Abortion-breast cancer hypothesis

The abortion-breast cancer (ABC) hypothesis (supporters call it the abortion-breast cancer link) posits that induced abortion increases the risk of developing breast cancer;]

Meta-analysis

Beral

In March 2004, Dr. Beral "et al." published a study in "The Lancet" as a collaborative reanalysis on "Breast cancer and abortion".cite journal |author=Beral V, Bull D, Doll R, Peto R, Reeves G |title=Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83?000 women with breast cancer from 16 countries |journal=Lancet |volume=363 |issue=9414 |pages=1007–16 |year=2004 |pmid=15051280 |doi=10.1016/S0140-6736(04)15835-2] This meta-analysis of 53 epidemiologic studies of 83,000 women with breast cancer undertaken in 16 countries did not find evidence of a relationship between induced abortion and breast cancer, with a relative risk of 0.93 (0.89 - 0.96). Organizations and media outlets referenced the Beral study as the most comprehensive overview of the ABC evidence.cite web |url=http://www.washingtonpost.com/ac2/wp-dyn?pagename=article&node=&contentId=A25076-2004Mar25&notFound=true |title=Abortion's Link to Breast Cancer Discounted |accessdate=2008-04-14 |format= |work=washingtonpost.com |author=Shankar Vedantam |date=March 26, 2004] cite web |url=http://www.nytimes.com/2004/03/25/health/25CND-ABORT.html?ei=5070&en=66a47746dbc96f40&ex=1208404800&adxnnl=1&adxnnlx=1208232765-You1/UPj1lwa6V9DBNhBFg |title=Abortions Do Not Raise Risk of Breast Cancer, Study Says |accessdate=2008-04-14 |format= |work=nytimes.com |author=Lawrence K. Altman |date=March 25, 2004]

Dr. Brind maintains that like meta-analysis this study is subject to selection bias, which he believes is reflected in the removal of 15 published, peer-reviewed studies with positive ABC results for "unscientific reasons"; and including 28 unpublished studies that outnumber the remaining 24 peer reviewed studies.cite web |url=http://bcpinstitute.org/beralpaperanalysis.htm |title=Breast Cancer Prevention Institute Fact Sheets |accessdate=2007-11-04 |format= |work=] Beral refers to the Lindefors-Harris response bias study as an explanation for higher ABC risk found in interview based studies, however Brind notes in 1998 that Lindefors-Harris conceded their initial conclusion may have been unsound.cite journal |author=Meirik O, Adami HO, Eklund G |title=Relation between induced abortion and breast cancer |journal=Journal of epidemiology and community health |volume=52 |issue=3 |pages=209–11 |year=1998 |pmid=9616432 |doi=]

Brind

Dr. Brind "et al." (1996) conducted a meta-analysis of 23 epidemiologic studies.cite journal |author=Brind J, Chinchilli VM, Severs WB, Summy-Long J |title=Induced abortion as an independent risk factor for breast cancer: a comprehensive review and meta-analysis |journal=Journal of epidemiology and community health |volume=50 |issue=5 |pages=481–96 |year=1996 |pmid=8944853 |doi=] It calculated that there was on average a relative risk of 1.3 (1.2 - 1.4) increased risk of breast cancer. The meta-analysis was criticized for selection bias by using studies with widely varying results, using different types of studies, not working with the raw data from several studies, and including studies that have possible methodological weaknesses.

The strong reaction to the study particularly in Britain and the United States prompted the editor-in-chief Stuart Donnan to write an editorial. In it he notes:

However, in the light of recent unease about appropriate but open communication of risks associated with oral contraceptive pills, it will surely be agreed that open discussion of risksis vital and must include the people – in this case the women – concerned. 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.cite journal |author=Donnan S |title=Abortion, breast cancer, and impact factors--in this number and the last |journal=J Epidemiol Community Health |volume=50 |issue=6 |pages=605 |year=1996 |month=December |pmid=9039374 |pmc=1060372 |doi= |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=9039374 |accessdate=2008-08-21]

The Royal College of Obstetricians and Gynaecologists (RCOG) in March 2000 published evidence-based guidelines on women requesting induced abortion. The review of the available evidence at the time was "inconclusive" regarding the ABC link. They also noted "Brind's paper had no methodological shortcomings and could not be disregarded."cite web |url=http://www.rcog.org.uk/resources/Public/pdf/induced_abortionfull.pdf |title=The Care of Women Requesting Induced Abortion |page=43 |format=PDF |work= |accessdate=2008-06-29] However, in 2003 the RCOG concluded that there was no link between abortion and breast cancer. [cite web |url=http://www.rcog.org.uk/resources/Public/pdf/induced_abortionfull.pdf |title=The Care of Women Requesting Induced Abortion |accessdate=2007-11-07 |format= |work=Royal College of Obstetricians and Gynaecologists] Some of the ABC studies RCOG reference as evidence (pg. 77) have been heavily criticized by Brind in 2005.cite web |url=http://www.jpands.org/vol10no4/brind.pdf |title=A Critical Review of Recent Studies Based on Prospective Data |accessdate=2008-04-01 |format= |work=jpands.org |author=Joel Brind]

