The Link Between Abortion & Breast Cancer

Miscarriages and abortions have been repeatedly linked to a significant and substantial increase in the risk of breast cancer. Women who have had miscarriages need to know that they may be at risk; women considering abortion need to know about this risk *before* they choose.

THE LINK BETWEEN ABORTION & BREAST CANCER

by Scott Somerville

INTRODUCTION

The rate of breast cancer is rising rapidly in the United States,[1] (Figure 1) and in many other countries around the world.[2] The rate of breast cancer is also rising at an alarming rate among certain subgroups in America, such as young African-American women[3] and poor women in certain states.[4] A fraction of this rise can be accounted for through known risk factors, but a full 60% of the increase has remained a mystery to scientists.[5] The popular press has been filled with articles such as "A Puzzling Plague: What is it about the American way of life that causes breast cancer?" (_Time_, Jan. 14,1991) and "In Pursuit of a Terrible Killer" (_Newsweek_, Dec. 10,1990).

What is the cause of this sudden surge in the breast cancer rate? Recent, reputable, and repeated medical research indicates that it may be abortion. Abortion of a first pregnancy interrupts the growth and changes which enable the breast to produce milk, leaving the breast at a heightened risk of cancer. This risk, multiplied by the millions of induced abortions around the world, can account for the mysterious jump in the breast cancer rate. This report discusses the twenty-two published studies which document a link between a first-pregnancy abortion and an increased risk of breast cancer, and concludes that women need to know about this risk before they choose abortion.

Figure 1:

115 | U.S. | 110 | * Breast Cancer | * * 105 | * Cases | 100 | per | 95 | * * 100,000 | * 90 | * * Women | * * * 85 | * | * * * 80 | | 75 +--------------------------------------------- 1970 1975 1980 1985 1990

[Note: Due to the limitations of ASCII Graphs, we recommend that you acquire typeset copies from the author. The graphs herein provided are to give a general idea of the trends involved. ]

THE BIOLOGICAL LINK

A woman's first full pregnancy causes hormonal changes which permanently alter the structure of her breast. The completed process greatly reduces the risk of breast cancer.[6] A premature termination of a first pregnancy interrupts this process. Instead of protecting the breast from cancer, abortion leaves millions of breast cells suspended in transitional states. Studies in animals and human tissue cultures indicate that cells in this state face exceptionally high risks of becoming cancerous.

Before a woman first conceives, her breasts consist mostly of connective tissue surrounding a branching network of ducts, with relatively few milk producing cells. When the first child is conceived, estrogen and other hormones flood the mother's system. (The pregnant woman experiences this as morning sickness.) Under the influence of these hormones, her breast cells undergo massive growth. (The resulting tenderness of the breast is one of the earliest signs of pregnancy.) The network of milk ducts begins to bud and branch, developing more ducts and new structures called "end buds." These end buds begin to form "alveolar buds," which will later develop into the actual milk-producing glands, called "acini." This period of rapid growth towards maturity is when breast cells arc most likely to be affected by certain cancer causing agents, or "carcinogens."[7]

Around the end of the first trimester, the hormone balance changes. Estrogen levels drop, and the level of other, different hormones begin to rise. The growth phase comes to an end, and a new phase of differentiation and maturation begins and continues until the child is born.

_Cell differentiation and maturation is the process by which cells become specialized_. Most people know that all living creatures begin as a single cell, which divides and reproduces. By mechanisms still barely understood by man, these basic cells are directed to become different from one another. Eventually, they become highly specialized into the various organs and tissues of the body.

In the woman's breast, this process of cell differentiation is directed by hormones produced in the later stages of pregnancy. _Once cells become specialized, they are very unlikely to turn cancerous_.

When the child is born, the breast is ready to produce milk to nourish the baby. _It will never return to its earlier state, or be as vulnerable to cancer as it was in its immature state or during the growth phase of early pregnancy_. The earlier this occurs, the lower the risk of breast cancer. Many studies have found that giving birth, especially at an early age, lowers the risk of breast cancer. Women who give birth before age 18 have about one-third the risk of women who have their first child after age 35.[8]

_Unfortunately, first-trimester abortions (whether spontaneous miscarriages or surgically induced) appear to interrupt the breast maturation process at the worst possible time_. When cells are reproducing the fastest, the risk that there will be an error in reproduction is the highest. _Cancer results from cells whose reproduction runs amok_.

Test tube studies on human breast cells indicate that human breast tissue is similar in many ways to that of rats,[9] and rat studies clearly suggest that first trimester abortions could lead to breast cancer. For example, in rats, the point at which breast tissue is most susceptible to cancer is when the breast tissue is rapidly developing in early pregnancy. Treating rats with carcinogens during this phase results in the greatest number of cancerous tumors. Most abortions take place during early pregnancy, at a time when the breast tissue seems to be highly vulnerable to cancer. _Terminating the pregnancy would appear to leave the breast cells in a highly susceptible state_.

THE STATISTICAL LINK

The biology of the breast suggests that abortion could cause breast cancer. It this is true, one would expect to find that, as a group, women diagnosed with breast cancer would have had more short-term pregnancies than other women. A great deal of research has been done in this area, and repeatedly, reputable studies have found unusually high abortion rates among women with breast cancer. The increased risk of breast cancer associated with abortion exists even after one adjusts for other known risk factors, such as the protective effect of an early live birth.

in one study, for example, researchers did a long-term study of a group of 3,315 Connecticut mothers [10]. (Figure 2) They were able to identify how many of these women developed breast cancer over the years. Women with a miscarriage before the first live birth were more likely to get breast cancer. Such women had an increased risk of 350%, but some of this was due to the later age at first birth among women who miscarried. After adjusting for this and other known risk factors, there was still a 250% increase in risk attributable to the miscarriage alone.

Many studies show that women who miscarry or abort their first pregnancy in the first trimester face an increased risk of breast cancer. Most of these studies are so-called "case-control" studies. In a case-control study. researchers look at two groups of subjects. One group is the group of "cases:" in this instance. women who have been diagnosed with breast cancer. The other group are the "controls." In our studies (see next section). these are women who are similar to the "cases," except that they do not have reproductive system cancers.

