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Abortion–breast cancer hypothesis

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Abortion–breast cancer hypothesis

The abortion–breast cancer hypothesis posits that having an induced pregnancy, hormone levels increase, leading to breast growth. The hypothesis proposes that if this process is interrupted by an abortion then more immature cells could be left behind, resulting in a greater potential risk of breast cancer over time.[1]

The abortion–breast cancer hypothesis has been the subject of extensive scientific inquiry, and the

  • National Cancer Institute: Abortion, Miscarriage, and Breast Cancer Risk
  • Induced abortion does not increase breast cancer risk, a fact sheet from the World Health Organization
  • Is Abortion Linked to Breast Cancer? from the American Cancer Society
  • American College of Obstetricians and Gynecologists: Finds No Link Between Abortion and Breast Cancer Risk
  • Jasen P (October 2005). "Breast cancer and the politics of abortion in the United States". Med Hist 49 (4): 423–44.  
  • The Care of Women Requesting Induced Abortion, from the Royal College of Obstetricians and Gynaecologists
  • Discover Magazine: The Scientist Who Hated Abortion by Barry Yeoman
  • Factors That Do Not Increase Risk from the Susan G. Komen Foundation

External links

  1. ^ Russo J, Russo I (1980). "Susceptibility of the mammary gland to carcinogenesis. II. Pregnancy interruption as a risk factor in tumor incidence". Am J Pathol 100 (2): 505–506.  
  2. ^ a b c d e f g h Jasen P (2005). "Breast cancer and the politics of abortion in the United States". Med Hist 49 (4): 423–44.  
  3. ^ a b c "WHO – Induced abortion does not increase breast cancer risk". who.int. Archived from the original on 13 January 2011. Retrieved 11 January 2011. 
  4. ^ a b Safe abortion: technical and policy guidance for health systems (PDF) (2nd ed.).  
  5. ^ "Abortion, Miscarriage, and Breast Cancer Risk". National Cancer Institute. Archived from the original on 21 December 2010. Retrieved 11 January 2011. 
  6. ^ "Politics & Science – Investigating the State of Science Under the Bush Administration". oversight.house.gov. Archived from the original on 27 March 2008. Retrieved 14 April 2008. 
  7. ^ "Is Abortion Linked to Breast Cancer?". American Cancer Society. Archived from the original on 31 January 2011. Retrieved 11 January 2011. 
  8. ^ a b c Committee On Gynecologic, Practice (June 2009). "ACOG Committee Opinion No. 434: induced abortion and breast cancer risk". Obstetrics and Gynecology 113 (6): 1417–8.  
  9. ^ a b "The Care of Women Requesting Induced Abortion" (PDF). Royal College of Obstetricians and Gynaecologists. p. 9. Retrieved 29 June 2008. Induced abortion is not associated with an increase in breast cancer risk. 
  10. ^ a b c "Krebsmythen: Kein Grund zur Sorge" [Cancer myths: no reason for concern] (in German). German Cancer Research Center. 4 December 2013. Retrieved 9 September 2014. 
  11. ^ a b c "Canadian Cancer Society's perspective on abortion and breast cancer". Canadian Cancer Society. 28 October 2013. Retrieved 9 September 2014. 
  12. ^ a b Guttmacher – Misinformed Consent
  13. ^ a b c d "Politics & Science In the Bush Administration" (PDF). oversight.house.gov. Archived from the original (PDF) on 15 December 2012. Retrieved 4 November 2007. 
  14. ^ Howe H, Senie R, Bzduch H, Herzfeld P (1989). "Early abortion and breast cancer risk among women under age 40". Int J Epidemiol 18 (2): 300–4.  