Interviews

Interview (case-control) based studies have been inconsistent on the ABC hypothesis. With the small numbers involved in each individual study and the possibility that recall bias skewed the results, recent focus has switched to meta-analysis and record based studies which are typically much larger. [cite web |url=http://www.religioustolerance.org/abo_canc.htm |title=Is there a link between abortion and breast cancer? A balanced review |accessdate=2007-11-04 |format= |work=religioustolerance.org] Included are a few interview studies of note.

Daling

Dr. Janet Daling from the Fred Hutchinson Cancer Research Center headed two studies on the ABC issue looking at women in Washington state. The 1994 study (845/961 ABC cases/controls) results indicated an associated relative risk of 1.5 (1.2 - 1.9) among women who had given birth before having an abortion.cite journal |author=Daling JR, Malone KE, Voigt LF, White E, Weiss NS |title=Risk of breast cancer among young women: relationship to induced abortion |journal=J. Natl. Cancer Inst. |volume=86 |issue=21 |pages=1584–92 |year=1994 |pmid=7932822 |doi=10.1093/jnci/86.21.1584] This was reflected in higher risks for women younger than 18 or older than 30 years of age who have had abortions after 8 weeks' gestation. Their conclusion emphasized that although the evidence suggested the possibility of a correlative relationship, their findings were not consistent enough to establish one.

The second larger study Daling conducted in 1996 (1,302/1,180 ABC cases/controls) found that abortion was associated with a relative risk value of 1.2 (1.0 - 1.5). The study also found a significant relative risk of 2.0 (1.2 - 3.3) for nulliparous women with an induced abortion at less than 8 weeks gestation. Daling "et al." concluded that:

Dr. Daling "et al." examined the possibility of response bias by comparing results from two recent studies on invasive cervical cancer and ovarian cancer. The results argued against significant response bias. However, Rookus (1996) study noted that patients with cervical cancer may report differently than breast cancer patients.cite journal |author=Rookus MA, van Leeuwen FE |title=Induced abortion and risk for breast cancer: reporting (recall) bias in a Dutch case-control study |journal=J. Natl. Cancer Inst. |volume=88 |issue=23 |pages=1759–64 |year=1996 |pmid=8944006 |doi=10.1093/jnci/88.23.1759]

anderson

A 2001 study (1,459/1,556 ABC cases/controls) conducted in Shanghai, China by Dr. Sanderson "et al." from the University of South Carolina and South Carolina Cancer Center at Columbia concluded that there was no ABC link and that multiple abortions did not put one at greater risk.cite journal |author=Sanderson M, Shu XO, Jin F, "et al" |title=Abortion history and breast cancer risk: results from the Shanghai Breast Cancer Study |journal=Int. J. Cancer |volume=92 |issue=6 |pages=899–905 |year=2001 |pmid=11351314 |doi=10.1002/ijc.1263] Since induced abortion is common, legal, and even mandated by the government in China, the recall bias was minimized.

Brind has argued that the same factors that make the Chinese study ideal for reducing recall bias also makes them inappropriate for comparison to the West. [cite journal |author=Brind J, Chinchilli VM |title=Breast cancer and induced abortions in China |journal=Br. J. Cancer |volume=90 |issue=11 |pages=2244–5; author reply 2245–6 |year=2004 |pmid=15150586 |doi=10.1038/sj.bjc.6601853] Specifically, with China’s strict population control, the vast majority of the abortions in the Chinese study were done after the first full-term pregnancy. This differs from North America.cite web |url=http://www.guttmacher.org/pubs/fb_induced_abortion.html |title=Facts on Induced Abortion in the United States |accessdate=2007-11-04 |format= |work=guttmacher.org]

Response bias

Response bias occurs when women intentionally "underreport" their abortion history, meaning that they deny having an abortion or claim to have fewer abortions than they actually had. This can happen because of the personal and controversial nature of abortion, which may cause women to not want to provide full disclosure. Women in control groups are less likely to have serious illnesses, and hence have less motivation to be truthful than those trying to diagnose their problem. When this occurs, it artificially creates an ABC link where none exists. Three major studies have been published examining abortion response bias.