Biologically, miscarriages and abortions may be able to cause breast cancer. The statistical studies strongly suggest that a short-term pregnancy does, in fact, cause this type of cancer. Furthermore, it would appear that the increase in risk is very significant. An analysis of all reputable studies done to date suggests, as a conservative figure, that women who have miscarriages or abortions before the first live birth initially have a risk 50% higher than women who do not. This risk appears to be strongly affected by the number of short-term pregnancies, and the presence of a live birth later in life. The only long-term follow-up study shows that the risk of breast cancer increases with time (Figure 2).

The biological evidence is that abortion can cause breast cancer. The statistical evidence is that it does. What does the abortion industry have to say in its defense?

Figure 2

12 | | X X X 11 | | X = Abortion before first live birth 10 | | Y = No prior abortion 9 | X Cases | 8 | X per | 7 | 100,000 | 6 | | X 5 | X | 4 | | 3 | X | X 2 | X X X Y Y Y Y Y | Y 1 | X YY Y Y Y Y | X Y X---+-Y-+---+Y-Y+---+---+---+---+---+---+---+---+- 10 20 30 40

Time Since Live Birth (Years)

OUR STUDIES

- Segi _et al_., 1957: Reported a higher rate of both miscarriages and abortions among breast cancer patients; increased risk ranged from 100% to 400% among the different subgroups in the study. [11]

- Stewart and Dunham, 1966: More Israeli breast cancer patients had pregnancies which terminated in the first trimester than did the control group.[l2]

- Yuasa and MacMahon, 1970: "There was a significant excess of [cancer] cases reporting one or more abortions.''[l3]

- Lin, _et al_., 1971: Women with one or more abortions had a risk 50% higher then that of women who did not; with two or more abortions, the risk rose to 100%.[14]

- Mirra, Cole and MacMahon, 1971: In a Brazilian study, more breast cancer patients reported having had abortions than did the control group.[l5]

- Stavraky and Emmons, 1974: Thirty-seven percent of patients who developed breast cancer after menopause had had at least one abortion; while only 27% of women with other cancers reported an abortion.[16]

- Choi _et al_, 1978: Women who had pregnancies lasting four months or less show a statistically significant increase in breast cancer.[l7]

- Soini, 1977: Rate of breast cancer among women in Finland increased with number of abortions.[18]

- Dvoirin and Medvedev, 1978: Case-control study in the North Caucasus, Soviet Union, found an increased risk in women with three or more induced abortions of 240%. With one or two induced abortions, the risk was 100%.[19]

- Kelsey, 1979: "Pregnancies of less than four to five month's duration may be associated with an increased risk."[20]

- Pike _et al_., 1981: First trimester abortion of first pregnancy led to increased risk of 140% among women under 32.[2l]

- Le _et al_., 1984: French women who had an abortion at any time (without differentiating between abortions before or after the first full pregnancy) had a risk 17% higher than women without abortions; with two or more abortions, increased risk was 58%.[22]

- Hirohata _et al_., 1985: After multiple logistic regression analysis, risk among women with any induced abortion was 52% higher than women without abortions.[23]

- Hadjimichael _et al_., 1986: Abortion before first live birth, after adjusting for other known risk factors, increased risk by 250%, leading him to report, "These data indicate that an abortion prior to the first live birth may increase a woman's risk of breast cancer."[24] (See Figure 2)

- La Vecchia _et al_., 1987: Risk among Italian women with one or more legal abortions before first live birth was increased by 42%.[25]

- Ewertz and Duffy, 1988: Termination of first pregnancy before 28 weeks increases risk by 43% times; two or more abortions before the first full pregnancy increased the risk to 73%; one induced abortion with no live births increased risk to 285%. [26]

- Yuan, Yu and Ross, 1988: Among Chinese women who developed breast cancer before the age of 40, abortion before first full term pregnancy led to increased risk of 140%. [27]

- Howe _et al_., 1989: Abortion of first pregnancy led to increased risk of 90%. Repeated abortions before live birth heightened risk by 300%. [28]

- Lindefors-Harris, _et al_., 1989: Women who had abortions before live births had 88% greater risk of breast cancer than did women who had a live birth before an abortion.[29]

- Olsson _et al_., 1991a: Abortion of first pregnancy led to more aggressive tumors.[30]

- Olsson _et al_., 1991b: Breast cancers of women who aborted their first pregnancy showed 18 times the normal rate of INT2, a specific gene associated with cancer.[3l]

- Parazzini _et al_., 1991: Legal abortions in Italy before first birth led to increased risk of 30%.[32]

The Abortion Industry Responds

Key individuals in the abortion industry have been aware of this link since at least 1982.[33] Malcolm Pike explicitly identified abortion as a risk factor in breast cancer in 1981.[34] A number of studies followed up his work. A close look at who knew what, and when, leads to the inescapable conclusion that the abortion industry has intentionally kept this information from its patients for the last twelve years.

The industry relies on one hypothesis for its excuse to not tell women about their risk: the "Recall Bias" theory. They suggest that women with breast cancer are more likely to remember or admit previous abortions than a comparison group would be.[35] In effect, women with cancer tell the truth, while healthy women lie. Thus, they suggest, studies which detect an increased risk of cancer find a risk which isn't really there.

The risk is not merely apparent, however, because "recall bias" cannot account for all the results. Recall bias might explain some studies, but it utterly fails to explain the following:

1) At least one study uses patients with non-reproductive cancers as controls,[36] so one can hardly attribute "recall bias" to the seriousness of their medical condition. Many of the studies use a control group of women who have been admitted to a hospital. Any hospital stay indicates a serious health risk, so even non-cancerous women have a good reason to tell the whole truth.

2) Where one can check official abortion records, it appears that although women do lie about their abortions, cancerous and non-cancerous women appear to lie in equal amounts.[37]

3) The long-term follow-up study previously discussed above (see Figure 2) starts with a group of mothers at the time of live birth, and observes what happens to them over the years. This study is therefore completely free of "recall bias," but shows an increased risk of 250% over time.

4) Insofar as "recall bias" depends on women being unwilling to admit that they had an abortion. it should not affect studies involving miscarriages. Studies of miscarriages, however, routinely show an increased cancer risk.

