Janet Gail was used to looking at mammograms and finding bad news. As a hospital technician in Pennsylvania, that was her job. But she was unprepared for what found in her own mammogram when she did a routine screening at age 42.
“I immediately recognized a suspicious area on the films,” Gail—who asked that her real name not be used because her children don’t know her history—says. “We returned to the X-ray room to take more specialized views, which only confirmed my suspicions. I knew at that moment that my life was forever changed. I knew I was a breast-cancer patient.”
Gail was changed. She knew what breast-cancer patients suffer—the cancer can go to your lungs and make you suffocate. It can get in your bones and make them so brittle that you can break a hip turning in bed.
Then there’s the debilitating treatments she knew lay ahead, the surgery that, victims say, strikes at their very identity as women. If you survive the disease, you worry constantly about relapse. But often you don’t survive the disease.
Surgeons helped. Gail realized that radical mastectomy was her only choice. “My emotions were raw and tender,” she says. “I was so angry! Angry at God, angry at my new body, angry at the world. I sought counseling and tried desperately to understand why God would put me in this situation.
“It was at that time that I plunged head-first into the research, trying to find a cause for my own cancer,” she says. She checked off the risk factors that she didn’t have: no family history, no abnormalities with her menstrual cycle, no estrogen treatments. But then she remembered one she’d read about before, one that she was trying hard not to think about.
Gail had an abortion when she was 18.
A Deadly Combination
Breast cancer is the most common cancer among women, other than skin cancer. It’s the second leading cause of cancer death in women after lung cancer.
And it kills more women in Gail’s age group (40 to 59) than almost anything else.
Meanwhile, abortion has become the most common surgical procedure for young women. National Right to Life estimates that there will be 1.3 million abortions in the United States this year.
According to the American Cancer Society, breast cancer has been detected in women at a dramatically increased rate since 1972. In 1962 there were 63,000 cases; in 1972, 90,000; in 1982, 120,000; and in 1992, 180,000. The year 2002 will see some 203,500 new cases of invasive breast cancer. An estimated 39,600 women will die from it.
True, detection methods have improved dramatically in that time span, and the number of women tested has increased. But so have abortions—and the evidence linking them to breast cancer.
Angela Lanfranchi, M.D., a New Jersey breast surgeon, came across the abortion/breast-cancer link in much the same way Gail did—only she was the surgeon, not the patient.
In the early 1990s, Lanfranchi began to notice that young women were coming into her office with breast cancer and that they all had a history of abortions, often in their teens.
“I began to change my intake form to ask about births, miscarriages, and abortions,” she says. “In the first month, I’d had two women with many abortions.”
She had gone through medical school in the 1970s, when there were still relatively few women in the profession. She considers herself a feminist, she says, but quickly adds, “Not a NOW [National Organization for Women] type.”
She wasn’t the first to notice a correlation. Studies had found the same thing—findings that somehow had not gotten into the clinicians’ literature.
It made her mad. “I just couldn’t stand seeing those 30-year-olds in the office, with breast cancer, with little toddlers,” she says. “These children weren’t going to have their mothers.”
In 1996 she read a metanalysis of the relevant studies by Joel Brind, Ph.D., a biology professor at Baruch College in New York, who had put the pieces together. According to his article, the first study that showed a link between breast cancer and abortion had been published when Brind and Lanfranchi were children. It appeared in 1957 in the prominent English-language Japanese Journal of Cancer Research. Japan was one of the few places where abortion was legal in those days (importantly, for abortion/breast-cancer link activists, Denmark was another). The study found that breast-cancer patients were three times more likely to have had abortions than the general population. If abortion was a contributor to breast cancer elsewhere, it went unreported. At that time, though abortion was becoming prevalent in the West, it wasn’t mentioned in polite society or on medical charts.
Everything changed with the sexual revolution.
In the 1970s and 1980s, evidence began to mount that abortion was putting women at risk. Today, there have been 37 studies on the abortion/breast-cancer link. More than 75 percent of them—28—show that abortion is a risk factor for breast cancer.