An editorial by Drs. Weed and Kramer focused on how Brind's meta-analysis dismissed bias as a factor. The editorial cites the Lindefors-Harris response bias study that used a "registry-based gold standard to show that healthy women consistently and widely underreport their history of abortion." Drs. Weed and Kramer considered this compelling evidence there could be systematic bias within the studies included in the meta-analysis. However, subsequently the Lindefors-Harris conclusion was quietly retracted in 1998. Drs. Weed and Kramer believed a causal conclusion was a "leap beyond the bounds of inference" and concluded:

Because bias impedes our vision "and" is subject to sound inquiry, we are far from reaching a scientific "limit". Indeed, after this excursion into the issue of abortion, bias, and breast cancer, it seems our future has as much to do with human behavior as with human biology.cite journal |author=Weed DL, Kramer BS |title=Induced abortion, bias, and breast cancer: why epidemiology hasn't reached its limit |journal=J. Natl. Cancer Inst. |volume=88 |issue=23 |pages=1698–700 |year=1996 |pmid=8943995 |doi=10.1093/jnci/88.23.1698]

A review of ABC studies was conducted by Dr. Bartholomew in 1998. It concluded that if studies least susceptible to response bias are considered, they suggest there is no association between abortion and breast cancer.cite journal |author=Bartholomew LL, Grimes DA |title=The alleged association between induced abortion and risk of breast cancer: biology or bias? |journal=Obstetrical & gynecological survey |volume=53 |issue=11 |pages=708–14 |year=1998 |pmid=9812330 |doi=] Chris Kahlenborn, M.D., a pro-life researcher and specialist in internal medicine, observes in his book "Breast Cancer: Its Link to Abortion and the Birth Control Pill" that if report bias were a significant factor in interview-based studies, then:

... thousands of other studies in medicine might now be deemed 'worthless.' Every time one had a disease or 'effect' that was caused by a controversial risk factor (i.e., one of the causes), the study might be considered invalid based upon 'recall bias.'cite web |url=http://catholiccitizens.org/platform/platformview.asp?c=4654 |title=Catholic Citizens |accessdate=2008-01-21 |format=HTML |work=CatholicCitizens.org title|=Abortion and Breast Cancer: The Scientific Debate That Never Happened |author=Karen Malec]

Lindefors-Harris

The Lindefors-Harris (1991) study (317/512 ABC cases/controls) was the first major study to examine response and recall bias.cite journal |author=Lindefors-Harris BM, Eklund G, Adami HO, Meirik O |title=Response bias in a case-control study: analysis utilizing comparative data concerning legal abortions from two independent Swedish studies |journal=Am. J. Epidemiol. |volume=134 |issue=9 |pages=1003–8 |year=1991 |pmid=1951288 |doi=] It used the data of two independent Swedish induced abortion studies, and concluded there was a 1.5 (1.1 - 2.1) margin of error due to recall bias. However, eight women (seven cases, one control) included in this error margin apparently "overreported" their abortions, meaning the women reported having an abortion that was not reflected in the records. It was decided that for the purposes of the study, these women did not have abortions.

The 1994 Daling study examined the findings on overreporting of the Lindefors-Harris study and found it "reasonable to assume that virtually no women who truly did not have an abortion would claim to have had one," and missing records could have occurred for a variety of reasons. With these eight women removed, the error margin was reduced from 50% to 16% which severely limited its statistical significance. Dr. Brind believes the remaining 16% could have resulted from the Swedish fertility registry [cite journal |author=Meirik O, Lund E, Adami HO, Bergström R, Christoffersen T, Bergsjö P |title=Oral contraceptive use and breast cancer in young women. A joint national case-control study in Sweden and Norway |journal=Lancet |volume=2 |issue=8508 |pages=650–4 |year=1986 |pmid=2876135 |doi=10.1016/S0140-6736(86)90166-2] ndash where women were interviewed as mothersndash which could have increased their tendency to underreport, given that a mother might not want to appear unfit. Subsequently Dr. Lindefors-Harris retracted the 50% conclusion in 1998, but they reasserted since the Melbye cohort study in 1997 found no significant ABC risk, the 30% increased risk in the Brind meta-analysis must be the accumulative result of response bias.

