The Truth About Breast Cancer and Abortion

Amie Newman

A new study confirms no variation in risk related to abortion and triple negative breast cancer. But the anti-choice crowd is misrepresenting it anyway.

There has been renewed excitement in the anti-choice, anti-health movement as of late over the potential link between abortion and breast cancer.  Everyone from Jill Stanek to Beliefnet is reporting on what they have decided is proof positive that induced abortion leads to breast cancer. They are writing about these two health incidents as if there now exists a distinct, clear cause and effect relationship between the two, as evidenced by a new study, the results of which were released in April 2009.

The only problem with reporting on this as if anything were new is that, well, nothing is new.

The April 2009 study to which Stanek, Beliefnet and others are referring is entitled, "Risk Factors for Triple Negative Breast Cancer In Women Under the Age of 45 Years" and was undertaken by researchers affiliated with the Fred Hutchinson Cancer Research Center in Seattle, University of Washington’s Department of Epidemiology and the National Cancer Institute. It was published in the April 2009 edition of the Journal of Cancer Epidemiology, Biomarkers and Prevention. An abstract is available for free but if you’d like to view the entire report, you’ll need to purchase it from the Journal

The goal of this paper was to "assess the risk for triple negative breast cancer" (a rare cancer that is found more frequently in younger women and African-American women and unfortunately, associated with a high mortality rate) among women younger than forty-five years old taking into account "demographic/lifestyle factors, reproductive history, and oral contraceptive use" – something for which the data from the previous studies was not analyzed. However, the data used was collected in the mid to late 1980s through 1990. From the paper itself:

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The cases included in this study were originally ascertained for two previous studies through the population-based Seattle–Puget Sound Surveillance, Epidemiology, and End Results cancer registry. Eligible cases from the first study population included all primary invasive breast cancers within the three-county Seattle metropolitan area, diagnosed between January 1, 1983, and April 30, 1990 (ages, 21-45 y).

This paper simply took older information in order to determine whether or not the relationships between breast cancer and other factors (family history, early menarche, induced abortion, etc.) held firm when women were stratified according to those with triple negative breast cancer and those without. 

What did this new study confirm in relation to abortion and breast cancer? The study confirms that there is no variation in risk related to abortion and breast cancer stratified by those with and those without triple negative breast cancer because that’s all the study was mean to undertake in regards to these particular conditions. 

According to one of the researchers and authors of the report, Kathi Malone, "There are no new findings related to induced abortion in this paper because the results of these women were published previously." 

In fact, the only reason abortion was included at all was because it was a factor in the old studies. The main conclusions related to this new research had to do with triple negative breast cancer and oral contraceptive use among younger women. 

So just how exactly are anti-choice publications, blogs and others turning this into new evidence about abortion and breast cancer? By wishing really, really hard it were so. And then writing it down and finding someone to publish it. 

Jill Stanek at World Net Daily headlines her article, "Top Scientist Finally Admits Abortion Breast Cancer Link." Over at Beliefnet, another headline claims "Doctor changes position on abortion-breast cancer link."  The doctor to whom they are referring is one of the researchers and authors of this report, Dr. Louise Brinton with the National Cancer Institute. Beliefnet writes,

"An April 2009 study co-authored by a researcher who has previously
denied an abortion-breast cancer link shows a statistically significant
increase in breast cancer risk among women who have had abortions or
who use oral contraceptives. The study by researchers including Jessica
Dolle of the Fred Hutchinson Cancer Research contained a table
reporting a statistically significant 40 percent risk increase for
women who have had abortions. According to the Coalition on
Abortion/Breast Cancer (CABC), the study listed abortion as among
"known and suspected risk factors."

The CABC says that one co-author of the study, U.S. National
Cancer Institute (NCI) researcher Dr. Louise Brinton, had organized a
2003 NCI workshop on the abortion-breast cancer link. That workshop
reportedly said the non-existence of an abortion-breast cancer link was
"well established." 

