Breast Cancer Prevention: "When Choice Really Matters"
By Jakki Jeffs

(Editor's note: The author submitted this article to the Breast Cancer Network News. It was not printed.)

I have agonized over this article for two reasons. The first reason is that I hold pro-life beliefs and what I raise here will probably be immediately disregarded by some and looked upon dubiously by others. However, I need to record what I know and what I believe. The second reason is that I am not an active volunteer with the Breast Cancer Awareness project in my local community and this may cause some to say that, if I am not actively doing my part to spread awareness, I have no right to comment. But I am a 53-year-old woman with a family history of breast cancer. This means I have three of the major risk factors for developing breast cancer. I have no control over these risks.

Thanks to those who have become involved, I do know that to decrease my chances of getting breast cancer, I need to regularly examine my breasts, eat well, exercise, and generally, try to improve my lifestyle. For those facing the reality of breast cancer and having to make difficult treatment decisions, I also realize that the national network of breast cancer survivors has been a tremendous force for demanding better and diverse care for women.

Having said all this, I am still amazed to learn that 75-80% of women developing breast cancer have none of these risk factors. The estimated Canadian figures for 2002 tell us that, although not the leading killer of women, breast cancer would result in the deaths of 5,400. And 20,500 expected new cases in the female population means that it continues to lead in cancer incidences among Canadian women, with more than twice as many new cases as lung cancer.

Risk Factors for Breast Cancer

Today, we are not helpless in the face of breast cancer. There are many booklets, fact sheets, and organizations to help us understand how breast cancer develops; and through knowledge, we have a better chance of safeguarding ourselves and improving our chances of avoidance. For instance, we have learned that exposure to estrogen and the age that we have our children are major determining factors, which either strengthen or weaken our risk of developing breast cancer. There is tremendous research interest and information on dietary factors and possible genetic or environmental risks. I know that there are many committed researchers all over the world who are seeking a cure, or at the very least a better insight, into this tragic disease.

The one area that has become anathema to many is within the question, "Does my right to choose include choosing to increase my chances of developing breast cancer?" I believe that, for the sake of women's lives, this issue needs to be laid to rest, and this cannot happen if we are not prepared to enter into discourse.

The Rohan et al Study

For almost twelve years, on a part-time basis, I have researched the growing body of evidence that suggests induced abortion heightens a woman's chance of developing breast cancer. At one point, I even suggested to Dr. Tom Rohan, currently at the National Cancer Institute, Toronto, that he might wish to repeat here in Canada the 1988 study on dietary risk factors and breast cancer that he carried out on Australian women. He declined.

Although the Rohan study looked at all known risk factors for breast cancer, including reproductive health, no data were shown for "induced abortion." It was not until seven years later that this came to light within a paper by a French research team, headed by Nadine Andrieu, that was published by the British Journal of Cancer . Rohan et al had found that the strongest and most significant risk factor for breast cancer in Australian women was induced abortion, as opposed to spontaneous abortion or miscarriage. In fact it was determined that, at a 160% increased risk, induced abortion was an even stronger factor than family history of breast cancer.

The Daling et al Study

Dr. Janet Daling, a cancer researcher at Fred Hutchinson Cancer Research Center and the University of Washington, describes herself as pro-choice. On November 2, 1994, Dr. Daling and fellow researchers published an article in the Journal of the National Cancer Institute (pp 1584-1592) concerning induced abortion and breast cancer. Some key findings were that women who were under 18 and had had an induced abortion have an increased breast cancer risk of 150% and that women over thirty who abort a first pregnancy increase their breast cancer risk by 110%. However, if a woman had a family history of breast cancer and had a first abortion at age thirty, her risk went up by 270%. Dr. Daling concluded that, overall, women who have an induced abortion have an increased breast cancer risk of 50%. Most ominous of all was the fact that every one of the 12 women in the study who had an abortion before the age of 18 and had a family history of breast cancer, had breast cancer.

Dr. Daling's own comments regarding her findings highlight the dilemma. " I would like to have found no association between breast cancer and abortion, but our research is rock solid, and our data is accurate. It's not a matter of believing, it's a matter of what is."

Dr. Daling's study only followed women into their forties. What about women who are older? In 1993, one such study of black women, by Howard University, was published in the US by the Journal of National Medicine . Black women aged 50 and above who had had at least one abortion were found to have a 370% increased risk of developing breast cancer.

Critics of the Daling study suggest that an overall 50% increased risk of breast cancer is "insignificant." However, it should be noted that an increased risk was established after just one induced abortion. In Canada, there are over 110,000 abortions annually, with over one third of them repeat abortions. Twenty percent of the total number of abortions are in the 10-19 age group. With 20,500 estimated new cases of breast cancer resulting in 5,400 deaths, this "insignificant" increased risk means a very large number of new cases of breast cancer can be attributed to induced abortion. Dr. Daling's study is important because of its size, and its thoroughness - over 1,800 women were interviewed on a one-on-one basis in their homes.

The Brind et al Meta-analysis

In 1996, in what is regarded by many as the most meticulously comprehensive meta-analysis of all abortion/breast cancer research articles, Brind et al found that women who had an abortion before their first term child had a 50% increased risk of developing breast cancer.

The following year, a study by Melbye et al that was published in the New England Journal of Medicine appeared to find no increased risk. However, Melbye's actual data pointed to a 44% increased risk of breast cancer due to abortion, but this result was not included. Also, over 30,000 women in the study were "misclassified" as not having abortions when they had really had one. The study did note that women who had an abortion after the twelfth week sustained a 38% increased risk of breast cancer, while women who had late term abortions (i.e. after 18 weeks) had a statistically significant increase of 89%. Neither of these results received much media attention.

National Cancer Institute denies abortion/breast cancer link

I must make it clear that I am not concluding that every woman who develops breast cancer has had an abortion, or that every woman who has an abortion will develop breast cancer. However, the evidence is growing every day - 27 out of 34 independent studies, including 13 out of 14 in the United States, have linked abortion and breast cancer. Yet here in Canada, in one form or another, on no less than eight occasions on its website, the National Cancer Institute states that ".... current scientific evidence does not support a relationship between induced abortion and breast cancer, with or without family history ....."

Time to tell women the truth

The US National Physicians Center for Family Resources has released a CD which is intended to be a resource for parents and teachers. It states, ".... During normal pregnancy, the female's body produces high levels of the hormone estrogen. This causes the milk-producing glands in the breast to become active, a process that is completed during the third trimester of pregnancy. When this change is complete, it helps protect against breast cancer. Elective abortion interrupts these changes in the breast tissue, which makes the cells more likely to become cancerous. Miscarriages generally do not result in a higher breast cancer risk because most pregnancies that miscarry do not produce very high amounts of estrogen ..... "

In conclusion, I firmly believe that Canadian women deserve to know the truth and that they deserve to be told it by those who say they care. The politics of abortion should no longer hold researchers hostage. I would entreat the National Cancer Institute and Dr. Rohan to undertake a study on Canadian women, before more women make a choice that may significantly increase their chances of developing breast cancer. This issue needs to be laid to rest for us all. Women's lives depend upon it.

Jakki Jeffs is Executive Director of Alliance for Life Ontario and President of LifeCanada.

To find out more about " the single most avoidable risk factor for breast cancer " you can visit Dr. Joel Brind's website, www.abortioncancer.com; and Dr. Chris Kahlenborn's website, www.polycarp.org, contains a list of questions and answers regarding the abortion/breast cancer link.