Rookus

The Rookus (1996) study (918 ABC cases/controls) compared two regions in the Netherlands to assess the effect of religion on ABC results based on interviews. The secular (western) and conservative (southeastern) regions showed ABC relative risks of 1.3 (0.7 - 2.6) and 14.6 (1.8 - 120.0) respectively. Although this was a large variance, Brind "et al." pointed out that it was attained with an extremely small sample size. [cite journal |author=Brind J, Chinchilli VM, Severs WB, Summy-Long J |title=Re: Induced abortion and risk for breast cancer: reporting (recall) bias in a Dutch case-control study |journal=J. Natl. Cancer Inst. |volume=89 |issue=8 |pages=588–90 |year=1997 |pmid=9106653 |doi=10.1093/jnci/89.8.588] (12 cases and 1 control)

Dr. Rookus "et al." supported their finding with an analysis of how much recall bias existed with oral contraceptive use that could be verified through records. It corroborated the bias, but Dr. Brind's "et al." letter argues that it only indicated response bias between the two regions, not between case and control subjects within regions. Dr. Rookus "et al." responded by noting that there was a 4.5 month underreporting difference between control and case subjects in the conservative Catholic region. This was indirect evidence for a reporting bias since women's comfort levels with reporting oral contraception are theoretically higher than induced abortion. Rookus "et al." also acknowledged the weakness in the Lindefors-Harris response bias study, but emphasized that more controls (16/59 = 27.1%) than case patients (5/24 = 20.8%) underreported registered induced abortions. They concluded that asserting a causal ABC link would be a disservice to the public and to epidemiological research when "bias has not been ruled out convincingly."

Tang

A study by Dr. Tang "et. al." (2000) (225/303 ABC cases/controls) done in Washington State found controls were not more reluctant to report induced abortion than women with breast cancer.cite journal |author=Tang MT, Weiss NS, Daling JR, Malone KE |title=Case-control differences in the reliability of reporting a history of induced abortion |journal=Am. J. Epidemiol. |volume=151 |issue=12 |pages=1139–43 |year=2000 |pmid=10905525 |doi=] Their results were that 14.0% of cases and 14.9% controls (a difference of -0.9%) did not accurately report their abortion history. They do note likely underreporting occurring in certain sub-groups of women; such as older women in a Newcomb study reporting abortions prior to legalization,cite journal |author=Newcomb PA, Storer BE, Longnecker MP, Mittendorf R, Greenberg ER, Willett WC |title=Pregnancy termination in relation to risk of breast cancer |journal=JAMA |volume=275 |issue=4 |pages=283–7 |year=1996 |pmid=8544267 |doi=10.1001/jama.275.4.283] and a predominantly Roman Catholic population in the Rookus study.

pontaneous abortion

Studies of spontaneous abortions (miscarriages) have generally shown no increase in breast cancer risk, [cite journal |author=Brewster DH, Stockton DL, Dobbie R, Bull D, Beral V |title=Risk of breast cancer after miscarriage or induced abortion: a Scottish record linkage case-control study |journal=Journal of epidemiology and community health |volume=59 |issue=4 |pages=283–7 |year=2005 |pmid=15767381 |doi=10.1136/jech.2004.026393] although a study by Dr. Paoletti concluded there is a "suggestion of increased risk" 1.2 (0.92 - 1.56) after three or more pregnancy losses. [cite journal |author=Paoletti X, Clavel-Chapelon F |title=Induced and spontaneous abortion and breast cancer risk: results from the E3N cohort study |journal=Int. J. Cancer |volume=106 |issue=2 |pages=270–6 |year=2003 |pmid=12800205 |doi=10.1002/ijc.11203] Some argue that this apparent lack of effect of miscarriages on breast cancer risk is evidence against the ABC hypothesis, and some pro-choice advocates have claimed it is proof that neither early pregnancy loss nor abortion are risk factors for breast cancer.

One of the problems with comparing miscarriage to abortion is the issue of hormone levels in early pregnancy, a key point because the ABC hypothesis rests on hormonal influence over breast tissue development. While it is true most miscarriages are not "caused" by low hormones, most miscarriages are "characterized" by low hormone levels. [cite web |url=http://web.archive.org/web/20050307221417/http://www.st-marys.nhs.uk/specialist/miscarriage_clinic/causes.htm |title=The Recurrent Miscarriage Clinic - What Causes Recurrent Miscarriage? |accessdate=2007-11-04 |format= |work=st-marys.nhs.uk] Kunz & Keller (1976) showed that when progesterone is abnormally low a miscarriage occurs 89% of the time. [cite journal |author=Kunz J, Keller PJ |title=HCG, HPL, oestradiol, progesterone and AFP in serum in patients with threatened abortion |journal=British journal of obstetrics and gynaecology |volume=83 |issue=8 |pages=640–4 |year=1976 |pmid=60125 |doi=] Advocates of the ABC hypothesis argue that, given the association of most first trimester miscarriages with low hormone levels, spontaneous abortion is not analogous to an induced abortion.