  15. ^ Daling JR, Malone KE, Voigt LF, White E, Weiss NS. (2 November 1994). "Risk of breast cancer among young women: relationship to induced abortion". Journal of the National Cancer Institute 86 (21): 1584–92.  
  16. ^ Daling JR; Brinton LA; Voigt LF; et al. (1996). "Risk of breast cancer among white women following induced abortion". Am. J. Epidemiol. 144 (4): 373–80.  
  17. ^ "Weird Science". Ms. Magazine. Retrieved 14 October 2008. 
  18. ^ a b Melbye M, Wohlfahrt J, Olsen J, Frisch M, Westergaard T, Helweg-Larsen K, Andersen P (1997). "Induced abortion and the risk of breast cancer". N Engl J Med 336 (2): 81–5.  
  19. ^ a b Michels KB, Xue F, Colditz GA, Willett WC (2007). "Induced and spontaneous abortion and incidence of breast cancer among young women: a prospective cohort study". Arch. Intern. Med. 167 (8): 814–20.  
  20. ^ a b c d "Summary Report: Early Reproductive Events Workshop – National Cancer Institute". cancer.gov. Retrieved 4 November 2007. 
  21. ^ "Breast Cancer Prevention". National Cancer Institute. 15 July 2011. Archived from the original on 27 July 2011. Retrieved 20 August 2011. 
  22. ^ Chris Mooney (2004). "Research and Destroy". washingtonmonthly.com. Archived from the original on 4 April 2008. Retrieved 14 April 2008. 
  23. ^ a b "THE PRO-CHOICE ACTION NETWORK". prochoiceactionnetwork-canada.org. Archived from the original on 11 October 2007. Retrieved 4 November 2007. 
  24. ^ a b Cannold, Leslie (2002). "Understanding and Responding to Anti-Choice Women-Centred Strategies" (PDF). Reproductive Health Matters 10 (19): 171–179.  
  25. ^ "Women's Health after Abortion". deveber.org. Archived from the original on 14 March 2008. Retrieved 14 April 2008. 
  26. ^ a b "Weldon Letter". abortionbreastcancer.com. Archived from the original on 23 October 2007. Retrieved 4 November 2007. 
  27. ^ "Is Abortion Linked to Breast Cancer?".  
  28. ^ http://www.nih.gov/about/almanac/organization/NCI.htm
  29. ^ "Briefing note—Scientific Information on Abortion".  
  30. ^ "The Care of Women Requesting Induced Abortion" (PDF).  
  31. ^ "Joel Brind, Department of Natural Sciences". Baruch College. Retrieved 29 June 2008. 
  32. ^ a b c d e Yeoman, Barry; Michael Lewis (1 February 2003). "Scientist Who Hated Abortion". Discover. Retrieved 9 September 2014. 
  33. ^ Brind J, Chinchilli VM, Severs WB, Summy-Long J (1996). "Induced abortion as an independent risk factor for breast cancer: a comprehensive review and meta-analysis.". J Epidemiol Community Health 50 (5): 481–96.  
  34. ^ a b Weed DL, Kramer BS (1996). "Induced abortion, bias, and breast cancer: why epidemiology hasn't reached its limit". J. Natl. Cancer Inst. 88 (23): 1698–700.  
  35. ^ Donnan S (December 1996). "Abortion, breast cancer, and impact factors—in this number and the last". J Epidemiol Community Health 50 (6): 605.  
  36. ^ a b c Russo J, Russo I (1980). "Susceptibility of the mammary gland to carcinogenesis. II. Pregnancy interruption as a risk factor in tumor incidence". Am J Pathol 100 (2): 497–512.  
  37. ^ a b Russo J, Tay L, Russo I (1982). "Differentiation of the mammary gland and susceptibility to carcinogenesis". Breast Cancer Res Treat 2 (1): 5–73.  
  38. ^ a b c Russo J, Russo I (1987). "Biological and molecular bases of mammary carcinogenesis". Lab Invest 57 (2): 112–37.  
  39. ^ "Reproductive Breast Cancer Risks Brochure". Archived from the original on 15 October 2007. Retrieved 20 October 2007. 
