The abortion/breast cancer debate; some details

When I mentioned in my Tribune column about the need to be objective and open-minded about research that points to a positive link between induced abortion and breast cancer, the usual hell broke loose. I was told that studies and the votes of medical groups, such as the National Cancer Society, have settled the matter without qualification: There is absolutely, positively connection between the two.

Perhaps the most thorough explication of why this supposedly is so is provided by the American Cancer Society. It's long, but it should be read with the same respect that the other side of the debate deserves. It's here.

So, how can anyone in his or her right mind challenge it? I give you Karen Malec, of the Coalition on Abortion/Breast Cancer, who has been conducting a courageous campaign to provide women with  health information they ought to have before having an abortion. She has been accused of all sorts of bad things for steadfastly analyzing the data, but here she is, at my request, going head to head with the ACS on the issue:

The American Cancer Society is not telling women the truth when it says, "Studies have also shown that healthy women are less likely to report that they have had induced abortions." The ACS is suggesting there is a hypothetical problem known as report bias or recall bias with the design of retrospective studies, which rely on women's reports of abortion histories, instead of relying on medical records of abortion histories. According to this theory, the only reason why scientists are finding that abortion raises risk is not because abortion really does raise risk. Rather, it is because more women with breast cancer accurately report their past abortions than do healthy women.

This theory has been tested in a number of countries around the world, and there are no scientists at the present time who claim to have found credible evidence that it exists. The Breast Cancer Prevention Institute reports on its website, "In point of fact, several studies that have confirmed the ABC link internally controlled for recall bias in their study populations."
Additionally, two studies reporting an abortion-breast cancer link ruled out any possibility of recall bias. The best database in the country for studying the link is in New York because that state passed legislation requiring a fetal death certificate to be filed for every abortion. In 1989, Holly Howe and her colleagues published a study in the International Journal of Epidemiology using that database, and they matched fetal death records with breast cancer records. They reported a statistically significant 90% increased risk for women with abortions. (Dr. Brind* tried to get the database, but New York's state health department led by Antonia Novello wouldn't permit it, although as a researcher at a state university he was entitled to have it. They wouldn't permit it because they knew he would be able to prove his case with it.)
Opponents of the ABC link don't know what to do about the study, Howe et al. 1989. They either ignore it altogether or misrepresent it in medical journal articles (i.e. Karin Michels' team's study from Harvard mentioned below).

The other study that ruled out any possibility of recall bias is Patrick Carroll's research published in the Journal of American Physicians and Surgeons in 2007. He did a different kind of epidemiological study called an ecologic study, which relied on national health records. Records of abortions in Great Britain are considered almost complete. He found that abortion is the "best predictor" of future breast cancer trends. He proved he could successfully predict future breast cancer rates for England and Wales with nearly 100% accuracy for the years 2003 and 2004 by relying primarily on abortion rates and secondarily on fertility rates in his mathematical model.
Finally, National Cancer Institute branch chief Dr. Louise Brinton (chief organizer of the NCI's phony workshop on the ABC link in 2003) proved she doesn't believe what she and the NCI told women at the 2003 NCI workshop about recall bias. In so many words, they said, "Ladies don't believe all of those retrospective studies that found an abortion-breast cancer link because those data are flawed due to recall bias." She was a co-author of two of those so-called flawed studies in the 1990s.
Then, in 2007, for the first time a medical journal defined triple-negative breast cancer. So Brinton and Jessica Dolle and their colleagues said to one another in so many words, "Do you remember the 897 samples of cancerous tumors we saved from those 1990s studies? Let's do a study on the link between use of oral contraceptives and triple-negative breast cancer.  Let's test the cancerous tumors for triple-negative breast cancer and then match them up with the patients' reproductive histories (i.e. how many children they had, starting at what ages, did they breastfeed and did they have abortions, etc.)."
So in their 2009 study, Dolle, Brinton and their colleagues used data that Brinton and the NCI said during the phony 2003 workshop were flawed due to recall bias! They reported a statistically significant 40% increased risk for women with abortions, and that women who use oral contraceptives starting before age 18 multiply their risk of triple-negative breast cancer by 6.4 times. Recent users within the last 1-5 years multiply their risk of TNBC by 4.2 times.
Here is the kicker: When they designed the study, they included abortion and oral contraceptives "among known and suspected breast cancer risk factors." They concluded abortion and oral contraceptives are risk factors for the disease.
We sent a letter to Obama and leaders of Congress signed by a few scientists and doctors, some medical groups and pro-family organizations. We called for an investigation of the NCI in January 2010 because of its failure to report the breast cancer risks of induced abortion and oral contraceptives on a timely basis. We never received the courtesy of response.
The Danish study that the ACS mentions is Melbye et al. 1997. These authors found no overall increase in risk, but the study has received criticism in the Journal of American Physicians and Surgeons, the New England Journal of Medicine and the National Catholic Bioethics Center for having fundamental methodological flaws. For instance, 60,000 women with abortions were misclassified as not having had abortions. Even though the authors found no overall increase in risk, the Results section of the paper found a statistically significant 3% increased risk per week of gestation at the time of abortion so that by 18 weeks gestation researchers reported a statistically significant 89% increase in risk. Our opponents, including the ACS, prefer to ignore these findings though.