It is true that in 2003 the NCI convened a workshop with over 100 of the world’s leading experts "who study pregnancy and breast cancer" and Dr. Brinton was one of those experts.  It is also correct that, according to NCI, "They concluded that having an abortion or miscarriage does not increase a woman’s subsequent risk of developing breast cancer." But what is not true is that Dr. Louise Brinton has "changed" her position on the link between abortion and breast cancer, at least publicly, because there is no new information on this link. Again, the study results released last year, on which Dr. Brinton was a researcher, do not include any new information on the overall risk of breast cancer among women who have had abortions. While the National Cancer Institute (NCI) is releasing a "no comment" statement in response to the barrage of poorly reported stories on anti-choice news sites, Dr. Brinton’s co-researcher and co-author, Kathi Malone, is clear about what this and all peer-reviewed studies show thus far on the link between abortion and breast cancer:

"The weight of scientific evidence to date strongly indicates that abortion doesn’t increase the risk of breast cancer."

While older studies have shown a modest increase in risk between abortion and breast cancer, the National Cancer Institute has discounted those studies on their web site for many years and, after a review of the information on their website this week, they are standing by these conclusions- because why? Because there is no new information to be released regarding the risk of breast cancer from a previous abortion. From the NCI web site,

The relationship between
induced and spontaneous abortion and breast cancer risk has been the subject of
extensive research beginning in the late 1950s. Until the mid-1990s, the
evidence was inconsistent. Findings from some studies suggested there was no
increase in risk of breast cancer among women who had had an abortion, while
findings from other studies suggested there was an increased risk. Most of
these studies, however, were flawed in a number of ways that can lead to
unreliable results. Only a small number of women were included in many of these
studies, and for most, the data were collected only after breast cancer had
been diagnosed, and women’s histories of miscarriage and abortion were based on
their “self-report” rather than on their medical records. Since then,
better-designed studies have been conducted. These newer studies examined large
numbers of women, collected data before breast cancer was found, and gathered
medical history information from medical records rather than simply from
self-reports, thereby generating more reliable findings. The newer studies
consistently showed no association between induced and spontaneous abortions
and breast cancer risk. 

Extremist, religious anti-choice web sites are using old data from an old study as proof of a cause and effect relationship even while the National Cancer Institute and one of the study’s own authors clearly state that over the course of years of research, including those old studies, overall evidence indicates no connection between the two. 

What this study may lay the groundwork for, however, is further research into a possible connection between oral contraceptives and triple negative breast cancer. It’s something that those falsely reporting on the abortion and breast cancer link have chosen to ignore. The data did show an increase in triple negative breast cancer amongst young women who use oral contraceptives:

The strong association between oral contraceptive use and the risk for triple-negative breast cancer observed in this study and the relative scarcity of such studies to date emphasize the need for future research.

That’s the evidence we should be discussing; the facts worth reporting.


 

Analysis Law and Policy

After ‘Whole Woman’s Health’ Decision, Advocates Should Fight Ultrasound Laws With Science

Imani Gandy

A return to data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous "informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

Whole Woman’s Health v. Hellerstedt, the landmark U.S. Supreme Court ruling striking down two provisions of Texas’ omnibus anti-abortion law, has changed the reproductive rights landscape in ways that will reverberate in courts around the country for years to come. It is no longer acceptable—at least in theory—for a state to announce that a particular restriction advances an interest in women’s health and to expect courts and the public to take them at their word.

In an opinion driven by science and data, Justice Stephen Breyer, writing for the majority in Whole Woman’s Health, weighed the costs and benefits of the two provisions of HB 2 at issue—the admitting privileges and ambulatory surgical center (ASC) requirements—and found them wanting. Texas had breezed through the Fifth Circuit without facing any real pushback on its manufactured claims that the two provisions advanced women’s health. Finally, Justice Breyer whipped out his figurative calculator and determined that those claims didn’t add up. For starters, Texas admitted that it didn’t know of a single instance where the admitting privileges requirement would have helped a woman get better treatment. And as for Texas’ claim that abortion should be performed in an ASC, Breyer pointed out that the state did not require the same of its midwifery clinics, and that childbirth is 14 times more likely to result in death.