  40. ^ a b Frazier, A Lindsay; Ryan, Catherine Tomeo; Rockett, Helaine; Willett, Walter C; Colditz, Graham A (February 2003). "Adolescent diet and risk of breast cancer". Breast Cancer Research 5 (3): R59.  
  41. ^ Alvarado MV, Alvarado NE, Russo J, Russo IH (1994). "Human chorionic gonadotropin inhibits proliferation and induces expression of inhibin in human breast epithelial cells in vitro". In Vitro Cell. Dev. Biol. Anim. 30A (1): 4–8.  
  42. ^ Russo IH, Koszalka M, Russo J (1990). "Effect of human chorionic gonadotropin on mammary gland differentiation and carcinogenesis". Carcinogenesis 11 (10): 1849–55.  
  43. ^ Bernstein L, Hanisch R, Sullivan-Halley J, Ross RK (1995). "Treatment with human chorionic gonadotropin and risk of breast cancer". Cancer Epidemiol. Biomarkers Prev. 4 (5): 437–40.  
  44. ^ B MacMahon, P Cole, and J Brown (1973). "Etiology of human breast cancer: a review". J. Nat. Cancer Inst. 50 (21–42): 21–42.  
  45. ^ Jasen, Patricia (1 October 2005). "Breast Cancer and the Politics of Abortion in the United States". Medical History 49 (4): 423–444.  
  46. ^ "Facts on Induced Abortion in the United States". guttmacher.org. Archived from the original on 13 October 2007. Retrieved 4 November 2007. 
  47. ^ "The Last Abortion Clinic". PBS.org. Archived from the original on 23 October 2007. Retrieved 4 November 2007. 
  48. ^ "Group angered by billboards linking breast cancer to abortion". Canada: CBC. 25 October 2005. Archived from the original on 18 December 2007. Retrieved 4 November 2007. 
  49. ^ Beral V, Bull D, Doll R, Peto R, Reeves G (2004). "Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83 000 women with breast cancer from 16 countries". Lancet 363 (9414): 1007–16.  
  50. ^ "Vote for the Golden Boob!". goldenboob.org. Archived from the original on 20 October 2007. Retrieved 4 November 2007. 
  51. ^ a b "ARCHIVE| March 28, 2002 – Judge Rejects Abortion-Breast Cancer Scare Tactic". crlp.org. Archived from the original on 27 September 2007. Retrieved 4 November 2007. 
  52. ^ "Physicians For Life – Abstinence, Abortion, Birth Control – Need to Inform Patients of Abortion – Breast Cancer Link". physiciansforlife.org. Archived from the original on 27 September 2007. Retrieved 4 November 2007. 
  53. ^ a b "John A. Kindley Law Office: The ABC Link". John Kindley. Retrieved 7 November 2007. 
  54. ^ Meckler, Laura (10 November 2004). "Questions on states' abortion warnings". The Boston Globe. Retrieved 4 November 2007. 
  55. ^ Chavkin W (1996). "Topics for our times: public health on the line—abortion and beyond". American journal of public health 86 (9): 1204–6.  
  56. ^ Appel, Jacob M. "Abortion: A Healthy Choice". Huffington Post. Retrieved 10 September 2014. 
  57. ^ "Abortion and Breast Cancer". New York Times. 2003-01-03. Retrieved 9 September 2014. 
  58. ^ a b "Breast Cancer Prevention Institute". bcpinstitute.org. Archived from the original on 15 October 2007. Retrieved 4 November 2007. 
  59. ^ "Abortion Clinic of Fargo". redriverwomensclinic.com. Archived from the original on 9 October 2007. Retrieved 4 November 2007. 
  60. ^ a b "Is there a link between abortion and breast cancer? A balanced review". religioustolerance.org. Retrieved 4 November 2007. 
  61. ^ "Controversy over alleged breast cancer link lands abortion clinic in court". womenspress.com. Archived from the original on 28 September 2007. Retrieved 4 November 2007. 
  62. ^ a b "Amy Jo Kjolsrud v. MKB Management Corporation". Retrieved 4 November 2007. 