Politicization

Public interest in an association between abortion and breast cancer coincided with the rise of the militant pro-life movement which turned to violence. However, the 1993 murder of physician David Gunn by a pro-life activist "irreparably harmed the movement". In response to the escalating violence, President Bill Clinton signed the Freedom of Access to Clinic Entrances Act (FACE) and clinic "buffer zones" were established to protect women and clinic employees. Though militant pro-life activists continued to bomb clinics and kill employees, their violence caused mainstream pro-life organizations to disavow their methods.

Pro-life organizations like National Right to Life turned to legal tactics that included lobbying against late-term abortions and RU-486. One of the other tactics adopted by the mainstream pro-life movement was promoting an alleged "ABC link". During the height of a publicized "breast cancer epidemic" pro-life organizations began to emphasize preliminary positive ABC results in an effort to further restrict abortion and to discourage women from having abortions. Currently, pro-life organizations lobby to increase obstacles to abortion, such as mandated counseling, waiting periods, and parental notification,cite web |url=http://www.guttmacher.org/pubs/fb_induced_abortion.html |title=Facts on Induced Abortion in the United States |accessdate=2007-11-04 |format= |work=guttmacher.org] and some feel that pro-life advocates treat ABC as simply another tactic in their campaign against abortion. There have been ongoing and incremental legal challenges to abortion in the United States by pro-life groups. [cite web |url=http://www.pbs.org/wgbh/pages/frontline/clinic/ |title=The Last Abortion Clinic |accessdate=2007-11-04 |format= |work=PBS.org] In 2005, a Canadian pro-life organization put up billboards in Alberta with large pink ribbons and the statement: "Stop the Cover-Up," in reference to the ABC hypothesis. [cite web |url=http://www.cbc.ca/health/story/2005/10/25/pink-ribbon051025.html |title=Group angered by billboards linking breast cancer to abortion |accessdate=2007-11-04 |format= |work=cbc.ca] The Canadian Breast Cancer Foundation was concerned the billboards misrepresented the state of scientific knowledge on the subject.

The continued focus on the "ABC link" by pro-life groups has created a confrontational political environment. Pro-choice advocates and scientists alike have responded with criticisms. The claims by pro-life advocates are sometimes referred to as pseudoscience. [cite web |url=http://www.goldenboob.org/ |title=Vote for the Golden Boob! |accessdate=2007-11-04 |format=HTML |work=goldenboob.org] The extent with which politics has infused the ABC issue is illustrated by an editorial that quoted Dr. Daling as saying:

During the late 1990s several United States congressmen became involved in the ABC issue. In 1998, congressman Tom Coburn questioned a National Cancer Institute (NCI) official on why the NCI website contained out of date information on the ABC issue. [cite web |url=http://www.physiciansforlife.org/content/view/105/26/ |title=Physicians For Life - Abstinence, Abortion, Birth Control - Need to Inform Patients of Abortion - Breast Cancer Link |accessdate=2007-11-04 |format= |work=physiciansforlife.org] Congressman Dave Weldon wrote a "Dear Colleague" letter to congress in 1999 shortly after the House debated FDA approval of the abortion drug Mifepristone; and partially as a result of John Kindley's law review on informed consent which was enclosed. In it Weldon expressed concern that the majority of studies indicate a possible ABC link and the politicization of the ABC issue is "preventing vital information from being given to women."cite web |url=http://www.abortionbreastcancer.com/weldon_letter.htm |title=Weldon Letter |accessdate=2007-11-04 |format= |work=abortionbreastcancer.com]

As of 2004, state law in Minnesota, Mississippi, Texas, Louisiana, and Kansas requires warning women seeking abortions about a possible breast cancer risk. Similar legislation requiring notification has also been introduced, and was pending, in 14 other states. [cite web |url=http://www.boston.com/news/nation/articles/2004/11/10/questions_on_states_abortion_warnings/?rss_id=Boston%20Globe%20--%20National%20News |title=Questions on states' abortion warnings |accessdate=2007-11-04 |format= |work=The Boston Globe] An editor for the American Journal of Public Health expressed concern over how such legislative bills propose warnings that do not agree with established scientific findings.cite journal |author=Chavkin W |title=Topics for our times: public health on the line--abortion and beyond |journal=American journal of public health |volume=86 |issue=9 |pages=1204–6 |year=1996 |pmid=8806368] However, it is possible that such legally-mandated disclosure could mitigate possible future lawsuits involving informed consent from women who might contend they should have been told of the ABC hypothesis possibility prior to having an abortion. [cite web |url=http://www.piercelaw.edu/risk/vol2/winter/merz.htm |title=Medical Informed Consent |accessdate=2007-11-04 |format= |work=piercelaw.edu]