So now, as Justice Ruth Bader Ginsburg pointed out in the case’s concurring opinion, laws that “‘do little or nothing for health, but rather strew impediments to abortion’ cannot survive judicial inspection.” In other words, if a state says a restriction promotes women’s health and safety, that state will now have to prove it to the courts.

With this success under our belts, a similar return to science and data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous “informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

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In Planned Parenthood v. Casey, the U.S. Supreme Court upheld parts of Pennsylvania’s “informed consent” law requiring abortion patients to receive a pamphlet developed by the state department of health, finding that it did not constitute an “undue burden” on the constitutional right to abortion. The basis? Protecting women’s mental health: “[I]n an attempt to ensure that a woman apprehends the full consequences of her decision, the State furthers the legitimate purpose of reducing the risk that a woman may elect an abortion, only to discover later, with devastating psychological consequences, that her decision was not fully informed.”

Texas took up Casey’s informed consent mantle and ran with it. In 2011, the legislature passed a law that forces patients to undergo a medical exam, whether or not their doctor thinks they need it, and that forces them to listen to information that the state wants them to hear, whether or not their doctor thinks that they need to hear it. The purpose of this law—at least in theory—is, again, to protect patients’ “mental health” by dissuading those who may be unsure about procedure.

The ultra-conservative Fifth Circuit Court of Appeals upheld the law in 2012, in Texas Medical Providers v. Lakey.

And make no mistake: The exam the law requires is invasive, and in some cases, cruelly so. As Beverly McPhail pointed out in the Houston Chronicle in 2011, transvaginal probes will often be necessary to comply with the law up to 10 to 12 weeks of pregnancy—which is when, according to the Guttmacher Institute, 91 percent of abortions take place. “Because the fetus is so small at this stage, traditional ultrasounds performed through the abdominal wall, ‘jelly on the belly,’ often cannot produce a clear image,” McPhail noted.

Instead, a “probe is inserted into the vagina, sending sound waves to reflect off body structures to produce an image of the fetus. Under this new law, a woman’s vagina will be penetrated without an opportunity for her to refuse due to coercion from the so-called ‘public servants’ who passed and signed this bill into law,” McPhail concluded.

There’s a reason why abortion advocates began decrying these laws as “rape by the state.”

If Texas legislators are concerned about the mental health of their citizens, particularly those who may have been the victims of sexual assault—or any woman who does not want a wand forcibly shoved into her body for no medical reason—they have a funny way of showing it.

They don’t seem terribly concerned about the well-being of the woman who wants desperately to be a mother but who decides to terminate a pregnancy that doctors tell her is not viable. Certainly, forcing that woman to undergo the painful experience of having an ultrasound image described to her—which the law mandates for the vast majority of patients—could be psychologically devastating.

But maybe Texas legislators don’t care that forcing a foreign object into a person’s body is the ultimate undue burden.

After all, if foisting ultrasounds onto women who have decided to terminate a pregnancy saves even one woman from a lifetime of “devastating psychologically damaging consequences,” then it will all have been worth it, right? Liberty and bodily autonomy be damned.

But what if there’s very little risk that a woman who gets an abortion experiences those “devastating psychological consequences”?

What if the information often provided by states in connection with their “informed consent” protocol does not actually lead to consent that is more informed, either because the information offered is outdated, biased, false, or flatly unnecessary given a particular pregnant person’s circumstance? Texas’ latest edition of its “Woman’s Right to Know” pamphlet, for example, contains even more false information than prior versions, including the medically disproven claim that fetuses can feel pain at 20 weeks gestation.

What if studies show—as they have since the American Psychological Association first conducted one to that effect in 1989—that abortion doesn’t increase the risk of mental health issues?

If the purpose of informed consent laws is to weed out women who have been coerced or who haven’t thought it through, then that purpose collapses if women who get abortions are, by and large, perfectly happy with their decision.

And that’s exactly what research has shown.