References

The decision was appealed and on 23 September 2003 the North Dakota Supreme Court ruled that Kjolsrud did not have standing and affirmed the lower court ruling dismissing the action.[62] The appeal noted that Kjolsrud "concedes she had not read the brochures before filing her action."[62] The appeal also noted that after the lawsuit was filed, the abortion clinic updated their brochure to the following:

Linda Rosenthal, an attorney from the Center for Reproductive Rights characterized the decision thus: "[t]he 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."[51] John Kindley, one of the lawyers representing Kjolsrud stated: "I think most citizens, whether they are pro-choice or anti-abortion, 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."[61] Kindley also wrote a 1998 Wisconsin Law Review article outlining the viability of medical malpractice lawsuits based upon not informing patients considering abortion about the ABC hypothesis.[53]

The case was originally scheduled for 11 September 2001, but was delayed as a result of the [60]

In January 2000, Amy Jo Kjolsrud (née Mattson), an anti-abortion counselor, sued the Red River Women's Clinic in Fargo, North Dakota, alleging false advertising.[59] The suit, Kjolsrud v. MKB Management Corporation, alleged that the clinic was misleading women by distributing a brochure quoting a National Cancer Institute fact sheet on the ABC hypothesis. The brochure stated:

North Dakota lawsuit

Brind was the only attendee at the workshop to file a dissenting opinion as a minority report criticizing the conclusions.[58] He contends the workshop evidence and findings were overly controlled by its organizers and that the time allotted was too short for a thorough review of the literature.[58]

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.[13][57] In response to the alteration the NCI convened a three-day consensus workshop entitled Early Reproductive Events and Breast Cancer on 24–26 February 2003. The workshop concluded that induced abortion does not increase a woman's risk of breast cancer, and that the evidence for this had been well established.[20] Afterwards, the director of epidemiology research for the American Cancer Society stated, "[t]his issue has been resolved scientifically … This is essentially a political debate."[13]

The Bush administration had altered the 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 had resolved the issue in the negative. The Bush administration removed this analysis and replaced it with the following:

National Cancer Institute

Bioethicist Jacob M. Appel argues that the mandatory disclosure statutes might be unconstitutional on "rational basis" grounds. Childbirth is significantly more dangerous than abortion, data that is not required in any disclosure law but which is necessary for a meaningful understanding of risks. According to Appel, "[i]f the roughly fifty million abortions that have occurred in the United States since Roe v. Wade had all ended in full-term deliveries, approximately five hundred additional women would have died during childbirth."[56]

As of 2006, abortion counseling materials in Alaska, Mississippi, Texas, West Virginia, and Kansas state that the data relationship between abortion and breast cancer are inconclusive, while Minnesota materials report no link.[12] Similar legislation requiring notification has also been introduced in 14 other states.[54] An editor for the American Journal of Public Health expressed concern that these bills propose warnings that do not agree with established scientific findings.[55]

During the late 1990s, several United States congresspeople became involved in the ABC issue. In a 1998 hearing on cancer research, congressperson Tom Coburn accused the National Cancer Institute of misleading the public by selectively releasing data.[52] In 1999, shortly after the House debated FDA approval of the abortion drug mifepristone, Congressperson Dave Weldon wrote a "Dear Colleague" letter, enclosing an article from John Kindley.[53] In it, Weldon expressed concern that the majority of studies indicated a possible ABC link and that politicization was "preventing vital information from being given to women."[26]

The continued focus on the ABC hypothesis by anti-abortion groups has fostered a confrontational political environment. Anti-abortion advocates and scientists alike have responded with criticisms.[2][18][34] The claims by anti-abortion advocates are sometimes referred to as pseudoscience.[50][51]

By the late 1980s, national politicians recognized that a focus on reducing access to abortion was not a winning political strategy. Some anti-abortion activists grew more aggressive and violent in the face of political abandonment, culminating with the murder of pink ribbons and the statement: "Stop the Cover-Up," in reference to the ABC hypothesis.[48] The Canadian Breast Cancer Foundation was concerned by the misrepresentation of the state of scientific knowledge on the subject.[49]