5) Insofar as "recall bias" depends on women forgetting their abortions, it is simply unbelievable. The abortion industry may not consistently claim that "abortion is the most private, personal decision a woman will ever make" and then argue that large numbers of healthy women forget their abortion history.[38]

6) In two large studies of women which were based solely on official abortion records (and therefore immune from recall bias), abortion of the first pregnancy was associated with an increased risk of approximately 90%.[39]

If it could be proven that all findings of an increased risk can be explained by recall bias or other well-documented factors, then the abortion industry might not be required to inform all women of this research. It is not enough to assert that "recall bias" may exist - the burden of proof is upon the industry to explain, with each new study, why they should not now inform women of the research.

The "Swedish Data Massage"

One of the two large computer-based studies mentioned opposite was conducted by Holly Howe and other researchers at the New York State Department of Health. Howe set up a carefully designed study of New York State's cancer and fetal death registries. This study is a devastating blow to the "recall bias" theory, since it depends solely on official records, uses a large sample of women, and can be followed up at any time by researchers with access to New York's records. (Around 10% of all legal abortions in the country take place in New York state, and every one is officially recorded in the Fetal Death Registry.) It took years for Howe's research to be published. After several American journals refused to print the article. it finally appeared in a respected British journal, the _International Journal of Epidemiology_ in 1989.

The Howe study was followed up, within months of publication, by a much hastier large-scale study in Sweden by Britt-Marie Lindefors-Harris _et al_., also published in 1989. This research was largely funded by "Family Health, International," a U.S. group which specializes in "contraceptive and family planning research." Family Health, International is a research arm of the abortion industry.

The Swedish study begins with an elegant introduction which precisely identifies the importance and plausibility of the hypothesis that abortion causes breast cancer.[40]

Many epidemiological studies have investigated the risk of cancer of the breast in women who have had one or more abortions [citing 21 studies]. Although the findings were not entirely consistent, most indicated increased risk.

This study has been aptly described as the "Swedish Data Massage." Like the Howe study, the Swedish study is based on official computerized cancer and abortion records, but unlike Howe. the Swedish team makes no effort to identify a control group, nor do they focus on women who aborted their first pregnancy. (In Sweden, unlike America, most women who get legal abortions have already had one or more children, and thus most women in this study have the lower risk of breast cancer associated with the protective effect of the first full pregnancy.) The Swedish study knowingly lumps women who have already had a child in with women who aborted their first pregnancy. The authors then compare the combined results to the total population (which includes a very high number of women who have had abortions) rather than to women who have not had abortions. Through the use of these transparent statistical devices, the Swedish researchers mask any possible link between first-pregnancy abortion and breast cancer, and conclude:

Contrary to _most_ earlier reports, this study did not indicate any _overall_ increased risk of breast cancer after an induced abortion in the first trimester in young women. [Emphasis added.]

Despite their apparently intentional effort to hide the relationship, even this Swedish study reveals some amazing statistics. There is only one paragraph in the published study which says anything about first-pregnancy abortions. Women who had an abortion after a live birth had a breast cancer risk of only 58% of the "average" risk in the study. Women who had an abortion before a live birth had a risk of 109% of ''average.'' [41] Comparing these two numbers yields an increased risk factor of nearly 88%, almost exactly the 90% risk reported in Howe's New York State study.[42]

This 88% increase, in a study based solely on official records, directly rebuts the "recall bias" hypothesis. Yet Lindefors-Harris immediately conducted another study for Family Health, International,[43] in which she still tries to prove the "recall bias" hypothesis. The abortion industry is trying to hide the facts, not reveal them.

The Logical Link

Sherlock Holmes said, "Once you have eliminated the impossible, whatever is left, no matter how improbable, must be true." We are searching for a single cause for the world-wide rise in breast cancer. As such, many of the potential culprits can be eliminated.

_There are many possible causes of breast cancer, but we are looking for one plausible cause of the sudden, global surge in this disease_. Genetics, diet, radiation, miscarriages, and a number of other factors all seem to influence the rate of the cancer. Unlike legalized abortion, however, most of these factors have always been at work, to some degree, and are probably responsible for a relatively stable base level of breast cancer.[44] Unfortunately, in the last forty years, the level of breast cancer has not been stable, but has been rising sharply around the world. A full 60% of this increase remains a mystery to American researchers. Something new must be responsible for the sudden change in the rate of breast cancer.

Figure 3 1.6|L = Reported legal L |I = Estimated illegal L L 1.4| L L L | L L L 1.2| L L L L | L L L L L 1.0| L L L L L L | L L L L L L L 0.8| L L L L L L L | I L L L L L L L L 0.6| I L L L L L L L L L | I I L L L L L L L L L L 0.4| I I L L L L L L L L L L | I I L L L L L L L L L L 0.2| I LI LI L L L L L L L L L |LI LI LI LI L L L L L L L L 0|LI LI LI LI LI LI L L L L L L +------------------------------------------------- 69 70 71 72 73 74 75 76 77 78 79 80

Rise in Number of Legal Abortions in America [45]

Aside from legalized abortion, the other prime suspect would be oral contraceptives (the "Pill"). The Pill became popular in the 1960's, some 10 to 20 years before the increase in breast cancer in the U.S. first became evident. This might fit the latency period for cancer. Some studies do suggest a link between use of the Pill and breast cancer.[46]

Nancy Krieger, a breast cancer researcher, suggested in 1989 that the popularity of the Pill and/or abortion might account for the "cross-over effect," the well-documented but highly troubling fact that young African-American women have a higher breast cancer rate than do young white women. while older black women face a lower risk. She theorized that if this were true, one would expect to find higher breast cancer rates among young upwardly mobile black women, because they use the Pill and abortion more than do women on welfare. Krieger followed up her thinking with a careful study of racial and economic patterns in the breast cancer rates of women in the San Francisco Bay area. She found a significant increased risk for young African-American women living in higher status neighborhoods. This supported her hypothesis that the Pill or abortion could be the cause of the cross-over effect.[47]

The Pill could be partially responsible for breast cancer. but it alone cannot be responsible for the sudden world-wide jump. Soviet women have had little access to Western-style drugs, including the Pill. Without birth control pills, or any other effective contraceptives, the Soviets have had one of the world's highest abortion rates. If the Pill were the sole cause of the sudden jump in breast cancer, one would expect no rise in the old Soviet Union. If abortion causes breast cancer. however, one would expect a very sharp rise in the incidence of breast cancer there. _In fact, the incidence of breast cancer among Russian, Estonian, and Soviet Georgian women appears to have tripled between 1960 and 1987_.[48] (The Chernobyl nuclear disaster, although devastating. has probably not had a significant effect on women living outside the Ukraine.)