Scientific studies indicate that the vast majority of women don’t regret their abortions, and therefore are not devastated psychologically. They don’t fall into drug and alcohol addiction or attempt to kill themselves. But that hasn’t kept anti-choice activists from claiming otherwise.

It’s simply not true that abortion sends mentally healthy patients over the edge. In a study report released in 2008, the APA found that the strongest predictor of post-abortion mental health was prior mental health. In other words, if you’re already suffering from mental health issues before getting an abortion, you’re likely to suffer mental health issues afterward. But the studies most frequently cited in courts around the country prove, at best, an association between mental illness and abortion. When the studies controlled for “prior mental health and violence experience,” “no significant relation was found between abortion history and anxiety disorders.”

But what about forced ultrasound laws, specifically?

Science has its part to play in dismantling those, too.

If Whole Woman’s Health requires the weighing of costs and benefits to ensure that there’s a connection between the claimed purpose of an abortion restriction and the law’s effect, then laws that require a woman to get an ultrasound and to hear a description of it certainly fail that cost-benefit analysis. Science tells us forcing patients to view ultrasound images (as opposed to simply offering the opportunity for a woman to view ultrasound images) in order to give them “information” doesn’t dissuade them from having abortions.

Dr. Jen Gunter made this point in a blog post years ago: One 2009 study found that when given the option to view an ultrasound, nearly 73 percent of women chose to view the ultrasound image, and of those who chose to view it, 85 percent of women felt that it was a positive experience. And here’s the kicker: Not a single woman changed her mind about having an abortion.

Again, if women who choose to see ultrasounds don’t change their minds about getting an abortion, a law mandating that ultrasound in order to dissuade at least some women is, at best, useless. At worst, it’s yet another hurdle patients must leap to get care.

And what of the mandatory waiting period? Texas law requires a 24-hour waiting period—and the Court in Casey upheld a 24-hour waiting period—but states like Louisiana and Florida are increasing the waiting period to 72 hours.

There’s no evidence that forcing women into longer waiting periods has a measurable effect on a woman’s decision to get an abortion. One study conducted in Utah found that 86 percent of women had chosen to get the abortion after the waiting period was over. Eight percent of women chose not to get the abortion, but the most common reason given was that they were already conflicted about abortion in the first place. The author of that study recommended that clinics explore options with women seeking abortion and offer additional counseling to the small percentage of women who are conflicted about it, rather than states imposing a burdensome waiting period.

The bottom line is that the majority of women who choose abortion make up their minds and go through with it, irrespective of the many roadblocks placed in their way by overzealous state governments. And we know that those who cannot overcome those roadblocks—for financial or other reasons—are the ones who experience actual negative effects. As we saw in Whole Woman’s Health, those kinds of studies, when admitted as evidence in the court record, can be critical in striking restrictions down.

Of course, the Supreme Court has not always expressed an affinity for scientific data, as Justice Anthony Kennedy demonstrated in Gonzales v. Carhart, when he announced that “some women come to regret their choice to abort the infant life they once created and sustained,” even though he admitted there was “no reliable data to measure the phenomenon.” It was under Gonzales that so many legislators felt equipped to pass laws backed up by no legitimate scientific evidence in the first place.

Whole Woman’s Health offers reproductive rights advocates an opportunity to revisit a host of anti-choice restrictions that states claim are intended to advance one interest or another—whether it’s the state’s interest in fetal life or the state’s purported interest in the psychological well-being of its citizens. But if the laws don’t have their intended effects, and if they simply throw up obstacles in front of people seeking abortion, then perhaps, Whole Woman’s Health and its focus on scientific data will be the death knell of these laws too.

News Abortion

Texas Pro-Choice Advocates Push Back Against State’s Anti-Choice Pamphlet

Teddy Wilson

The “A Woman’s Right to Know” pamphlet, published by the state, has not been updated since 2003. The pamphlet includes the medically dubious link between abortion care and breast cancer, among other medical inaccuracies common in anti-choice literature.

Reproductive rights advocates are calling for changes to information forced on pregnant people seeking abortion services, thanks to a Texas mandate.

