant before the abortion, the higher the risk of breast cancer. This was shown in the 1994 Daling study commissioned by the National Cancer Institute and reported in their journal.

5. There should be a large effect observed.

In the case of abortion and breast cancer there are subsets of women with very high risks. For example, in the 1994 Daling study, all the teenagers who had abortions at 18 or younger and had a family history of breast cancer, developed breast cancer by the age of 45. The risk could not be calculated and was reported as infinity.

Now even having satisfied these criteria, the ABC link would still not be proven unless there was a sound biologic basis for this risk. All the studies in the world showing that lung cancer occurs most frequently in people who carry matches in their pockets does not mean matches cause lung cancer. I believe that the biologic basis for the ABC link is the most powerful and persuasive argument supporting it.

The same biology that accounts for 90 percent of all risk factors for breast cancer accounts for the ABC link.

Simply stated, the biology rests on two principles.

1. The more estrogen a woman is exposed to in her lifetime, the higher her risk for breast cancer.

2. The younger a woman matures her breast from Type 1 and 2 lobules to Type 3 and 4 lobules the lower her risk.

If a woman starts her menstrual cycles early at age nine and continues to menstruate into her late fifties, she is at higher risk as she has more years exposed to monthly estrogen elevations. Through a large, recent, well-publicized study, women became aware that the estrogen in their hormone replacement therapy increased their breast cancer risk. In a similar way, birth control pills elevate breast cancer risk.

Type 1 and 2 lobules are known to be where cancers arise. Type 3 and 4 lobules are mature and resistant to carcinogens. When a child is born, she has only a small number of primitive Type 1 lobules. At puberty when estrogen levels rise they form Type 2 lobules. But it is only through the hormonal environment and length of a full-term 40 week pregnancy that there is full maturation to Type 3 and 4 lobules. This maturation protects a woman and lowers her risk of breast cancer. This is why women who undergo a full-term pregnancy have a lower risk of breast cancer and why women who remain childless have a higher risk of breast cancer.

It is the interplay of these two principles, estrogen exposure and breast lobule maturation, that accounts for the fact that abortion can cause breast cancer. Within a few days of conception, a woman’s estrogen level rises. By the end of the first trimester estrogen levels have increased by 2000 percent. Every woman notices her breasts get sore and tender because the estrogen stimulation results in the multiplication of Type 1 and 2 lobules. It is only after 32 weeks that her breasts stop getting larger and mature into Type 3 and 4 lobules in preparation for the breastfeeding of her child. If abortion ends her pregnancy before full maturation of her breasts, she is left with an increased number of the immature Type 1 and 2 lobules. She now has a greater number of breast lobules where a cancer can arise. This causes her to be at greater risk for breast cancer. It is through this same biologic mechanism that any premature birth before 32 weeks more than doubles breast cancer risk.

I will now mention the experimental data in rats done over 20 years ago that supports this biology in other mammals. Aborted rats have a 77 percent chance of developing breast cancer when given the carcinogen DMBA. None of the rats that had a litter of pups prior to receiving DMBA developed breast cancer. These rats enjoyed the protective effect of a full-term pregnancy.

I challenge anyone to find a risk factor for breast cancer with more documentation than this one that hasn’t been publicized by the government and cancer organizations.

I will now address those arguments used by pro-abortionists to dismiss the ABC link.

The most widely and oft-reported argument used is that of recall bias. Recall bias is the hypothesis that women who have breast cancer will be more likely to admit they have had an abortion because they’re looking for a reason why. It supposes that most women who do not have cancer will not report their abortion. This would cause a study to be inaccurate.

This has been studied in many ways and has never been found to exist. A 1991 study was done in Sweden to specifically look for recall bias, and was reported as finding evidence supporting it. The researchers had both cancer and abortion computer registries so that they could verify the responses of the women who were interviewed. Their conclusions are as follows:

“Analysis demonstrated … an observed ratio of 22.4 (p<0.007) between underreporting of previous induced abortions among controls relative to overreporting among cases.”

This means that if a woman told a researcher she had had an abortion which had not been reported in the computer registry, the researcher believed her to be mistaken or lying. It was as if the researcher had said to the woman, “Sorry lady, the computer says you did not have an abortion, the computer is right, you’re wrong, you’ve overreported having an abortion.” This, of course, is ludicrous. Only with the assumption of overreporting, could the authors conclude that they had significant evidence of response bias. Overreporting does not exist. The researchers were forced to acknowledge their error through letters to the editor. Women would never be mistaken about whether or not they had had an abortion.

A 1994 study confirming the ABC link was done on Greek women. This study checked for and found no evidence of recall bias. One week after it was submitted for publication, one of its authors, Karen Michaels, stated in the New York Times that the 1994 Daling study, which confirmed the ABC link, did so because of recall bias. This demonstrates most clearly what kind of bias really is the issue.