Politicization

Despite the fact that the Russos' studies found similar risk rates between virgin and pregnancy interrupted rats, their research would be used to support the contention that abortion created a greater risk of breast cancer for the next twenty years.[45] However, because rats do not exhibit naturally occurring breast cancer, the extrapolation of these results to human abortion and breast cancer is viewed as dubious.[32]

Russo & Russo from the Fox Chase Cancer Center in Philadelphia conducted a study in 1980 examining the proposed correlation between abortion and breast cancer. While analysing the effects of the carcinogen 7,12-Dimethylbenz(a)anthracene (DMBA) on the DNA labeling index (DNA-LI) in terminal end buds (TEBs), terminal ducts (TDs) and alveolar buds (ABs) of Sprague-Dawley rats in various stages of reproductive development, they found that rats who had interrupted pregnancies had no noticeable increase in risk for cancer.[36] However, they did find that pregnancy and lactation provided a protective measure against various forms of benign lesions, such as hyperplastic alveolar nodules and cysts. While results did suggest that rats who had interrupted pregnancies might be subject to "similar or even higher incidence of benign lesions" than virgin rats, there was no evidence to suggest that abortion would result in a higher incidence of carcinogenesis. A more thorough examination of the phenomenon was conducted in 1982, confirming the results.[37] A later study in 1987 further explained their previous findings.[38] After differentiation of the mammary gland resulting from a full-term pregnancy of the rat, the rate of cell division decreases and the cell cycle length increases, allowing more time for DNA repair.[38][40]

Rat models

The first study involving statistics on abortion and breast cancer was a broad study in 1957 examining common cancers in Japan.[2] The researchers were cautious about drawing any conclusions from their unreliable methodologies. During the 1960s several studies by Brian MacMahon et al. in Europe and Asia touched on a correlation between abortion and breast cancer. Their 1973 paper published in the Journal of the National Cancer Institute inaccurately[2] concluded that "where a relationship was observed, abortion was associated with increased, not decreased, risk."[44] Research relevant to the current ABC discussion focuses on more recent large cohort studies, a few meta-analyses, many case-control studies, and several early experiments with rats.

History

Later on, Russo et al. found that placental human chorionic gonadotropin (hCG) induces the synthesis of inhibin by the mammary epithelium.[41][42] Bernstein et al. independently observed a reduced breast cancer risk when women were injected with hCG for weight loss or infertility treatment.[43] Contrary to the ABC hypothesis, Michaels et al. hypothesize since hCG plays a role in cellular differentiation and may activate apoptosis, as levels of hCG increase early on in human pregnancy, "an incomplete pregnancy of short duration might impart the benefits of a full-term pregnancy and thus reduce the risk of breast cancer."[19]

During early pregnancy, type 1 lobules quickly become type 2 lobules because of changes in estrogen and progesterone levels. Maturing into type 3 and then reaching full differentiation as type 4 lobules requires an increase of human placental lactogen (hPL) which occurs in the last few months of pregnancy. According to the abortion–breast cancer hypothesis, if an abortion were to interrupt this sequence then it could leave a higher ratio of type 2 lobules than existed prior to the pregnancy.[39] Russo and Russo have shown that mature breast cells have more time for DNA repair with longer cell cycles,[40] accounting for the slightly reduced risk of breast cancer for parous women against the baseline risk for women who have never conceived and those who have conceived and terminated their pregnancies.[36]

  • Type 1 has 11 ductules (immature)
  • Type 2 has 47 ductules (immature)
  • Type 3 has 80 ductules (mature, fewer hormone receptors)
  • Type 4 are fully matured (cancer resistant) and contain breast milk

Breast tissue contains many lobes (segments) and these contain lobules which are groups of breast cells. There are four types of lobules:

In early pregnancy, levels of estrogen, progesterone, estradiol increase, leading to breast growth in preparation for lactation. It has been hypothesized that if this process is interrupted by an abortion—before full maturity (differentiation) in the third trimester—then more immature cells could be left than there were prior to the pregnancy. These immature cells could then be exposed to carcinogens and hormones over time, resulting in a greater potential risk of breast cancer. This mechanism was first proposed and explored in rat studies conducted in the 1980s.[36][37][38]

Lobules are 3, ducts are 6.