Many of these studies were funded, at least in part, by the National Cancer Institute. At the Fred Hutchinson Cancer Research Institute in Seattle, veteran cancer researcher Janet Daling and a team of scholars found that, in her words from this 1994 study, “[a]mong women who had been pregnant at least once, the breast cancer rate in those who had experienced an induced abortion was 50 percent higher than among other women. Highest risks were observed when the abortion was done at ages younger than 18 years…or at least 30 years of age or older.”
Most troubling of all were the statistics on teens with a family history of breast cancer who had gotten abortions. In the study, this deadly combination (though found in just twelve of the women studied) seemed to guarantee that a woman would get breast cancer.
The Clueless Culture
Lanfranchi and Brind, via the Breast Cancer Prevention Institute in upstate New York, deserve much of the credit for publicizing the link outside the medical world. In a way, they’ve been committed to the cause since childhood. Lanfranchi said she learned to do the right thing from her father, a surgeon who fought back when his Akron, Ohio, hospital was doing illegal abortions. Brind has been a medical crusader since he went to get a haircut as a ten-year- old: “My local barber had run out of Archie comics,” he told me. “I read an old well-worn Life magazine instead.” The story he read was about biochemistry’s great promise to the world of medicine, suggesting it might someday find the cure to cancer. Brind wrote himself a letter that day, which he discovered years later, that said: “I don’t know how, I don’t know when, but I will become a biochemist.” Nineteen years later, he did.
How do they explain the abortion/breast-cancer link? Lanfranchi points to two factors: estrogen—the hormone that grows breast tissue and that increases 2,000 percent in pregnancy—and lobules—the cells in that tissue that grow at puberty, mature in pregnancy, and produce milk after childbirth.
In the natural course of events, estrogen and breast lobules work in tandem—the estrogen grows the lobules, which differentiate and mature into full-fledged cells during the third trimester of pregnancy. But if the lobules’ development is interrupted while estrogen levels are high, then the extra estrogen may cause mutated cells to grow and multiply into a cancerous tumor.
This estrogen flood and breast-cell growth explain many of the recognized risk factors for breast cancer. A girl who gets her first period early or a woman who has a late menopause are at a higher risk for breast cancer because they have more estrogen exposure. Nuns who have no children have a higher risk than women who have many children, because their breast cells never mature into the protective type-four phase. Birth control pills—which work by tricking a woman’s body into thinking it’s pregnant—increase estrogen and, therefore, the risk of breast cancer. (There is one recent study that claims they don’t, but this study also claims that a family history of breast cancer doesn’t increase the risk—a giant red flag.)
Miscarriage doesn’t increase the risk of breast cancer because miscarriage usually happens when estrogen levels are abnormally low.
Tell most people about the abortion/breast-cancer link and they’re incredulous. That’s because modern lifestyles and pop culture have left Americans clueless about breasts. From the move away from nursing in the 1950s and 1960s to the sexual revolution and the contraceptive age, sex has filled the culture, and having one or two children has become the norm for families. In such a culture, the abortion/breast-cancer link sounds preposterous—because the link between the femininity of women and their childbearing capability is all but lost.
The culture may be clueless about breasts, but clinicians aren’t. So why are so many clinicians skeptical of the abortion/breast-cancer connection?
To begin with, many doubt that the statistical evidence, however strong, justifies the conclusions. “Some of my colleagues call epidemiology a pseudoscience,” Brind observes. Lanfranchi explains why: “Epidemiology shows associations. If you did a study on lung cancer, you would find that people with lung cancer have more matches in their pockets than people without. Are there emanations from the matches? Or is it something else? You need to show a biological basis.” At any rate, breast surgeons either don’t read the epidemiological journals that show the link, or they take them with a grain of salt when they do.
Others say the research doesn’t adequately allow for “recall bias.” This is the argument, made on many a pro-abortion Web site, that studies showing the abortion/breast-cancer link get all their information about a woman’s abortion history from the woman herself. But women often misstate their abortion history, meaning many cancer-free women who have had abortions aren’t counted. Conversely, the women with breast cancer are the most likely to report abortions—they’re eager to find reasons for their cancer. “One of the reasons recall bias may sound persuasive is that it is a reasonable hypothesis,” Brind says. But he distinguished between underreporting and bias—the idea that the underreporting is different in the two groups. He told me that “no credible evidence of recall bias in abortion/breast-cancer studies has ever been reported. They’ve looked for it and haven’t found it.”