Some go so far as to publish lies such as that all the studies that show the ABC link are tainted by recall bias. The National Abortion Federation web site states that only cohort studies that rely on computerized records, free of recall bias, are accurate. They fail to mention the 1989 study on New York State women under 40 that showed a 90 percent increase in risk of breast cancer and was based solely on computerized records.

Another argument used to refute the ABC link is that there is one large and flawless study, the 1997 Melbye study, referred to as the Danish study, that negates all other studies to the contrary. It is touted as a large study with 1.5 million women, but in reality only about 350,000 had breast cancer, an abortion or both. The study stated that abortion was legalized in 1973. Danish records show that abortion was legalized in 1939 and therefore 60,000 women who had abortions between 1939 and 1973 were listed as not having an abortion when they had. These were the oldest women in the study who were the most likely to have developed breast cancer. This skewed the results to reduce the effect of abortion.

Another factor skewing the results is based on the biology of breast cancer. It takes on the average eight years for a cancer cell to grow into a clinically detectable cancer of about half an inch. If an abortion in an 18-year-old causes a breast cancer cell to form, it is not likely to be detectable until she is at least 26 years old. Fully 25 percent of the patients in the Melbye study were 25 years old or less when the study ended and accounted for only eight cases of breast cancer.

And yet despite all of this, Melbye found a statistically significant increased risk of breast cancers with second trimester abortions. The risk increased 3 percent for each week of gestation before abortion, more evidence of the biology and dose effect of this risk. And unlike the risk of cigarettes where tens of thousands need to be smoked to increase risk, only one abortion could give that woman a life-threatening disease.

The most egregious of the flaws of the Melbye study was the one already mentioned. Melbye violates the most basic of the criteria needed for a valid study, which is that the risk, abortion, must precede the development of the disease, breast cancer. Melbye collected breast cancer cases for five years, from 1968 to 1973, when by his own methodology none of these women could have been exposed to abortion, again skewing the results. He didn’t start collection of abortion cases until 1973. The risk must always precede the disease in a valid study.

Now that recall bias and the Melbye study have been refuted, pro-abortionists need other tactics to dismiss the ever more apparent truth of the ABC link. When science is not on your side, you can resort to name-calling. Pro-lifers that disseminate the truth are fearmongers. Editors collectively dismiss 28 studies done worldwide by different research groups as junk science.

The most recent and most disturbing tactic comes from those that will use a half-truth to eviscerate the abortion-breast cancer link. Half-truths always work well on the uninformed. They seem reasonable. Logical. But using a half-truth is no different than telling a lie. There are those that say that yes there is an increased risk of breast cancer among patients who choose abortion, but it is because those women don’t get the benefit of risk reduction by completing the pregnancy. That makes their situation comparable to a woman who chooses to start a family later in life. She’s merely delayed a pregnancy and is no worse off with an abortion than if she had never become pregnant at all. How very clever an argument if you mean to mislead. I would say to any physician alleging this - what about those women who more than double their risk of breast cancer through premature births before 32 weeks? Isn’t an abortion a physician-induced premature delivery of an infant? Why would biology change because of the patient’s and abortionist’s intent? So if you ever hear someone say abortion can increase risk but that it is not an independent risk factor, listen very carefully because he’s either ill-informed or has another bias.

The question now arises, why if this is so true, that abortion increases breast cancer risk, would organized medicine not support the data. One reason is fear of the results of peer pressure. In my own case, I have worried that I would lose referrals from ob-gyns who do abortions when I have lectured on this topic. Even a family doctor who would refer numerous patients said to me ‘you don’t tell my patients that, do you?’ I worried about my practice. I was also worried about being labeled a pro-life zealot or an anti-choice fanatic. I can understand why a Harvard professor of risk assessment at a Boston cancer institute would tell me privately that she knew abortion was a risk factor for cancer but would not bring it up in her talks on risk. She might lose her job. I have a colleague who did lose an appointment at a New York medical school just because he was quoted in Lancet giving credence to a study supporting the ABC link.

Janet Daling, an adamantly pro-choice epidemiologist, told me she refused to speak on the topic anymore because she was tired of having rocks thrown at her. I learned what it felt like firsthand when I presented a research project in a poster session at the San Antonio Breast Symposium this past December. Although the abstract had been accepted 6 months earlier and had the word abortion in the title, the program director angrily accused me of using his meeting as a platform to hand out anti-abortion literature.