Texas lawmakers passed the Texas Woman’s Right to Know Act in 2003, which requires abortion providers to inform pregnant people of the medical risks associated with abortion care, as well as the probable gestational age of the fetus and the medical risks of carrying a pregnancy to term.

The “A Woman’s Right to Know” pamphlet, published by the state, has not been updated or revised since it was first made public in 2003. The pamphlet includes the medically dubious link between abortion care and breast cancer, among other medical inaccuracies common in anti-choice literature. 

The Texas Department of State Health Services (DSHS) in June published a revised draft version of the pamphlet. The draft version of “A Woman’s Right to Know” was published online, and proposed revisions are available for public comment until Friday.

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John Seago, spokesperson for the anti-choice Texas Right to Life, told KUT that the pamphlet was created so pregnant people have accurate information before they consent to receiving abortion care.

“This is a booklet that’s not going to be put in the hands of experts, it’s not going to be put in the hands of OB-GYNs or scientists–it’s going to be put in the hands of women who will range in education, will range in background, and we want this booklet to be user-friendly enough that anyone can read this booklet and be informed,” he said.

Reproductive rights advocates charge that the information in the pamphlet presented an anti-abortion bias and includes factually incorrect information.

More than 34 percent of the information found in the previous version of the state’s “A Woman’s Right to Know” pamphlet was medically inaccurate, according to a study by a Rutgers University research team.

State lawmakers and activists held a press conference Wednesday outside the DSHS offices in Austin and delivered nearly 5,000 Texans’ comments to the agency.  

Kryston Skinner, an organizer with the Texas Equal Access Fund, spoke during the press conference about her experience having an abortion in Texas, and how the state-mandated pamphlet made her feel stigmatized.

Skinner told Rewire that the pamphlet “causes fear” in pregnant people who are unaware that the pamphlet is rife with misinformation. “It’s obviously a deterrent,” Skinner said. “There is no other reason for the state to force a medical professional to provide misinformation to their patients.”

State Rep. Donna Howard (D-Austin) said in a statement that the pamphlet is the “latest shameful example” of Texas lawmakers playing politics with reproductive health care. “As a former registered nurse, I find it outrageous that the state requires health professionals to provide misleading and coercive information to patients,” Howard said.

Howard, vice chair of the Texas House Women’s Health Caucus, vowed to propose legislation that would rid the booklet of its many inaccuracies if DSHS fails to take the thousands of comments into account, according to the Austin Chronicle

Lawmakers in several states have passed laws mandating that states provide written materials to pregnant people seeking abortion services. These so-called informed consent laws often require that the material include inaccurate or misleading information pushed by legislators and organizations that oppose legal abortion care. 

The American Congress of Obstetricians and Gynecologists (ACOG) sent a letter to DSHS that said the organization has “significant concerns with some of the material and how it is presented.”

Among the most controversial statements made in the pamphlet is the claim that “doctors and scientists are actively studying the complex biology of breast cancer to understand whether abortion may affect the risk of breast cancer.”

Texas Right to Life said in a statement that the organization wants the DSHS include “stronger language” about the supposed correlation between abortion and breast cancer. The organization wants the pamphlet to explicitly cite “the numerous studies that indicate undergoing an elective abortion contributes to the incidence of breast cancer in women.”

Rep. Sarah Davis (R-West University Place) said in a statement that the state should provide the “most accurate science available” to pregnant people seeking an abortion. “As a breast cancer survivor, I am disappointed that DSHS has published revisions to the ‘A Woman’s Right to Know’ booklet that remain scientifically and medically inaccurate,” Davis said.

The link between abortion and cancer has been repeatedly debunked by scientific research.

“Scientific research studies have not found a cause-and-effect relationship between abortion and breast cancer,” according to the American Cancer Society.

A report by the National Cancer Institute explains, “having an abortion or miscarriage does not increase a woman’s subsequent risk of developing breast cancer.”

DSHS spokesperson Carrie Williams told the Texas Tribune that the original booklet was written by a group of agency officials, legislators and public health and medical professionals.

“We carefully considered medical and scientific information when updating the draft booklet,” Williams said.