Debunking the Abortion-Breast Cancer Hypothesis – pt1.

In everything I’ve written on the subject of abortion over the las four to five years perhaps the only issue I’ve not addressed in detail is the Abortion-Breast Cancer (ABC) hypothesis for the simple reason that I had thought it to have been so comprehensively discredited that it was unlikely to resurface.

However, after receiving a message via Twitter asking me whether I had ever written anything on this subject I took a quick look around teh Interwebs and turned up this very recent article at the Catholic Herald:

Fight breast cancer – by speaking out against abortion

Every so often I receive a round-robin email headed by a list of other women also emailed, in which I am charged with passing on the urgent request to find a cure for breast cancer. The latest I received last week showed a picture of a pretty little girl toddler wearing a T-shirt with the slogan, “Find a cure before I grow boobs.” It is a very good cause and I am sure that much medical research is going on around the world with this specific aim, even as I type this. Because it is so common, we all know someone who has died of breast cancer; indeed, a very dear friend of mine lost her battle with it some years ago, leaving three young sons.

So why do I pause before pressing the “Forward” button to send on the message of this obvious good cause? Because what these round robins never say is “Spread the word! There is a proved link between induced abortion and breast cancer.” In other words, the sadly high rates of breast cancer would drop significantly – if there were fewer induced abortions.

Of course, there are other factors in breast cancer, such as childlessness, delaying first pregnancy, age and genetic inheritance. And of course we all hope for a cure. But as Dr Angela Lanfranchi, a breast cancer surgeon and co-founder of the Breast Cancer Prevention Institute in New Jersey, writes in an edited extract from a new paper entitled “The Abortion and Breast Cancer Link”, that has been published in Endeavour Forum Inc newsletter for May 2012:

There is a very good reason why these round robin emails from reputable cancer charities don’t mention a ‘proved link between induced abortion and breast cancer’ – it doesn’t exist; that is to say that the best evidence from the largest and most comprehensive epidemiological studies that have investigated the claim that induced abortion may be a risk factor for breast cancer have failed to produce evidence to support such a hypothesis.

So far as this supposedly ‘proved link’ goes, the US National Cancer Institute has this to say:

In February 2003, the National Cancer Institute (NCI) convened a workshop of over 100 of the world’s leading experts who study pregnancy and breast cancer risk. Workshop participants reviewed existing population-based, clinical, and animal studies on the relationship between pregnancy and breast cancer risk, including studies of induced and spontaneous abortions. They concluded that having an abortion or miscarriage does not increase a woman’s subsequent risk of developing breast cancer. A summary of their findings can be found in the Summary Report: Early Reproductive Events and Breast Cancer Workshop.

NCI regularly reviews and analyzes the scientific literature on many topics, including various risk factors for breast cancer. Considering the body of literature that has been published since 2003, when NCI held this extensive workshop on early reproductive events and cancer, the evidence overall still does not support early termination of pregnancy as a cause of breast cancer.

As for the American Cancer Society, it notes that:

The topic of abortion and breast cancer highlights many of the most challenging aspects of studies of people and how those studies do or do not translate into public health guidelines. The issue of abortion generates passionate viewpoints in many people. Breast cancer is the most common cancer, and it is the second leading cancer killer in women. Still, the public is not well-served by false alarms. At this time, the scientific evidence does not support the notion that abortion of any kind raises the risk of breast cancer or any other type of cancer.

And on the same page cites the views of the American College of Obstetricians and Gynecologists:

The American College of Obstetricians and Gynecologists (ACOG) Committee on Gynecologic Practice also reviewed the available evidence in 2003 and again in 2009. ACOG published its most recent findings in June 2009. At that time, the Committee said, “Early studies of the relationship between prior induced abortion and breast cancer risk were methodologically flawed. More rigorous recent studies demonstrate no causal relationship between induced abortion and a subsequent increase in breast cancer risk.”

And the view of the Collaborative Group on Hormonal Factors in Breast Cancer

In 2004, the Collaborative Group on Hormonal Factors in Breast Cancer, based out of Oxford University in England, put together the results from 53 separate studies done in 16 different countries. These studies included about 83,000 women with breast cancer. After combining and reviewing the results from these studies, the researchers concluded that “the totality of worldwide epidemiological evidence indicates that pregnancies ending as either spontaneous or induced abortions do not have adverse effects on women’s subsequent risk of developing breast cancer.” These experts did not find that abortions (either induced or spontaneous) cause a higher breast cancer risk.

The Collaborative Group’s study was co-ordinated and supported by Cancer Research UK whose own take on its findings can be read here.

A study coordinated by Cancer Research UK scientists and published in The Lancet has shown that pregnancies that end in miscarriage or abortion do not increase a woman’s risk of developing breast cancer later in life.

An international collaboration, led by a team in Oxford, re-analysed original information from 53 epidemiological studies from 16 countries, including previously unpublished data.

The research included 44,000 breast cancer patients who took part in studies where any history of abortion had been recorded before their cancer was diagnosed.