National Cancer Institute

A report from the Committee on Oversight and Government Reform found that in November 2002, the Bush administration altered the National Cancer Institute's (NCI) website. The previous NCI analysis had concluded that while some question regarding an association between abortion and breast cancer existed prior to the mid-1990s, a number of large and well-regarded studies such as Melbye "et al." (1997) had resolved the issue; and there was no link between abortion and breast cancer. The Bush administration removed this analysis and replaced it with the following:

This alteration, which suggested that there was scientific uncertainty on the ABC issue, prompted an editorial in the New York Times describing it as an "egregious distortion" and a letter to the Secretary of Health and Human Services from members of Congress. In response to the alteration the NCI convened a three-day consensus workshop entitled "Early Reproductive Events and Breast Cancer" on February 24-26, 2003. The workshop concluded that induced abortion does not increase a woman's risk of breast cancer, and that the evidence for this was well-established. Afterwards, the director of epidemiology research for the American Cancer Society said, “This issue has been resolved scientifically . . . . This is essentially a political debate."

Dr. Brind was the only one to file a dissenting opinion as a minority report criticizing the NCI's and Dr. Melbye's conclusions.cite web |url=http://www.bcpinstitute.org/nci_minority_rpt.htm |title=Breast Cancer Prevention Institute |accessdate=2007-11-04 |format= |work=bcpinstitute.org] [cite web |url=http://cancer.gov/cancer_information/doc.aspx?viewid=15e3f2d5-5cdd-4697-a2ba-f3388d732642 |title=Minority Dissenting Comment - National Cancer Institute |accessdate=2007-11-04 |format= |work=] Brind alleges the workshop evidence and findings were overly controlled by its organizers since Dr. Daling, who has published on the abortion-breast cancer issue, was asked to present on another topic; and Dr. Melbye submitted unpublished data during the workshop instead allowing attendees to review it beforehand.cite web |url=http://www.usatoday.com/news/health/2003-02-26-cancer-usat_x.htm |title=USATODAY.com - No breast cancer-abortion link |format= |work=USA TODAY |accessdate=2008-06-29] Preterm delivery was listed as an epidemiological "gap" even though there was preliminary evidence of a correlation with higher breast cancer risk.cite journal |author=Melbye M, Wohlfahrt J, Andersen AM, Westergaard T, Andersen PK |title=Preterm delivery and risk of breast cancer |journal=Br. J. Cancer |volume=80 |issue=3-4 |pages=609–13 |year=1999 |pmid=10408874 |doi=10.1038/sj.bjc.6690399]

Dr. Jasen notes: "A very public target of the anti-abortion movement has been the National Cancer Institute, not only for its dismissal of Daling's findings and uncritical support of Melbye's report, but also for the information supplied on its website, which potentially reaches millions of women around the world." Dr. Lawrence R. Huntoon editor-in-chief for the conservative non-mainstream "Journal of American Physicians and Surgeons" notes in a Malec article that while the workshop had over 100 experts who voted on the findings the NCI website does not elaborate on the vote results.cite web |url=http://www.jpands.org/vol8no2/malec.pdf |title=The Abortion-Breast Cancer Link: How Politics Trumped Science and Informed Consent |accessdate=2008-03-30 |format=PDF |work=Journal of American Physicians and Surgeons]

North Dakota lawsuit

One example of the politicization of science is the case of "Kjolsrud v. MKB Management Corporation". In January 2000, Amy Jo Kjolsrud (née Mattson), a pro-life counselor, sued the Red River Women's Clinic in Fargo, North Dakota alleging false advertising. [cite web |url=http://www.redriverwomensclinic.com |title=Abortion Clinic of Fargo |accessdate=2007-11-04 |format= |work=redriverwomensclinic.com] The suit alleged the clinic was misleading women by distributing a brochure quoting a National Cancer Institute fact sheet on the ABC issue which stated:

:"Anti-abortion activists claim that having an abortion increases the risk of developing breast cancer and endangers future childbearing. None of these claims are supported by medical research or established medical organizations." [cite web |url=http://www.religioustolerance.org/abo_canc1.htm |title=Is there a link between abortion and breast cancer? A balanced review |accessdate=2007-11-04 |format= |work=religioustolerance.org] (emphasis in original)

The case was originally scheduled for September 11, 2001, but was delayed as a result of the terrorist attacks. On March 25, 2002, the trial started and after four days of testimony, Judge Michael McGuire ruled in favor of the clinic. In his decision, he said:

