Abortion and breast cancer: update on evidence of a causal

association

Joel Brind, Ph.D.Professor of Human Biology and

Endocrinology

Baruch College, CUNY, New York, NY and

Breast Cancer Prevention Institute,

Somerville, NJ

[GANN, Vol. 48, Supplement; April, 1957]

AN EPIDEMIOLOGICAL STUDY ON CANCER IN JAPAN

The Report of the Committee for Epidemiological Study on Cancer,Sponsored by the Ministry of Welfare and Public Health

(Chairman: Dr. Tomosaburo Ogata)

Tabulated and analysed by

M. SEGI, I FUKUSHIMA, S. FUJISAKU, M. KURIHARA,S. SAITO, K. ASANO and M. KAMOI

(Department of Public Health, Tohoku University Medical School, Sendai, Japan)

April, 1957

Bull. Org. mond. SantéBull. Wld Hlth Org.

Age for First Birth and Breast Cancer Risk *B. MACMAHON, P. COLE, T. M. LIN, C. R. LOWE, A. P. MIRRA, B. RAVNIHAR,

E. J. SALBER, V. G. VALAORAS & S. YUASA

1970, 43, 209-221

“Differences between cases and controls with respect to frequency of abortion were observed in only a few centres and were in the direction which suggested increased risk associated with abortion — contrary to the reduction in risk associated with full-term births.”

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Epidemiological measures of relative risk

(RR; the relative likelihood of having a given disease—such as breast cancer—if one has had a particular exposure—such as induced abortion– compared to those who have not had the exposure).

If a factor has a:

RR 1.0 – there is no or in risk RR 1.5 – there is a 50% in risk RR 2.0 – there is a 100% in risk RR 0.5 – there is a 50% in risk

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Br. J. Cancer (1981) 43, 72

ORAL CONTRACEPTIVE USE AND EARLY ABORTION AS RISK FACTORS FOR BREAST CANCER IN YOUNG WOMENM. C. PIKE, B. E. HENDERSON, J. T. CASAGRANDE, I. ROSARIO AND G. E. GRAY

From the Department of Family and Preventive Medicine, University of Southern California,School of Medicine, Los Angeles, California, U.S.A. -- Received 27 August 1980 Accepted 14 October

1980

Summary.— A case-control study was conducted in Los Angeles County, California, of 163 very young breast-cancer cases (all aged 32 or less at diagnosis) to investigate the role, if any, of oral contraceptives (OC) in the development of the disease. OC use before first full-term pregnancy (FFTP) was associated with an elevated risk, which increased with duration of OC use (relative risk ~ 2.2 at 6 years of use, P<0.01). This increased risk could not be explained by other risk factors. OC use after FFTP was not associated with any change in risk. A first-trimester abortion before FFTP, whether spontaneous or induced, was associated with 2-4-fold increase in breast-cancer risk (P<0.005).

“A first-trimester abortion before FFTP, whether spontaneous or induced, was associated with 2.4-fold increase in breast-cancer risk (P<0.005).”

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Br. J. Cancer (1982) 45, 327

ORAL CONTRACEPTIVE USE AND ABORTION BEFORE FIRSTTERM PREGNANCY IN RELATION TO BREAST CANCER RISK

M. P. VESSEY, K. McPHERSON, D. YEATES AND R. DOLLFrom the Department of Community Medicine and General Practice and the Imperial Cancer Research Fund Cancer Epidemiology and Clinical Trials Unit, Radcliffe Infirmary, Oxford OX2 6HE

Received 6 November 1981 Accepted 20 November 1981

Summary.—A recent publication from California in this journal has suggested that both prolonged oral contraceptive use and abortion before first term pregnancy increase the risk of breast cancer in young women. Data was presented on 1176 women aged 16-50 years with breast cancer, interviewed in London or in Oxford, together with a like number of matched control subjects. The results are entirely reassuring, being, in fact, more compatible with protective effects than the reverse. Possible reasons for the differences between the 2 sets of data are discussed.

“The results are entirely reassuring,”

“Only a handful of women…”

Journal of the National Cancer Institute, Volume 86, No. 21, Nov. 2, 1994

“Results: Among women who had been pregnant at least once, the risk of breast cancer in those who had experienced an induced abortion was 50% higher than among other women.”

EDITORIALS

Induced Abortion and Breast Cancer:More Scientific Data Are Needed

Lynn Rosenberg

“…the overall results as well as the particulars are far from conclusive, and it is difficult to see how they will be informative to the public.”

“A major concern, especially because the observed effect was small, is the possibility of reporting bias.”