The researchers compared the chances of developing breast cancer in women with and without any record of having had an abortion. This comparison gives the ‘relative risk’, where a value of 1.0 or less means no adverse effect on the risk of developing breast cancer. The relative risk of breast cancer for women who have had a miscarriage is 0.98. For women who have had an induced abortion the relative risk of breast cancer is 0.93.

For good measure, CRUK’s press release throws in a comment from Professor Sir Richard Doll who was just about the foremost epidemiologist of the 20th century as was reflected in his citation on being elected to the Royal Society in 1996:

Doll is distinguished for his researches in epidemiology, and particularly the epidemiology of cancer where in the last 10 years he has played a prominent part in (a) elucidating the causes of lung cancer in industry (asbestos, nickel & coal tar workers) & more generally, in relation to cigarette smoking, and (b) in the investigation of leukaemia particularly in relation to radiation, where using the mortality of patients treated with radiotherapy he has reached a quantitative estimate of the leukaemogenic effects of such radiation. In clinical medicine he has made carefully controlled trials of treatments for gastric ulcer. He has been awarded the United Nations prize for outstanding research into the causes & control of cancer & the Bisset Hawkins medal of the Royal College of Physicians for his contributions to preventative medicine.

Doll’s comment on Collaborative Group’s study?

“Some previous reviews on abortion and breast cancer have reached mistaken conclusions because they mixed together data from reliable and unreliable types of study.

“This is the first time that so much information has been brought together and the findings are more reliable than ever before.”

So why is Francis Phillips, who apparently reviews books for the Catholic Herald claiming that proven link exists between abortion and breast cancer?

To begin with we need to look at the provenance of Phillips’ claim which, as the article states, is based on a ‘new paper’ published in the Endeavour Forum Inc, newsletter – and as might already be apparent, the Endeavour Frum Inc. newsletter is not a scientific journal.

Endeavour Forum Inc. is an Australian NGO which describes itself as follows:

Endeavour Forum was set up to counter feminism, defend the unborn and the traditional family.  (“A feminist is an evolutionary anachronism, a Darwinian blind alley”.)

Before going on to add a little more detail:

Endeavour Forum stated out as Women Who Want to be Women. It was set up in response to militant feminism which first came around in the early 1970s and which became increasingly influential in the Whitlam and even Fraser governments.

While militant feminism did address some legitimate grievances it went to far getting into issue like abortion, equal opportunity and affirmative action.

There was a need to defend the legitimate rights of traditional women in families and the rights of male breadwinners to get jobs.

So, not so much ‘Back to Basics’ as ‘Back to the Kitchen and make me a sammich’ and the kind of source which makes JPandS look like the New England Journal of Medicine.

The author of this ‘paper’ is Angela Lanfranchi, an American Cancer Surgeon and co-founder of the Breast Cancer Prevention Institute with biologist Joel Brind, of whom I’ll have more to say later. BCPI exists primarily to promote the ABC hypothesis and as for Lanfranchi, a recent article on the contraceptive pill (‘The Pill Kills’) at a website calling itself ‘New Feminism’ nicely illustrates where she’s coming from, which, for anyone living in London, is several stops past Barking.

The pill does kill many women every year.  Even a low risk if it’s taken by 82% of the 16 million women of reproductive age (15-45 years old) translates into thousands of deaths a year.  The pill not only increases her risk of heart attack, stroke, lung clots, breast cancer, cervical cancer, and liver cancer but it also increases her risk of contracting HPV (human papilloma virus) and contracting and transmitting HIV, the AIDS virus.  It influences what partner she chooses and increases her risk of violent death.

These are the facts which are ignored and/or unknown by both women and their doctors.  During the next months I will review the data that have established the four major ways the Pill Kills: clots, cancer, contagion and violence.

A detailed discussion of the clinical risks associated with oral contraceptives is beyond the scope of this article, but linking the pill to the spread of HPV and HIV and to domestic violence takes victim blaming to a new low, even by the already abyssal standards of the frothing-at-the-mouth American Christian right – and as for the ‘New Feminism, a cursory glance at the sites contents suggests that this looks very much like the old misogyny from which one can only conclude that it originated in Oceania where the clocks strike thirteen, ignorance is strength and correlation equals causation.

Unsurprisingly, the full version of Lanfranchi’s ‘paper’ turns up at ‘We Care Experts’, a site set up by Priscilla Coleman to promote her own discredited claims linking abortion and mental health problems, all of which calls for a brief digression and bit of personal crowing because, in April 2011, I wrote about a paper by Coleman which had appeared in the Journal of Psychiaric Research and, after taking a look at the data sets that Coleman has used in her paper and critique of the paper by Laurence Finer and Julia Steinberg, came to the following conclusion:

What can be said, with some confidence, is that her [Coleman’s] assertion that she used 12 month prevalence data throughout her study is unsustainable given that her estimates for the prevalence of drug and alcohol abuse in the no abortion group cannot be obtained from the raw dataset using the final weighting calculated from the figures for other disorders without recourse to using the lifetime rather than 12 month prevalence data for these mental health problems.