The tripling of Soviet cases makes it possible to rule out a number of other possible causes for the sudden world-wide jump. While young American women were experimenting with illegal drugs, Soviet women were not. Soviet women have also been spared most of the additives and preservatives in American foods. _Abortion is one of the few influences which has been linked to breast cancer and has been present on both sides of the Iron Curtain_.

The rise in breast cancer has routinely been blamed on changes in diet, but a recent report states that the popular theory that eating fatty foods in adulthood might cause breast cancer seems to have "bombed out." [49] It is hard to provide much concrete evidence that dietary changes are actually responsible for the dramatic rise in breast cancer around the world. In Japan, the rising rate of breast cancer has been blamed on the introduction of red meat to the Japanese diet. Women in the former Soviet Union, however, have not been eating more red meat, while their breast cancer rate, as noted earlier, has tripled. Women in the U.S. have become very health-conscious in the last several decades, but they, too, have seen a huge rise in the rate of breast cancer. It is very hard to believe that the rate of breast cancer in Japan is rising because women are eating richer foods, is rising in the former Soviet Union because women are eating more poorly, and is rising in the United States because women are eating more healthful foods. It is far more reasonable to attribute the world-wide rise in breast cancer to the one new world-wide risk factor which _has_ been linked to breast cancer: abortion.

There are other facts about the sudden rise in breast cancer which can only be explained by legalized abortion. _Almost every early study on breast cancer which looks at socioeconomic status notes that rich women have a higher rate of the disease than poor women._[50] Before 1969, a legal abortion in a hospital was likely to cost more than $500, which meant that women of high economic status were much more likely than other women to obtain abortions.[51] This would account for the historical link to socioeconomic status.

_Cheap and/or free abortions would change this pattern, and studies in states which fund free abortions indicate that the pattern has changed_. Washington state has long had a very liberal attitude towards abortion. The state legalized it in 1970, several years before the U.S. Supreme Court decided Roe v. Wade. As a result, rich women in Washington have had little trouble getting abortions. In the early 1970s, Washington began to publicly fund abortions for the poor. The results are striking. After the state started funding free abortions, the breast cancer rate among poor women rose by 53% in the period from 1974 to 1984, while it actually dropped by 1% among wealthy women. Rich women, who supposedly have always had access to abortions, experienced no increase in the rate of breast cancer, while the rate among poor women skyrocketed. The most plausible explanation for this is the availability of free abortions in Washington state.

Figure 4

1.5| + | +*+ 1.4| + | 1.3| | 1.2| | 1.1| + | + +*+ 1.0| +*+ + | + 0.9| | +-------------------------------------------------------- 1974-1977 1978-1981 1982-1984

Breast Cancer Rate Among Poor Women In Washington State

A similar study in California (which also funds abortions for the poor) found that by 1990, among young white women. there was no difference in the rate of breast cancer between rich and poor.[52] Washington and California have equalized poor women's access to abortion, and appear to have simultaneously equalized their risk of breast cancer.[53]

Different religions have very different teachings about abortion. Catholics and conservative Protestants believe that human life begins at conception, and therefore oppose abortion. while most Jews and liberal Protestants permit abortion. One would expect that this would lead to a difference in breast can- cer rates along religious lines. This is precisely what researchers have found, with Jewish women showing a risk 2.8 times that of Catholics in one multi-national study in 1983,[54] and Protestant women showing a greatly increased risk over Catholic women in Canada in 1978.[55] This difference is very, very hard to explain on any grounds _except_ for the abortion difference.

Abortion is the one common factor that explains the rapid increase in breast cancer from East to West, among rich and poor, and in black and white. _No other single known risk factor can account for this world-wide surge_.

Studies Which Find No Link

As we have demonstrated, some researchers have intentionally obscured evidence of the link. Many other researchers have accidentally muddied the waters because they are unaware of the critical importance of the first live birth. A large case-control study in Milan, Italy, for example, reported no link between legal abortion and breast cancer.[56] Over three-quarters of legal abortions in Italy occur among women who have already had one or more children, however.[57] This means that these women are at a lower risk of breast cancer, because of the previous live birth, even with a later abortion. Studies which lump all abortions together often fail to find an increase in breast cancer.[58]

Even studies that lump together all abortions sometimes find a statistically significant increase in breast cancer.[59] This result is probably due to different national patterns of abortion use. In the U.S., for example, most abortions occur before the first full pregnancy, whereas 60% of legal abortions among Swedish women are performed on women who have had one or more children, as are 75% of legal abortions in Italy.[60] This can easily account for the differing results in studies which fail to distinguish first from later abortions.

Until relatively recently, legal first-pregnancy abortions were quite rare. Because of this, several studies done since the ground-breaking Pike study in Los Angeles in 1981 depend on very small numbers of first-pregnancy abortions in their sample.[61] Sound statistical research depends on having enough cases to be able to rule out chance as the explanation. Larissa Remennick, a Russian researcher, carefully analyzed many of these earlier studies in her 1990 review of the relevant research.[62] On a larger scale, Dr. Joel Brind and a team of researchers are performing a "meta-analysis" which compiles every research result to date. Even these studies which do not find an increased risk among a very small number of cases appear to be consistent with a 50% increase in risk.

The 1981 Pike study, which first suggested that abortions might cause cancer, also found a higher risk for women who took the Pill. Earlier research on the Pill had never been checked for a possible "confounding" risk of abortion. If Pike was right, the Pill might also be called into question. Drug companies quickly funded several studies,[63] which, to be blunt, use research techniques which seem designed to minimize finding that a particular drug or procedure causes cancer.[64]

In two such studies, when the researchers compare women with cancer to women without cancer, they make little to no effort to match the ages of the two groups.[65] The single biggest risk factor for cancer is _age_ . One study compares a group of women who have cancer, with a median age of 52. to another group without cancer, who have a median age of 40. It makes no sense to compare women who discover they have cancer at age 52 to women without cancer at age 40 some of the younger women can expect to detect cancer in the next twelve years. This factor makes the study unreliable.