If recall bias were a sufficient argument on its own, says the Coalition on Abortion/Breast Cancer (www.abortionbreastcancer.com; it also looks at alleged bias in particular studies), then we could disregard a number of health concerns: the link between cervical cancer and the number of sexual partners a woman has had, the link between liver cancer and alcoholism, and the link between AIDS and the number of homosexual partners a man has had.
Rotten in Denmark
Deniers of the abortion/breast-cancer link also fight studies with studies. “Right now we can say that there are 28 of 37 studies,” says Karen Malec of the coalition, “but these scientists used the Melbye study and the Sanderson study to deny a link. They’ve used two studies to deny 28.”
The Melbye study is the mighty “Danish study” that was published by the New England Journal of Medicine in 1997, and it was supposed to put the abortion/breast-cancer link to rest by keeping all recall bias out of the study.
To understand the importance of this study, look at the following quote from the Web site of the National Abortion and Reproductive Rights Action League: “Anti-choice forces are impeding medical research and distorting scientific findings to frighten women into believing that abortion causes breast cancer.” The emphasis in the next part is from the original: “The largest and most comprehensive investigation of this potential link examined population registry information on abortion and breast cancer for 1.5 million women born in Denmark between 1935 and 1978. This study, recently published in The New England Journal of Medicine, concluded that induced abortions have no overall effect on the risk of breast cancer.”
Sounds conclusive—unless you’re a researcher who has read the study. For one thing, the study did find a link to second-trimester abortions. Brind also points out that the study’s breast-cancer records start in 1968, but its abortion records start in 1973—even though abortion has been legal in Denmark since the 1930s. Women with breast cancer who had their abortions before 1973 weren’t counted as having had abortions. In fact, Brind says, records of abortions exist for 60,000 women who are counted in the study as never having had an abortion—older women who would have been more likely to have developed breast cancer.
Likewise, women having abortions in the final years of the study could have developed breast cancer after the study was over. But those women would have been counted as having had abortions but no breast cancer. A quarter of the women in the Melbye study was still under the age of 25, Brind says, and these women were being compared with middle-aged women.
Sacrificed for Science
How could scientists countenance such a flawed study?
Lanfranchi answers by telling the story of Ignaz Semmelweiss (1818-1865), the Hungarian physician who noticed that laboring mothers in the care of doctors in Vienna hospitals had much higher mortality rates than those in the care of midwives. Those were the days before germ theory, and Semmelweiss formed a hypothesis: The doctors, who went between morgue and maternity ward without washing their hands, were carrying some sort of odor particle that invaded their patients. To test his theory, he asked the doctors to wash their hands. It worked. The mortality rates went down. In response, the doctors drove Semmelweiss out of mainstream medicine—be died in a mental hospital. Lister soon proved he was right.
We already know that modern-day breast-cancer surgeons aren’t immune to the Semmelweiss syndrome, the blind refusal to make a paradigm shift. Many of them chafed at the suggestion that radical mastectomies weren’t always necessary in cases of breast cancer.
Another inexcusable reason for ignorance of the abortion/breast-cancer link is political ideology. While Catholics have faith, hope, and charity, abortion ideologues have “safe, legal, and rare” abortion. The “rare” part was never really true; activists are clinging for dear life to the “legal” part; but at least the “safe” part was supposed to be accurate.
This political ideology has hardened abortion proponents so that they are insensible to evidence for the link. Pro-abortion bias seems to be at play in mainstream cancer awareness Web sites where cagey language hides the abortion/breast-cancer link. Some sites use Clintonisms (using the term “abortion” in its broadest sense to include miscarriages and stillbirths as well). Some cling to aspects of researchers’ studies that the researchers themselves have abandoned. Many harp on recall bias without showing what studies the criticism applies to. All take frequent trips to the eternal well of Melbye.
Another reason many doctors are unaware of the link is the nature of the disease itself, Brind says. “Women don’t come forward complaining about it, because they’re either too sick, too traumatized, or don’t survive long enough.” Even if they did, they wouldn’t find doctors receptive to the information. The reason is simple: money. “Do you want to hear from a lawyer about why you haven’t been telling patients about the abortion risk for so long?” Lanfranchi asks.