Proposed mechanism

Brind's paper was criticized in the Journal of the National Cancer Institute for ignoring the role of [32]

Joel Brind, a faculty member at Baruch College in the Department of Natural Sciences,[31] is the primary advocate of an abortion–breast cancer (ABC) link. Brind is strongly anti-abortion and began lobbying politicians with the claim that abortion caused breast cancer in the early 1990s.[32] Brind found that his lobbying efforts were not taken seriously because he had not published his findings in the peer-reviewed medical literature. He therefore collaborated with two anti-abortion physicians and a statistician to publish a 1996 article in the Journal of Epidemiology and Community Health,[33] arguing that induced abortion was a risk factor for breast cancer.[32] The statistician who collaborated with Brind later stated of their findings: "I have some doubts. I don't think the issue has been resolved. When we were talking about the conclusions, he [Brind] wanted to make the strongest statements. I tried to temper them a little bit, but Dr. Brind is very adamant about his opinion."[32]

Proponents

  • The World Health Organization concluded in 2012 that "sound epidemiological data show no increased risk of breast cancer for women following spontaneous or induced abortion",[4] updating their earlier finding that "induced abortion does not increase breast cancer risk".[3]
  • The American Cancer Society concluded: "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."[27]
  • The U.S. National Cancer Institute, which is part of the National Institutes of Health,[28] found that "induced abortion is not associated with an increase in breast cancer risk", assigning this conclusion the strongest possible evidence rating.[20]
  • The American Congress of Obstetricians and Gynecologists found that "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."[8]
  • The Royal College of Obstetricians and Gynaecologists reviewed the medical literature and concluded that "there is no established link between induced abortion or miscarriage and development of breast cancer."[29] The College recommended in its official clinical practice guidelines that "Women should be informed that induced abortion is not associated with an increase in breast cancer risk."[30]
  • The German Cancer Research Center concluded in 2013 that abortion and miscarriage pose no risk of breast cancer.[10]
  • The Canadian Cancer Society stated in 2013: "The body of scientific evidence does not support an association between abortion and increased breast cancer risk."[11]

Major medical organizations which have analyzed data on abortion and breast cancer have uniformly concluded that abortion does not cause breast cancer. These organizations include the National Cancer Institute, the American Cancer Society, the American Congress of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynaecologists, the German Cancer Research Center, and the Canadian Cancer Society.[3][8][9][10][11][20]

Views of medical organizations

Contents

  • Views of medical organizations 1
  • Proponents 2
  • Proposed mechanism 3
  • History 4
    • Rat models 4.1
  • Politicization 5
    • National Cancer Institute 5.1
    • North Dakota lawsuit 5.2
  • References 6
  • External links 7

The ongoing promotion of a link between abortion and breast cancer is seen by others as part of the anti-abortion "woman-centered" strategy against abortion.[22][23][24] Anti-abortion groups maintain they are providing information necessary for legally required informed consent,[25] a concern shared by some politically conservative politicians.[26] The abortion–breast cancer issue remains the subject of political controversy.[2]

National Cancer Institute website to suggest that abortion might cause breast cancer.[13] In response to public concern over this intervention, the NCI convened a 2003 workshop bringing together over 100 experts on the issue. This workshop concluded that while some studies reported a statistical correlation between breast cancer and abortion,[14][15][16] the strongest scientific evidence[17] from large prospective cohort studies[18][19] demonstrates that abortion is not associated with an increase in breast cancer risk,[20] and that the positive findings were likely due to response bias.[21]

[11].Canadian Cancer Society and the [10],German Cancer Research Center the [9],Royal College of Obstetricians and Gynaecologists the [8],American Congress of Obstetricians and Gynecologists the [7],American Cancer Society the [6][5],National Cancer Institute the U.S. [4][3]

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