The judge noted it was their "intent" to provide accurate information because the brochure used an outdated 1996 fact sheet that stated there was "no established link", instead of the 1999 fact sheet wording of "inconsistent" evidence for the ABC issue. [cite web |url=http://www.beyondmainstream.com/archives/politics/feminist/abortion_breast_cancer.php |title=Beyond Mainstream - alternative news, progressive politics, holistic healing, humor jokes, alternative media, alternative culture |accessdate=2007-10-20 |format= |work=] [cite web |url=http://www.worldnetdaily.com/news/article.asp?ARTICLE_ID=27027 |title=Judge rules in favor of abortion clinic |accessdate=2007-11-04 |format= |work=WorldNetDaily.com] Linda Rosenthal, an attorney from the Center for Reproductive Rights characterized the decision thusly: "The judge rejected the abortion-breast cancer scare tactic. This ruling should put to rest the unethical, anti-choice scare tactic of using pseudo-science to harass abortion clinics and scare women."cite web |url=http://crlp.org/pr_02_0328ND.html |title=ARCHIVE| 3/28/02 - Judge Rejects Abortion-Breast Cancer Scare Tactic |accessdate=2007-11-04 |format= |work=crlp.org]

John Kindley, one of the lawyers representing Ms. Kjolsrud stated: "I think most citizens, whether they are pro-choice or pro-life, believe in an individual's right to self-determination. They believe people shouldn't be misled and should be told about [procedural] risks, even if there is controversy over those risks." [cite web |url=http://www.womenspress.com/main.asp?Search=1&ArticleID=1580&SectionID=1&SubSectionID=1&S=1 |title=Controversy over alleged breast cancer link lands abortion clinic in court |accessdate=2007-11-04 |format= |work=womenspress.com] Kindley also wrote an article published in 1998 by the Wisconsin Law Review outlining the viability of medical malpractice lawsuits based upon not informing patients considering abortion about the evidence indicating an ABC link.cite web |url=http://johnkindley.com/johnak/p4.html |title=John A. Kindley Law Office: The ABC Link |accessdate=2007-11-07 |format= |work=John Kindley]

The decision was appealed and on September 23, 2003, to the North Dakota Supreme Court which ruled the false advertising law should not have been used by Ms. Kjolsrud. [cite web |url=http://www.legis.nd.gov/cencode/t51c12.pdf |title=CHAPTER 51-12 FALSE ADVERTISING |accessdate=2007-11-04 |format= |work=legis.nd.gov] This was because she personally had suffered no injury and hence had no standing (according to North Dakota jurisprudence) to file the lawsuit on behalf of others. In the appeal, Ms. Kjolsrud "concedes she had not read the brochures before filing her action." [cite web |url=http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=nd&vol=20030023&invol=1 |title=Amy Jo Kjolsrud v. MKB Management Corporation |accessdate=2007-11-04 |format= |work=] However, the appeal also noted that after the lawsuit was filed the abortion clinic updated their brochure to the following:

:"Some anti-abortion activists claim that having an abortion increases the risk of developing breast cancer. A substantial body of medical research indicates that there is no established link between abortion and breast cancer. In fact, the National Cancer Institute has stated, ' [t] here is no evidence of a direct relationship between breast cancer and either induced or spontaneous abortion.'"

Carroll

In the Fall of 2007, Patrick S. Carroll published a statistical analysis in the "Journal of American Physicians and Surgeons", [ [http://www.jpands.org/vol12no3/carroll.pdf The Breast Cancer Epidemic: Modeling and Forecasts Based on Abortion and Other Risk Factors] , by Patrick Carroll, MA. Published in the Journal of American Physicians and Surgeons, Fall 2007. Accessed November 15 2007.] a politically conservative journal with a pro-life stance. [" [http://www.aapsonline.org/resolutions/2003-2.htm 2003 Resolution - Affirming the Sanctity of Human Life] ." A position statement from the Association of American Physicians and Surgeons, publisher of the "Journal of American Physicians and Surgeons". Retrieved on November 15, 2007.] The study claimed that, among seven risk factors, abortion was the "best predictor of breast cancer," and fertility was also a useful predictor. It forecasts, for the year 2025, higher breast cancer rates for Czech Republic, England and Sweden and lower for Finland and Denmark based on abortion trends. Carroll's study was criticized by a Guardian editor, who alleged that the study's methodology was flawed and noted that it was funded by an anti-abortion group and published in a "right wing" journal. [Brooks, Libby. " [http://www.guardian.co.uk/comment/story/0,,2192579,00.html British women's right to choose is under covert attack] ." "The Guardian." October 12, 2007. Retrieved on November 19, 2007.]