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

But note that the authors invented the term “overreporting”, that breast

cancer patients had imagined abortions that had never taken place!

Also note how those who deny the ABC link still rely on this Swedish study to support the reporting bias explanation, but ignore the fact that the preposterous claim of “overreporting” was retracted in 1998!

The fact is that retrospective studies are relied upon all the time in epidemiology, with effective safeguards in place. For example, those who interview the study subjects to collect the data on reproductive history other variables are blinded as to the status of the subjects. That is, they do not know, at the time of the interview, whether they are interviewing a patient or a control.

Moreover, the most well done prospective ABC link study—the study by Howe, et al. in 1989—reported a significant 90% risk increase:

Odds ratios (OR) were significantly elevated among those with an induced abortion (OR=1.9)

Even though the reporting bias hypothesis has been repeatedly and publicly disproved—as documented in our meta-analysis—it is still used routinely to deny the ABC link!

During the past decade, study after study has been published based on prospective data, but with such monstrous flaws as to render their conclusions entirely invalid.

“In 1973, the legal right to an induced abortion through 12 weeks’ gestation was established for women with residence in Denmark … The induced abortions included in this analysis (were) those occurring between 1973 and 1992”.

“Follow-up for breast cancer for all the women began on April 1, 1968 or on their 12th birthday, whichever came later.”

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British Journal of Cancer (1999) 20(3/4), 600-613©1999 Cancer Research CampaignArticle no. bjoc.1990.0399

Preterm delivery and risk of breast cancer

M Melbye, J Wohlfahrt, A-MN Andersen, T Westergaard and PK Andersen

Danish Epidemiology Science Centre, Statens Serum Institut, 5 Artiltervej, DK-2300 Copenhagen S, Denmark

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Table 2 Adjusted relative risk of breast cancer in 474, 158 parous womenAccording to gestational age at delivery

Gestational No of cases Person-years RR (95% CI)Age (weeks (in thousands)

<29 7 9 2.11 (1.00-4.45)29-31 13 17 2.08 (1.20-3.50)32-33 11 26 1.12 (0.62-2.04)34-35 22 58 1.08 (0.71-1.56)36-37 82 214 1.04 (0.83-1.32)38-39 350 949 1.02 (0.89-1.17)40 552 1526 1>40 326 985 1.03 (0.90-1.18)*Adjusted for age, calendar period, parity and age at first childbirth.

Some reasons for eliminating 10 previously published studies showing an ABC link

1.1. ““Principal investigators…could not be traced”

2. “original data could not be retrieved by the principal investigators”

3. “researchers declined to take part in the collaboration”

4. “principal investigators judged their own information on induced abortion to be unreliable” (even though it had been vetted by peer review and published in a prominent medical journal).

Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83,000 women with breast cancer from 16 countries

Lancet, March 27, 2004

Journal of Epidemiology and Community Health 1996;50:481-496 481

Induced abortion as an independent risk factor for breast cancer: a comprehensive review and

meta-analysis

Joel Brind, Vernon M Chinchilli, Walter B Severs, Joan Summy-Long

Department of Natural Science, Baruch CollegeThe City University of New York17 Lexington AvenueNew York, NY 10010, USAJ Brind

Center for Biostatistics and Epidemiology and Department of PharmacologyPennsylvania State UniversityThe Milton S Hershey Medical CenterHershey, PA 17033, USAV M ChinchilliW B SeversJ Summy-Long

Correspondence to:Professor J BrindAccepted for publicationApril 1996

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10. Changing the design, methodology or results of a study in response to pressure from a funding source.

We surveyed several thousand early and mid-career scientists, who are based in the United States and funded by the NationalInstitutes of Health (NIH), and asked themto report their own behaviours. Our findingsreveal a range of questionable practices thatare striking in their breadth and prevalence.

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NCI Scientific Panel Concludes Abortion Has No Impact on Breast Cancer Risk Abortion Has No Impact on Breast Cancer Risk By Rachael Myers Lowe, cancerpage.com (March 3, 2003) –

A scientific panel of the National Cancer Institute has concluded there is no connection between abortion and risk of breast cancer; having had an abortion neither raises nor reduces the risk of developing breast cancer.

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Leslie Bernstein, Ph.D., of the Keck School of Medicine at the University of Southern California, presented the findings. In an interview with reporters after the advisory board briefing, she said even though the findings clearly show that “the biggest bang for the buck is the first birth and the younger you are the better off you are, ” women should not necessarily make life-altering decisions based on these findings.

“There are so many other messages we can give women about lifestyle modification and the impact of lifestyle and risk that I would never be a proponent of going around and telling them that having babies is the way to reduce your risk.” (To listen to Bernstein's remarks, click here.)