The Harvard study by Karin Michels and her colleagues in 2007 received criticism in the Journal of American Physicians and Surgeons that summer. Like Melbye's team, Michels' group violated some of the most fundamental rules of scientific investigation, i.e. insufficient follow up time between the study subjects' exposure to abortion and the development of their breast cancers (abortion doesn't develop over night) and the exclusion of in situ breast cancers which develop earlier than do invasive breast cancers. Michels also has a history of having lied to the New York Times about recall bias being a problem with the studies. Her own research proved otherwise in a Greek study she authored. See our press release:

Dr. Joel Brind publicly accused the authors of the California Teachers Study, DeLellis-Henderson et al. 2007, of outright fraud. You may want to read our press release concerning it because one of the senior authors, Dr. Leslie Bernstein, was a leader/moderator of the NCI's phony 2003 workshop. She gave a shocking quote to journalist Rachel Lowe after the workshop telling why she didn't want women to learn the truth about the ABC link. Here is our press release:
It's highly irregular that the ACS relies on the abortion providers - the American College of Obstetricians and Gynecologists - as authorities on the ABC link. That's comparable to relying on the tobacco industry for a statement that smoking doesn't cause lung cancer.
The Oxford study by Valerie Beral in 2004 received criticism in five medical journals from four authors (independently of one another). It was supposedly an analysis of dozens of studies, but the authors included unpublished data from many studies and used unscientific reasons to exclude a number of studies finding an abortion-breast cancer link (i.e. couldn't locate the original authors - In one case, the study, Segi et al. 1957, was 47 years old and the authors were dead). Here is our press release on that study:

Of course, the NCI's workshop and the Oxford study are 9 years old and 8 years old respectively, and they do not cover the studies published since that time.

For example, an Armenian study published last year, Khachatryan et al. 2011, involved co-authors from Johns Hopkins School of Public Health and the University of Pennsylvania School of Nursing who found a nearly tripled breast cancer risk for women with abortions. Why doesn't the ACS want women to know?

A Turkish study, Ozmen et al. 2009, reported a statistically significant odds ratio (OR) of 1.66 for women with abortions, meaning that women with abortions multiply their risk by 1.66 times. Why doesn't the ACS tell women about it? Its authors said most studies report an abortion-breast cancer link.

And why doesn't the ACS tell women about Dolle et al. 2009 or Howe et al. 1989 or Patrick Carroll's 2007 study on 8 European nations?

You can see a complete list of the epidemiological studies and their odds ratios here:


*Joel Brind, Ph.D., is a Professor of biology and endocrinology at Baruch College of the City University of NY, where he has been teaching since 1986. He earned his B.S. from Yale in 1971 and his Ph.D. from NY University in 1981. His research on the connections between reproductive hormones and human disease has included breast cancer since 1982.

So, did you read Malek's entire presentation? If you didn't, I wish you would before you dismiss her position as "anti-choice" or whatever nastiness you intend to label her with.







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