In February 2012, the Journal of Psychiatric Research published a letter from Steinberg and Finer which clearly demonstrated that Coleman had used lifetime data in her study, not the 12 month data she’d previously claimed, together with a short response from Coleman in which she admitted to this and a detailed critique by the journal’s editor-in-chief, Alan Schatzberg, and Ronald Kessler, principal investigator of the National Comorbidity Survey. This last commentary concluded that Coleman’s analysis does not support her assertion that abortions led to psychopathology in the NCS data and describes Coleman’s justification for using lifetime diagnoses as “unpersuasive” and her approach of using lifetime diagnoses a “flawed method.” – a full overview of the entire story is available from the Guttmacher Institute and leaves one wondering quite how Coleman hasn’t – yet – been investigated for research misconduct.

Moving on to Joel Brind, his background and role in peddling the ABC hypothesis has been dealt with in considerable detail by both Barry Yeoman (Discover Magazine) and Chris Mooney (Washington Monthly) – so much so that only a couple of illustrative quotations from the Yeoman article are necessary to illustrate the issues that arise from relying on Brind’s work:

There’s only one thing wrong with this picture: The vast majority of epidemiologists say Brind’s conclusions are dead wrong. They say he conducted an unsound analysis based on incomplete data and drew conclusions that meshed with his own pro-life views. They say that epidemiology, the study of diseases in populations, is an inexact science that requires practitioners to look critically at their own work, searching for factors that might corrupt the results and drawing conclusions only when they see strong and consistent evidence. “Circumspection, unfortunately, is what you have to do to practice epidemiology,” says Polly Newcomb, a researcher at the Fred Hutchinson Cancer Research Center in Seattle. “That’s something Brind is incapable of doing. He has such a strong prior belief in the association [between abortion and cancer] that he just can’t evaluate the data critically.”

Brind was at home the day his fax machine spit out the results of Chinchilli’s* analysis: Women who had induced abortions appeared to suffer from breast cancer at a rate 30 percent higher than those who didn’t. In biostatistical terms, this is called a “relative risk” or “odds ratio” of 1.3. (A risk of 1.0 means there’s no danger.) Because there are so many variables that can corrupt data, epidemiologists regard any risk under 2.0 with skepticism unless it appears consistently from one study to the next. (For example, scientists at the National Cancer Institute once argued that mouthwash users had a 50 percent higher chance of contracting oral cancer. Critics later showed that once other variables such as alcohol and tobacco use were properly controlled for, the risk all but disappeared.)

Chinchilli is a co-author and statistician on Brind’s 1996 paper ‘Induced abortion as an independent risk factor for breast cancer: a comprehensive review and meta-analysis”.

In later meetings, Chinchilli tried to control the enthusiasm of the three pro-life scientists. “Being a statistician, I have some doubts,” he says. “I don’t think the issue has been resolved.” But Brind remained resolute in his conclusion that the abortion-breast cancer link had been proved. “When we were talking about the conclusions, he wanted to make the strongest statements,” Chinchilli recalls. “I tried to temper them a little bit, but Dr. Brind is very adamant about his opinion.”

If Chinchilli was cautious in pronouncing a link between abortion and breast cancer, other scientists were—and still are—dismissive. “In epidemiology, if there’s a true relationship, you’d expect to find the majority of studies would show some consistency,” says Phyllis Wingo, chief of the cancer surveillance branch for the Centers for Disease Control and Prevention. When Wingo surveyed the literature for the journal Cancer Causes and Control, she found results that were all over the map. “There were some studies that showed a small increase in risk, some that showed a small decrease, and some that showed neither. That lack of consistency was not persuasive.” Besides, she says, a relative risk of 1.3—compared with the relative risk of 20 associated with smoking and lung cancer—is usually considered too weak to draw definite conclusions.

Brind is a zealot, a point made eminently clear by Mooney is the opening paragraph of his article:

Ever since he was a kid, Joel Brind found himself drawn to science. In 1961, when he was 10, Brind got his hands on a Life magazine story about the electron microscope and the fresh window it had opened onto the cell and its curiously shaped organelles. “Then and there I decided to become a biochemist,” Brind recalled in a 2000 essay in Physician magazine, a publication of Focus on the Family, a leading religious right group. You see, Brind may have received his biochemistry Ph.D. from New York University in 1981, but he passed a far more important personal milestone four years later when he found Jesus. Soon Brind recognized the “noble task” God had chosen for him. He would prove the biological connection between having an abortion and contracting breast cancer later in life, thereby dissuading countless women from killing their unborn children. “With a new belief in a meaningful universe, I felt compelled to use science for its noblest, life-saving purpose,” Brind wrote.

He – and Lanfranchi – both believe themselves to be on a mission from god and unlike the Blues Brothers there’s no great rhythm and blues and no car crashes, unless you count Lanfranchi’s ‘new paper’ which isn’t actually new at all, it’s just the same old discredited guff that Brind has been peddling since the mid-1990s.

Okay, so that’s the background and provenance dealt with. In part 2 we’ll look at the science ans what it does and doesn’t say, regardless of what the Catholic Herald’s book reviewer thinks.