In addition, the age difference means that the study compares women who were very unlikely to get abortions to women who were very likely to get abortions. The average woman with cancer in this study would have turned 40 about the time that abortion was legalized nationwide. The average woman in this group, therefore, would not be looking for a legal abortion of her first pregnancy. The average woman in the cancer-free group, however, would have just turned 28, making her a good candidate for a legal abortion of a first pregnancy. Counting abortions among the older women and comparing them to abortions among younger women leads to grossly unreliable results.

One other large-scale study does not report the median age, and therefore is not so visibly flawed. [66] It was, however, conceived, conducted, reviewed, and published very hastily, within mere months of the initial Pike study in 1981. (The paper was received by the journal on November 6, 1981, and was accepted for publication within two weeks.) The authors quickly reviewed their data from an earlier research project on oral contraceptives, and report an "entirely reassuring" absence of any link. Given the steadily mounting evidence from studies which have been done with more time and less research bias, this "quick and dirty" report may not merit a great deal of reliance.

Each study which finds no link appears to be easily explained away, while the studies that find a link seem very solid. If the researcher knows what to look for, the link between abortion and breast cancer always seems to show up.

If You Are At Risk

Women who have had a miscarriage or an abortion before their first live birth may find this report to be very alarming. Women who have had miscarriages will need professional guidance from a doctor on how they should cope with this risk. Women who have had abortions may need additional professional assistance from lawyers and counselors. This report offers some information in each of these areas, but women at risk are advised to seek personalized help from a qualified professional who is made aware of her particular circumstances.

Medically, it is important to note that breast cancer can be one of the easiest cancers to treat--if it is detected in time. Most women are aware of the general risk of breast cancer, but many do not really believe it will affect them. Our goal in making this information available is to save lives by revealing the risk in time for women to act. A competent doctor who has read this report and who knows your full medical history can best advise you on what you should do. For some women, this may simply mean regular self-examinations. For others, it may mean routine mammograms, under your doctor's supervision.

Legally, the abortion industry should be liable for damages both to women who have contracted breast cancer and to those who are at increased risk. To hold an abortionist liable, a woman must be able to prove that she probably would not have had the abortion if she had known the full risk, and must prove that her abortion probably caused the cancer. Because clear evidence of this link has been available since 1981, every woman receiving an abortion after this date should have been informed of the risk. Juries may find it hard to believe that the average woman would knowingly choose to raise her risk of breast cancer to Russian roulette's one in six odds. (If the last abortion occurred before 1981, liability will depend on the circumstances surrounding the abortion.)

Women seeking more information on their legal rights should contact a qualified legal professional. Many attorneys are willing to represent a woman with a valid malpractice claim on a contingency basis, where the lawyer only gets paid if the case is successful.

Emotionally, women who realize that they are at risk may also need serious counseling. The abortion decision can be the most intensely personal and moral decision any human being ever makes. For years, religious opponents of abortion have said that "God hates abortion." This makes it is easy for a woman at risk to think, "I had an abortion. God will punish me. I am going to die." Such thoughts are a dangerous trap.

Most counselors agree that no woman should have to live in fear of divine punishment. The basic message of the Christian church has always been that although God truly hates sin, He loves the sinner. The New Testament repeatedly tells of how Jesus accepted people who had made tragic choices in their own lives. See, for example, Luke 15:11-32 (the story of the prodigal son); John 3:16-21 (Jesus did not come to condemn); 1 John 1:8-10 (God will forgive sins). People who have not read the New Testament tend to assume that a person has to be good to come to God. However, the Bible says that all people are bad, which is why God had to come to us (Romans 3:10-26). The Bible does require each person to accept the moral responsibility for their actions, but offers complete forgiveness for all who in faith accept that forgiveness. Pastoral counseling is available at no cost at most churches.

Doctors, lawyers, and counselors are available to help women deal with the risks outlined in this report. Not every woman will seek out or accept that help. It is essential that such women encounter supportive and compassionate people in time to prevent the predictable vicious cycle of fear, guilt, and despair.

The Missing Link: The Media

Much of the information in this report has been available in published form for a number of years. Why isn't this common knowledge?

When Pike published his initial research in 1981, the abortion industry acted very quickly to do reassuring follow-up studies, which the medical journals were quick to review and publish. Meanwhile, researchers reporting a statistically significant connection between abortion and breast cancer had to go to Britain to find publishers, even though their research was done on large populations of women in places like New York or Connecticut. Even then, when Howe's New York research was finally published in 1989, it was immediately followed by a well-timed study funded by the abortion industry which reported "entirely reassuring" results.

Dr. Joel Brind, a breast cancer researcher unaffiliated with the abortion industry, stumbled onto the link in November 1992, and has been trying to get the news out ever since. Spokesmen for the abortion industry report that the evidence is "inconclusive" and that it "hasn't been suppressed." Scott Somerville, the author of this report, has spoken to a number of journalists on the subject, most of whom were extremely uncomfortable about the issue. A mere handful of papers have reported on this material.

_The right to an abortion is important to many young, upwardly mobile women; the right to choose, however, includes the right to know_. Those who suffer the most from the silence of the medical and popular press are poor women,[67] young women,[68] minority women, and women who have suffered miscarriages. If this news had been reported in 1981, when the first clear indications of a link were published, an entire generation of young, African-American women could have been spared. If the 1986 study of the cancer rate among women with miscarriages had been widely reported, women in that risk group would have had seven years of opportunity for early detection which has now been lost forever.

Conclusion

Evidence from a number of different independent sources all converge on the same conclusion: abortion before the first live birth dramatically raises the risk of breast cancer. The abortion industry has had this information for at least a dozen years, and has told no one. Instead, they have hidden behind the "recall bias" hypothesis, which is demonstrably false. Up until the present, the press has made little to no effort to warn women of their risk. Silence, in this case, can mean death. We urge each reader to critically evaluate the information in this publication. If you are convinced that this is a risk women need to know about _before_ they choose abortion, please help us help them by helping to distribute this report.