Criticism of media coverage

In an article entitled "Blinded by Science" for the "Columbia Journalism Review", Chris Mooney argues that "balanced" coverage by the media of the ABC hypothesis, among other scientific hypotheses championed by the religious right, is an example of how the scientific fringe manipulates public opinion by insisting on the illusory notion of journalistic "balance" instead of scientific accuracy. In the article, Mooney criticizes John Carroll (former Editor-in-Chief of the "Los Angeles Times") for a rebuke Carroll made regarding an article written by Scott Gold about the ABC hypothesis for the "L.A. Times".cite web |url=http://pqasb.pqarchiver.com/latimes/access/339453241.html?dids=339453241:339453241&FMT=ABS&FMTS=ABS:FT&type=current&date=May+22%2C+2003&author=Scott+Gold&pub=Los+Angeles+Times&edition=&startpage=A.1&desc=THE+NATION%3B+Texas+OKs+Disputed+Abortion+Legislation |title=THE NATION; Texas OKs Disputed Abortion Legislation |accessdate=2008-03-04 |format= |work=Los Angeles Times] Gold's article covered the National Cancer Institute (NCI) workshop, and Carroll notes that when a scientific advocate (Joel Brind) for the ABC hypothesis is found:

It is not until the last three paragraphs of the story that we finally surface a professor of biology and endocrinology who believes the abortion/cancer connection is valid. But do we quote him as to why he believes this? No. We quote his political views.

Apparently the scientific argument for the anti-abortion side is so absurd that we don't need to waste our readers' time with it.cite web |url=http://www.laobserved.com/carrollmemo.html |title=L.A. Observed: John Carroll memo |accessdate=2008-03-04 |format= |work=laobserved.com |author=John Carroll]

Carroll's concern is that Gold's article provides fodder to critics who claim that the "L.A. Times" has a liberal bias. Mooney writes in defense of Gold that:

As a general rule, journalists should treat fringe scientific claims with considerable skepticism, and find out what major peer-reviewed papers or assessments have to say about them. Moreover, they should adhere to the principle that the more outlandish or dramatic the claim, the more skepticism it warrants. The Los Angeles Times’s Carroll observes that “every good journalist has a bit of a contrarian in his soul,” but it is precisely this impulse that can lead reporters astray. The fact is, nonscientist journalists can all too easily fall for scientific-sounding claims that they can’t adequately evaluate on their own.cite web |url=http://cjrarchives.org/issues/2004/6/mooney-science.asp |title=CJR November/December 2004: Blinded by Science |accessdate=2007-12-24 |format= |author=Chris Mooney |work=Columbia Journalism Review]

Responding to criticism Carroll reiterated:

You have an obligation to find a scientist, and if the scientist has something to say, then you can subject the scientist’s views to rigorous examination.

References

External links

* [http://cis.nci.nih.gov/fact/3_75.htm National Cancer Institute: Abortion, Miscarriage, and Breast Cancer Risk]
* [http://www.who.int/mediacentre/factsheets/fs240/en/index.html Induced abortion does not increase breast cancer risk] , a fact sheet from the World Health Organization
* [http://www.cancer.org/docroot/CRI/content/CRI_2_6x_Can_Having_an_Abortion_Cause_or_Contribute_to_Breast_Cancer.asp American Cancer Society: Can Having an Abortion Cause or Contribute to Breast Cancer?]
* [http://www.acog.org/from_home/publications/press_releases/nr07-31-03-2.cfm American College of Obstetricians and Gynecologists: Finds No Link Between Abortion and Breast Cancer Risk]
* [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1251638 Breast Cancer and the Politics of Abortion in the United States] by Dr. Patricia Jasen
* [http://www.rcog.org.uk/resources/Public/pdf/induced_abortionfull.pdf The Care of Women Requesting Induced Abortion] , from the Royal College of Obstetricians and Gynaecologists

Pro-choice:
* [http://www.plannedparenthood.org/issues-action/abortion/state-abortion-restrictions/reports/anti-choice-claims-about-abortion-breast-cancer-5095.htm Planned Parenthood: Anti-choice Claims About Abortion and Breast Cancer]
* [http://www.religioustolerance.org/abo_canc.htm Religious Tolerance: Is There A Link Between Abortion And Breast Cancer?]
* [http://www.crlp.org/pub_fac_brcancer.html Center for Reproductive Rights: False Claims of Breast Cancer Risk]
* [http://www.barryyeoman.com/articles/hatedabortion.html Discover Magazine: The Scientist Who Hated Abortion] by Barry Yeoman

Pro-life:
* [http://www.bcpinstitute.org/home.htm Breast Cancer Prevention Institute]
* [http://catholiccitizens.org/platform/platformview.asp?c=4654 CatholicCitizens.Orgndash The Scientific Debate That Never Happened]
* [http://www.abortionbreastcancer.com/ Coalition on Abortion/Breast Cancer]
* [http://www.johnkindley.com/weldonletter.htm JohnKindley.com] ndash Dr. Weldon's Dear Congress Letter


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