“I don’t want the issue relating to induced abortion to breast cancer risk to be part of mix of the discussion of induced abortion, its legality, its continued availability.  I think it should not be part of the argument,” Bernstein says.  (To hear more of Bernstein's remarks, click here) http://www.cancerpage.com/news/article.asp?id=5601

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Table 4: Results of logistic regression model for factors associated with Breast cancer risk.______________________________________________________________ Factors* OR (95%CI) P value______________________________________________________________

Age (>50) years 2.61 (2.20—3.11) <0.001

______________________________________________________________

Induced abortion 1.66 (1.30—1.98) < 0.001

Oral contraceptive use 0.60 (0.48—0.74) < 0.001______________________________________________________________*The significant risk factors in Table 3 with a distribution frequency >10% including age >50, induced abortion, BMI >25, education >13 years, spon- taneous abortion, smoking, breast feeding, oral contraceptive use and nulli- pars were further evaluated in the multivariate logistic regression analysis.

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Asian Pacific J Cancer Prev 2007;8:395-398

Am J Pathol 1980:497-512

Biological Facts Most breast cancers start in Type 1 and

2 lobules Breast cancers do not start in Type 3

and 4 lobules Induced abortions result in increased

numbers of Type 1 and 2 lobules Full-term pregnancies result in

increased numbers of Type 3 and 4 lobules

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Type 1 Lobule(TDLUs)

85% of all breast cancers arise Type 1 Lobules (Ductal cancer)

Type 2 Lobule

10% of all breast cancers arise in Type 2 Lobules

(Lobular cancer)

Type 3 Lobule

Cancer resistant when they are the result of regression of Type 4 lobules

Types of Breast Lobules

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January 2007

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Breast lobule maturation before and after first pregnancy

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The “susceptibility window” The “susceptibility window” The period between puberty and a full-term

pregnancy

The time the breast is most susceptible to forming cancer

I.e., when the woman’s breast is composed primarily of Type 1 and 2 lobules.

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The breast maturation process through a normal full-term pregnancy

By the end of the 1By the end of the 1stst trimester: trimester:

During the maturation of Type 1 lobules into Type 2, the actual numbers of these lobules will increase while the surrounding tissue (stroma) decreases.

The breast now has more places for cancers to start.

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The breast maturation process through a normal full-term pregnancy

By the end of the 3By the end of the 3rdrd trimester: trimester:

The breast is now:

85% Type 4 lobules

15% immature cancer susceptible lobules

There are now fewer places for cancer to start.

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J. KUNZandP.J. KELLER

Department of Gynaecology and Obstetrics,University of Zurich, Switzerland

British Journal of Obstetrics and GynaecologyAugust 1976. Vol 83 pp 640-644

Journal of the National Cancer Institute, Volume 86, No. 21, Nov. 2, 1994

“Results: Among women who had been pregnant at least once, the risk of breast cancer in those who had experienced an induced abortion was 50% higher than among other women.”

45Journal of the National Cancer Institute, Volume 86, No. 21, Nov. 2, 1994

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Conclusions

At least three causal connections between induced abortion and breast cancer incidence have been well established by over 50 years of published epidemiological evidence, supported by every other line of published biological and medical evidence. Such evidence has resulted in a very detailed understanding of the role of pregnancy in normal breast development and the development of cancer.

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The three connections are:

1. Termination of the pregnancy before 32 weeks gestation deprives a woman of the risk-lowering effect of full-term pregnancy.2. The burst of growth stimulation during the pregnancy before it is terminated leaves a post-abortive woman with more places for cancer to start.3. Abortion leaves a woman with a higher risk of verypremature delivery (before 32 weeks) in subsequent pregnancies, which increases risk in the same way as induced abortion.

A 4th connection may also be added: The risk loweringeffect of breastfeeding, which cannot occur after a pregnancy terminated by abortion.

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Conclusions (cont’d)

The cover-up of the abortion-breast cancer link (ABCLink) has also been well established by the published evidence for over 25 years, which has acceleratedover the past decade.

Since 1997, a continuing stream of publications in prestigious medical and epidemiological journals,issuing from prestigious research institutions and sup-ported by the highest government agencies such as theNational Cancer Institute and voluntary institutions such as the American Cancer Society, has embodiedjunk science at its worst: Deliberate conflation of induced and spontaneous abortion, which are physio-logically different events, mischaracterization of the published record, the statement of outright falsehoods, And all manner of illicit data manipulation have been documented in medical and scientific journals.

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