About the Author

Scott Somerville, Esq., is a graduate of Dartmouth College, (Phi Beta Kappa, 1979) and of Harvard Law School (cum laude, 1992).

Endnotes

[1] General Accounting Office, Breast Cancer, 1971-1991: Prevention, Treatment and Research, Washington, D.C.: GAO/PEMD-92-12 (1991).

[2] Up 40% in Italy and Sweden, up 200% in the former Soviet Union. C. La Vecchia, A. Decarli, F. Parazzini. A. Gentile, E. Negri. C. Cecchetti and S. Franceschi, General epidemiology of breast cancer in Northern Italy. _Intl. J. Epidemiol._ 16: 347-355 (1987). National Board of Health and Welfare, Cancer incidence in Sweden 1971-1984, Stockholm: National Board of Health and Wellfare (1987); L.I. Remennick, Reproductive patterns and cancer incidence in women: A population-based correlation study in the USSR, _Intl. J. Epidemiol._, IX: 498-510 (1989).

[3] N. Krieger, Social class and the black/white crossover in the age-specific incidence of breast cancer: a study linking census derived data to population-based registry records, _Am. J. Epidemiol._ 131: 804-814 (1990).

[4] E. White, J. Daling, T.L. Norsted, J. Chu, Rising incidence of breast cancer among young women in Washington State, _J. National Cancer Inst._ 79:239-43 (1987); Krieger, 1990, supra.

[5] E. Marshall, Search for a killer: focus shifts from fat to hormones, _Science_ 259: 618-621 (1993).

[6] M. Ewertz, and S.W. Duffy, Risk of breast cancer in relation to reproductive factors in Denmark, _Brit. J. Cancer_, 58: 99-104 (1988); J.L. Kelsey. D.B. Fischer, R.K. Holford, V.A. LiVoisi, E.D. Mostow, I.S. Goldenberg, and C. White, Exogenous estrogens and other factors in the epidemiology of breast cancer, _J. National Cancer Institute_ 67: 327-333 (1981); J.L. Kelsey, A review of the epidemiology of human breast cancer, _Epidemiol. Rev._, 1: 74-109 (1979) (citing fourteen earlier studies).

[7]. "The higher susceptibility of terminal end buds to neoplastic transformation is attributed to the fact that this structure is composed of actively proliferating epithelium. Furthermore, autoradiographic studies show that the greatest uptake of tritiated DMBA [a carcinogen commonly used in rat studies] occurs in the nucleus of epithelial cells of the terminal end buds, indicating that the highest DMBA-DNA interaction is associated with the structure with the highest proliferative rate. This observation has been corroborated by _in vitro_ experiments using human breast tissue." S.C. Brooks and R.J. Pauley, Breast cancer biology, _Encyclopedia of Human Biology_, R. Dulbecco, ed. (1991); See also, J. Russo, L.K. Tay, and I.H. Russo, Differentiation of the mammary gland and susceptibility to carcinogenesis, _Breast Cancer Res. Treat._ 2: 5-73 (1982). This monumental work (68 pages) covers nearly every relevant aspect of the development and differentiation of breast tissue.

[8] Kelsey, 1979, supra (citing fourteen earlier studies).

[9] Russo, Tay and Russo, 1982, supra.

[10] O.C. Hadjimichael. C.A. Boyle. and J.W. Meigs. Abortion before first livebirth and risk of breast cancer, _British J. Cancer_ 53: 281-284(1986).

[11] M. Segi, I. Fukushima, and M. Kurihara, An epidemiological study of cancer in Japan, _GANN_ 48 (Supp): I ( 1957).

[12] H.L. Stewart and L.J. Dunham, Epidemiology of cancer of the uterine cervix and corpus, breast and ovary in Israel and New York city, _J. Natl. Cancer Inst._ 37: 1-95 (1966).

[13] S. Yuasa. and B. MacMahon, Lactation and reproductive histories of breast-cancer patients in Tokyo, Japan. Bull. WHO 42: 195- 204(1970).

[14] T.M. Lin, K.P. Chen, and B. MacMahon, Epidemiologic characteristics of cancer of the breast in Taiwan. _Cancer_ 27: 1497- 1504(1970)

[15] P. Mirra, P. Cole. and B. MacMahon, Breast cancer in an area of high parity. _Cancer Res._ 31: 77-83 ( 1971).

[16] K. Stavraky. and S. Emmons. Breast cancer in pre-menopausal and post-menopausal women, _J. Natl. Cancer Inst._ 53: 647-654 (1974).

[17] N.W. Choi, G.R. Howe, A.B. Miller. V. Matthews, R.W. Morgan, L. Munan, J.D. Burch, J. Feather, M. Jain, and A. Kelly. An epidemiologic study of breast cancer. _Amer J. Epidemiol._ 107: 510-521(1978).

[18] I. Soini, Risk factors of breast cancer in Finland, _Intl. J. Epidemiol._, 6: 365-373 (1977).

[19] V.V. Dvoirin, and A.B. Medvedev, The role of reproductive history in breast cancer causation, _Methods and results of studies of breast cancer epidemiology_, 53-56. Tallinn, Estonia (in Russian) (1978).

[20] Kelsey. 1979, supra.

[21] M.C. Pike, B.E. Henderson, J.T. Casagrande, I. Rosario, and G.E. Gray, Oral contraceptive use and early abortion as risk factors tor breast cancer in young women, _Brit. J. Cancer_ 43:72-76 (1981)

[22] M.-G. Le, A. Bachelot, F. Doyon, A. Kramar, C. Hill, Oral contraceptive use and breast or cervical cancer: preliminary results of a French case-control study. in _Hormones and sexual factors in human cancer aetiology_, J. P. Wolff, and J.S. Scott, eds. Elsevier Science Publishers, B.V. (1984).

[23] T. Hirohata, T. Shigematsu, A.M.Y. Nomura, Occurrence of breast cancer in relation to diet and reproductive history: a case- control study in Fukuoka, Japan, _Natl. Cancer Inst. Mono._ 69: 187 (1985).

[24] Hadjimichael _et al_., 1986, supra.

[25] C. La Vecchia, A. Decarli, F. Parazzini, A. Gentile. E. Negri. G. Cecchetti and S. Franceschi, General epidemiology of breast cancer in Northern Italy, _International J. Epidemiol._ 16: 347-355 (1987).