There have been a number of lawsuits on the abortion/breast-cancer link recently. No plaintiff has prevailed against an abortion business—so far. In a 1999 case, a North Dakota abortion business was sued for false advertising. In 2000, three California women sued Planned Parenthood for calling abortion safe on brochures and its Web site. Those cases are still in appeals.
How can the truth about the abortion/breast-cancer link become better known against such odds?
The Truth Will Win Out
The fact is, the truth is already coming out.
Two recent lawsuits in Australia ended in settlements, which means that while no judge has looked at the matter and decided that the evidence for the link was strong, nervous abortionists are looking at the evidence for the link and starting to pay women who complain that they weren’t informed. Importantly, unlike the U.S. cases, in which activists were the plaintiffs, one of the Australian cases (the other is gag-ordered) involved a woman who had received an abortion herself. (Similar suits are in the works in the United States, Karen Malec says.)
The link is also showing up in popular culture. Brita Stream is a sign of that. An evangelical Christian, Stream was crowned Miss Oregon on July 13 and the abortion/breast-cancer link is her platform.
She’s not your typical beauty queen. The Miss Oregon competition was her first beauty pageant, and she entered it to talk about the abortion/breast-cancer link. Will that hurt her chances at becoming Miss America this September? “I don’t really care,” she told me, smiling. “I won because God wanted people to hear about my platform. I had a duty. It was like I was Esther. If I perish, I perish. If people attack me for it, too bad, because this is what God charged me with.”
Television audiences are hearing about the link in San Diego, in an ad that shows a volleyball coach talking to her team, while her voiceover describes her abortion and breast-cancer experience. In a soon-to-air Ohio public TV debate, Lanfranchi and Brind debate an abortion activist.
The message is even being heard in Washington. For years, the Web site of the National Cancer Institute (NCI) included a page about abortion and breast cancer denying the connection. A group of U.S. representatives led by Chris Smith (R-N.J.) changed that, National Institutes of Health (NIH) spokesman Michael Miller says. The page was removed on June 19, he says, because the congressmen questioned its accuracy.
What Comes Next
What does the future hold for the discussion about abortion and breast cancer?
Miller told me that the National Cancer Institute is currently funding one study “looking specifically at the association of induced abortion and the risk of breast cancer,” and three other NCI-sponsored studies “are examining a variety of possible breast-cancer risk factors, including induced abortion.”
That news doesn’t necessarily cheer battle-scarred activists like Malec. “My fear is that these scientists will practice what Dr. Brind has called ‘outcome-based science.’ ” she says. “My fear is that they’re beating the bushes for studies that will make them look good?’
Serrin Foster, president of Feminists for Life, hopes not. Her reaction to the abortion/breast-cancer connection is appropriate: “This really makes me angry,” she says. “I have friends who had abortions at that time when everybody was saying it was just a product of conception, a couple of cells on the tip of a needle. Now they’re asking, what does this mean for them? The NCI and NIH owe them a good answer.”
Informing the public about abortion and breast cancer can reduce abortions. As Lanfranchi points out, women who choose abortion are often looking for excuses not to—and parents who choose abortion for their daughters might not if they knew about the dangers.
Gail wishes that she had known before her abortion—and hopes others will find out before it’s too late for them. “Even if the woman won’t spare the life for the sake of the unborn, she may spare the life growing inside her when she considers the consequences of breast surgery years down the road.”
At the same time, Foster warns against considering the abortion/breast-cancer link just another arrow in a quiver of pro-life arguments. “This is not a tactic, this is life and death for these women,” she says. “Are we not committed to saving these women, or do we only care about the baby?
“Women shouldn’t be put at risk simply because it’s not politically correct to say anything bad about abortion,” she adds. “Whether you support abortion or not, you have to take the politics out. Even those women who believe that women should have the right to have an abortion should ‘fess up and speak for women.”
To his credit, Dr. Stuart Donnan, when he was editor-in-chief of the British Medical Association’s Journal of Epidemiology and Community Health, did just that. In a 1996 opinion piece on the evidence linking abortion and breast cancer, he wrote, “[l]t will surely be agreed that open discussion of risks is 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.”