Most troubling is that several years ago the then-president of the American Society of Breast Surgeons told me that her board didn’t want to have a speaker on the subject at their meeting because they felt it was “too political.” I argued that it was also medical but to no avail. The director of the Miami Breast Cancer Conference also felt it was “too political.” He returned a check I had given him so that our Breast Cancer Prevention Institute couldn’t even have an exhibit table. I am waiting for a response from the American College of Surgeons. I hope they too won’t deem it “too political.” What is so telling is that not one authority in the field of breast cancer that I have spoken to directly has said that the data isn’t true, that I was wrong about the science.

Perhaps another reason physicians haven’t acknowledged the link is the Semmelweiss Phenomenon. In 1840, 40 years before the germ theory was known, a resident in obstetrics noted that there was a 25 percent mortality rate from childbed fever on the doctors’ ward. On the midwives’ floor, where there was frequent hand washing, the mortality rate was only 2 percent. When at his suggestion an experiment was done by having doctors wash their hands, the infection and death rate on their ward was greatly reduced. Instead of rewarding Semmelweis and promoting hand washing to reduce mortality, he lost his job and was vilified. It seems that it was easier for doctors to let women die than to change their own practices. They would have had to acknowledge that the midwives had provided better care and that professors had been corrected by a lowly resident.

Fear of litigation may be another reason. A case has been settled in Australia in favor of the plaintiff. She was not warned about the risk of breast cancer and damage to her mental health before her abortion. Other cases are pending both here and Down Under.

Women’s groups such as the National Organization for Women have not brought the information out. The idea of safe and legal abortion is the foundation of their cherished reproductive rights. What if it became known that abortion is not safe but lethal to some women exercising their right?

The abortion industry does not want to lose clients for its billion-dollar industry, so their trade organization, the National Abortion Federation, tries to dismiss it.

Public knowledge of abortion as a risk factor for breast cancer will not only help women obtain true informed consent, it also helps women who have had an abortion. Once a woman knows she’s at higher risk, she will get screened with mammograms. This can increase survival should she develop cancer.

Even if someone remains unconvinced of the causal nature of the abortion-breast cancer link, surely no one can feel that there is insufficient evidence that women should not be informed of this possibility. It is unconscionable that women’s lives and health are sacrificed to maintain political correctness.

I am glad to report there are signs of hope. This past June the National Cancer Institute took down its inaccurate and misleading fact sheet on the ABC link on its web site. Twenty-eight Congressmen had sent a letter to the NCI’s Director pointing out the errors.

My older textbooks did not even mention abortion as a possible risk. The newer ones do, even if they try to dismiss the data as inconclusive. One very notable exception to this was a researcher who is still here at Georgetown, Professor Robert Dickson, who included it in his chapter on the molecular biology of breast cancer more than 10 years ago.

The issue is being discussed in the lay press. Crisis magazine, a Washington, D.C.-based publication, recently explored this issue in a feature article. There have been countless letters to the editor in newspapers all over the country by laymen and doctors. There have been billboards. Miss Oregon, Brita Stream, had as her platform the abortion-breast cancer link and went on to the Miss America pageant in Atlantic City this year.

This issue has also entered breast cancer research politics. The Coalition on Abortion Breast Cancer, an international lay organization, has made the public aware of this issue. They have made women aware that the Susan G. Komen Foundation, an organization that raises money for breast cancer research, also gives this money to Planned Parenthood. They pointed out to Komen and its donors that Planned Parenthood caused a significant amount of breast cancer as the nation’s largest abortion provider. This has placed pressure on the Komen organization to stop that practice with some success.

A month ago I saw in my office identical twin women. One had several abortions as a teenager and was 36 years old when she got breast cancer. I was able to reassure her worried sister, who had a child in her twenties, that she did not share the same risks as her twin and that most likely her biopsy would be benign, and it was. An analysis of my own patients in their thirties with breast cancer showed 30 percent had abortions but no family history.

I leave you with a quote by Dr. Stuart Donnan in an editorial. It was written in response to the furor raised by the most important paper written concerning the abortion breast cancer link. That paper is the 1996 meta-analysis done by Dr. Joel Brind. His paper prevented someone from saying, “Some studies say yes, some studies say no.” At the time of publication there were 17 out of a total of 23 studies that show a link. If it hadn’t been published I’d still be in my office wondering why I have so many 30 year olds with breast cancer.

The following is a quote from this editorial:

“I believe that if you take a view (as I do), which is often called ‘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.”

Dr. Brind likes to add “And that’s from an understated Englishman.” At the risk of political incorrectness, I would like to add, “God bless them both.”

This article is taken from a talk delivered at a symposium examining 30 years of abortion and its impact on women on November 16, 2002, at Georgetown University. Dr. Lanfranchi is a breast cancer surgeon and cofounder of the Breast Cancer Prevention Institute as well as codirector of the Breast Center at Somerset Medical Center.