[26] Ewertz and Dufty, 1988, supra.

[27] J.-M. Yuan, M.C. Yu, and R.K. Ross. Risk factors for breast cancer in Chinese women in Shanghai. _Cancer Res._ 48: 1949 (1988).

[28] H.L. Howe. R.T. Senie, H. Bzduch, and P. Herzteld, Early abortion and breast-cancer risk among women under 40, _Int. J. Epidemiol._ 18: 300-304 (1989).

[29] B.-M. Lindefors-Harris, G. Edlund. O. Meirik, L.E. Rutqvist, and K. Wiklund, Risk of cancer of the breast after legal abortion during first trimester: a Swedish register study. _British Med. J._, 299: 1430-1432 (1989). This is not a case-control study, and claims to prove that abortion is not related to breast cancer. See discussion of this study below.

[30] H. Olsson, J. Ranstam, B. Baldetorp, S.-B. Ewers, M. Ferno, D. Killander, H. Sigurdsson. Proliferation and DNA ploidy in malignant breast tumors in relation to early oral contraceptive use and early abortions. _Cancer_ 67: 1285-1290 (1991)

[31] H. Olsson, A. Borg, M. Ferno, J. Ranstam, and H. Sigurdsson, Her-2/neu and INT2 proto-oncogene amplification in malignant breast tumors in relation to reproductive factors and exposure to exogenous hormones, _J. Natl. Cancer Inst._ 83: 1483-1487 (1991).

[32] F. Parazzini, C. La Vecchia, and E. Negri, Spontaneous and induced abortions and risk of breast cancer, _Int. J. Cancer_ 48: 816- 820 (1991). Note, however, that illegal abortions account for a significant number of first pregnancy abortions in Italy. See I. Figa-Talamanca, M. E. Grandolfo, and A.Spinelli, Epidemiology of legal Abortion in Italy, _International J. Epidemiol._ 15:343-351 (1986).

[33] In March, 1982, Willard Cates, Jr. wrote an article in _Science_ which discussed the evidence of the link. (W. Cates, Jr., Legal abortion: the public health record, _Science_ 215: 1586-1590. His manuscript was reviewed by D.A. Grimes, C. Tietze, R.W. Rochat, and C.W. Tyler. These are authors who, between them, have contributed many articles to the premiere journal of the abortion industry, _Family Planning Perspectives_, as well as other important trade journals such as the _American Journal of Obstetric Gynecology_, _New England Journal of Medicine_, _Studies in Family Planning_ ,and _Obstetric Gynecology_. Christopher Tietze, who reviewed the Cates article, has had an enormous amount of influence in the abortion industry.

[34] Pike _et al_. 1981, supra.

[35] Cates, 1982,. supra.

[36] Stavraky and Emmons, 1974, supra.

[37] Howe _et al_, 1989. For example, official records for a first fetal death may report it as a "miscarriage," even though the same woman on a second fetal death report may list it in her prior pregnancy history as an abortion. This practice does occur, but occurs both with cancer cases and with controls.

[38] It is possible that women might suppress the memory of an abortion. but if this were the case. it would seem to be a fairly serious psychological disorder, and so would be a mental health risk in its own right. If it can be shown that women are unconsciously suppressing these memories, it would hardly be accurate to call them "healthy."

[39] Howe _et al_., 1989, supra Lindefors-Harris _et al_.. 1989. supra

[40] Lindefors-Harris, _et al_., 1989. supra.

[41] Note, too. that according to the study, the "average" risk of breast cancer is 40% higher than it was only a few years earlier. If one converts the risk factors to reflect this 40% rise. one sees that women who have an abortion after a live birth have an adjusted risk factor of 81%, while women who have the abortion first have an adjusted risk of 153% that of Swedish women before the legalization of abortion.

[42] It is absurd to have to resort to this sort of mathematical "reading between the lines" in a study on a subject of this importance. I am grateful that this research was published at the prestigious Karolinska Institute, home of the Nobel Prize. and that the authors were forced to report all statistically significant information, even if it might cut against their own research biases.

[43] Lindefors-Harris, Response bias in a case-control study: Analysis using comparative data concerning legal abortions from two independent Swedish studies, _Am. J. Epidemiology_ 134: 1003-1008(1991).

[44] Some of these risk factors are actually decreasing. Body fat has been linked in some studies to the incidence of breast cancer (R.E. Frisch, Body fat, menarche, and fertility, _Encyclopedia of Human Biology_, R. Dulbecco, ed. (1991)), but American women have been getting thinner, not fatter, in the last few decades.

[45] Cates, 1982. supra.

[46] F. Clavel, A.S.E. Benham, R. Sitruk-Ware _et al_.. Breast cancer and oral contraceptives: a review, _Contraception_ 32: 553-69 (1985); B.V. Stadel, S. Lai, J.J. Schlesselman _et al_.. Oral contraceptives and premenopausal breast cancer in nulliparous women, _Contraception_ 38: 287-99 (1988); D.R. Miller. L. Rosenberg. D.W. Kaufman. _et al_., Breast cancer before age 45 and oral contraceptive use: new findings, _Am. J. Epidemiol._ 129: 269-80 ( 1989): C.R. Kay, and P.C. Hannaford, Breast cancer and the pill - a further report from the Royal College of General Practitioners' oral contraception study, _Br. J. Cancer_ 58: 675-80 ( 1988).

[47] Krieger, 1 990, supra.

[48] Remennick, 1989, supra. According to this researcher, more than three quarters of Russian breast cancer cases in the former Soviet Union can be attributed to reproductive factors (abortion, age at first birth, cumulative fertility rate, age at marriage, and breast feeding).

[49] Marshall, 1993, supra.

[50] See, e.g., Choi _et al_, 1978, supra; S.S. Devesa, and E.L. Diamond, Association of breast cancer and cervical cancer incidence with income and education among whites and blacks, _J. National Cancer Inst._ 65: 515-28 (1980); Kelsey _et al_., 1981, supra; J.L. Kelsey, and N.G. Hildreth, _Breast and gynecological cancer epidemiology_, Boca Raton, FL: CRC Press (1985); C. Lowe, and B. MacMahon, Breast cancer and reproductive history of women in South Wales. _Lancet_ 1:153-156 (1970).

[51] Cates, 1992,. supra.

[52] Krieger. 1990, supra.

[53] An additional note on socio-economic status and breast cancer. Among women in Taiwan, which had little to no experience with Western-style abortions, researchers found no significant difference in breast cancer rates with socio-economic status. Lin _et al_, 1971, supra. This supports the theory that rich Westerners have breast cancer because they have traditionally had more access to abortion.

[54] S.P. Helmrich, S. Shapiro, L. Rosenberg, D.W. Kaufman, D. Slone, C. Bain, O.S. Miettinen, P.D. Stolley, N.B. Rosenshein, R.C. Knapp, T. Leavitt, Jr., D. Schottenfeld, R.L. Engle, Jr. and M. Levy, Risk factors for breast cancer, _American Journal Epidemiol._ 117: 35- 45 (1983). Other studies which distinguish between religions also find an increased risk among Jews. See, e.g., Kelsey _et al_., 1981, supra

[55] Choi _et al_, 1978, supra.

[56] La Vecchia _et al_, 1993, supra; Parazzini _et al_, 1991, supra; F. Parazzini, C. La Vecchia, E. Negri, S. Franceschi, and L. Bocciolone, Menstrual and reproductive factors and breast cancer in women with family history of the disease, _International J. Cancer_ 51: 677-681 (1992).

[57] Figa-Talamanca _et al_., 1986, supra.

[58] Helmrich _et al_, 1983, supra, in a world-wide study in Canada, the U.S., and Israel; G. Kvale, J. Heuch, and G.F. Eide, A prospective study of reproductive factors and breast cancer; 1. Parity, _Am. Journal Epidemiology_ 126: 831-841 (1987); in Norway; R.S. Paffenbarger, Jr., J.B. Kampert, and H.-G. Chang, Characteristics that predict breast cancer before and after the menopause, _Amer. J. Epidemiol._ 11 : 258-268 (1980), in a study of Californian women diagnosed with breast cancer between 1970-77; Lindefors-Harris _et al_., 1989, supra (although, as noted above, this is hardly accidental).

[59] Le _et al_. 1984, supra.

[60] In Sweden, Swedish National Board of Health and Welfare, Abortions 1975-1983. _Statistics of the National board of Health and Welfare_ (1984); in Italy, Figa-Talamanca, _et al_., 1986, supra.

[61] H.-O. Adami, R. Bergstrom, E. Lund, and O. Meirik, Absence of association between reproductive variables and the risk of breast cancer in young women in Sweden and Norway, _Br. J. Cancer_ 62: 122-126 (1990): Risk factor for one induced abortion before first full-term pregnancy was 0.7, where researchers found only 15 such women in a study of 47? cases of breast cancer. The confidence interval for this finding ranges from 0.3 to 1.5, which does not rule out the possibility of an elevated risk.

L.A. Brinton, R. Hoover, and J.F. Fraumeni, Jr.. Reproductive factors in the aetiology of breast cancer, _Brit. J. Cancer_ 47:757-782.(1983): Only 1.17% of cases and 1.20% of controls had ever had an induced abortion, with even less cases of abortion before the first live birth. Even so, researchers found that miscarriage in first four months of first pregnancy led to risk 1.61 times normal. The researchers also state, "[A]lthough based on small numbers, the finding of excess risk among nulliparous women who experienced an induced abortion is noteworthy."

Kvale, Heuch and Eide, 1987, supra. A finding of a slightly decreased breast cancer risk among women who had abortions was not statistically significant, and failed to show any dose-response gradient.

[62] L.I. Remennick, Induced abortion as cancer risk factor: a review of the epidemiological evidence, _J. Epidemiology and Community Health_, 44: 259-264 (1990).

[63] L. Rosenberg, J.R. Palmer, D.W. Kaufman, B.L. Strom, D. Schottenfeld, and S. Shapiro, Breast cancer in relation to the occurrence and time of induced and spontaneous abortion. _Amer. J. Epidemiol._, 127: 981-989 (1988); M.P. Vessey, K. McPherson, D. Yeates, and R. Doll, Oral contraceptive use and abortion before first term pregnancy in relation to breast-cancer risk, _Brit. J. Cancer_ 45: 327-331(1982); S. P. Helmrich, S. Shapiro, L. Rosenberg _et al_., Risk Factors for Breast Cancer, _Am. J. Epidemiol._ 117: 35-45 (1983).

[64] For example, one common trick is to group subjects by age in five or ten year blocks. This initially appears to be a reasonable way to match ages, but yields very predictable, distorted results. Since cancer is very strongly associated with increasing age, a group of cancer patients between the ages of thirty and forty may have an average age of thirty-eight or even thirty-nine, while the control group will have an average age of thirty-five. It can be shown that even using five-year intervals can mask a 30% increased risk of cancer in women under the age of 40.

[65] Rosenberg _et al_.. 1988, supra; Helrich _et al_., 1983, supra.

[66] Vessey _et al_., 1982, supra.

[67] Welfare mothers are often placed under heavy social pressure to abort, despite their personal feelings about when human life begins.

[68] A teenager who has a live birth has a very low breast cancer risk; but if she aborts and then waits a number of years before having a baby, she would appear to remain at risk tor a longer time. Thus, this information probably should have the greatest impact on the pregnant teenager.

*Hardcopy Design and Production by Darby H. Waters*

Publication Orders

The abortion industry and national media have chosen not to present this data to the American public, so we rely on you to distribute this information. Please order as many copies as you can to give to friends, relatives, church members, doctors, and women considering abortion in your area. Single copies of this report are available for $5.00 each; 10 copies for $15.00; and 100 copies for $100.00.

Also available: "Does Abortion Cause Breast Cancer?" This single-sheet leaflet summarizes the evidence in layman's terms. 100 copies are available for $5.00; 1000 copies for $30.00.

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Copyright Notice (C) Scott W. Somerville 1993

This material is copyrighted. Shareware permission has been granted for electronic distribution on the Internet. A two-color, glossy printed version of this material may be obtained from Scott W. Somerville, P.O. Box 871, Purcellville, VA 22132. Single copies are available for $5.00, 10 copies for $15.00.

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