Tuesday, November 18, 2008

Breast Health Information

by Dr. and Mrs. J.C. Willke

There is an ominous relationship between the abortion of your first pregnancy and later development of breast cancer.

Is this proven?
No, but there is a very close correlation that has been demonstrated in a large number of scientific studies. If further studies continue to demonstrate this and no other definitive cause is found, it is highly likely that this will some day be seen as a cause and effect.
Is breast cancer increasing?
According to the American Cancer Society. In 1962 there were 63,000 cases.
In 1972, 90,000 In 1982, 120,000 In 1992, 180,000 Perhaps some of the above is attributable to better diagnoses with mammograms, etc. Even so, the increase is dramatic. In 1960, one women in fourteen developed breast cancer. Today, it is nearing one in eight.

There are certain other risk factors, are there not?
Major risk factors that are well recognized are:
- family history in first degree relatives
- early onset and late cessation of menstruation
- being female (male breast cancer, while rare, has not increased)
- nulliparity, i.e., not being pregnant.
There are other suspected risk factors?
Yes, diet is one. It is postulated that a high fat diet may contribute. Toxic chemicals, pesticides and pollutants have been suggested, as have lack of antioxidants in the diet. Alcohol, smoking and drugs may be implicated. Electromagnetic fields, such as living under high-tension wires or being exposed to electronic display boards have been suspected. Certain genes may predispose. None of these, however, have been proven.
Contraceptive pills have been implicated. While nothing has been proven, it would seem that the use of the pill before twenty years of age, or the continuing use of pills for more than 10 years might be a causative factor.
In the overall, however, 60% to 70% of all breast cancer occurs in women who do not have any of the classic risk factors.

Does pregnancy protect?
Yes, definitely. Women who have never been pregnant have twice the risk of breast cancer compared to those who have had children. Women who delay their first pregnancy into their thirties have almost a doubled risk of breast cancer compared to those who have babies in their late teens or early twenties. It is also possible that breast-feeding may add another protective affect, but there is no real proof for this. B. MacMahon, et al., 1970 Bull. Wld. Halth. Org., 43:20921

When was abortion first suspected as a cause?
Dr. M. C. Pike, at the University of Southern California in l981, published the first serious scientific study that demonstrated a direct association of induced abortion with later breast cancer. He studied 163 women who developed breast cancer before age 33, and compared them with 272 controls. He showed that if a woman had aborted her first pregnancy, her chance for developing breast cancer was increased by a factor of 2.4 times. Pike MC, Henderson BE, Casagrande JT, Rosario I, Gray CE (1981) Brit. J. Cancer, 43:726.

Give me other definitive studies.
Certainly one of the definitive studies was by H. L. Howe. Her study was done in upstate New York using official statistics from the New York State Health Department. This was an excellent study by epidemiologic standards and was not subject to any kind of recall memory bias from people asked in questionnaires. It used only hard data. She investigated all the women in this area who developed breast cancer under age 40 and checked to see whether or not they had had abortions. The conclusion was that women who had aborted their first pregnancy had a 1.7 times increased risk of breast cancer. Those who had gone on to abort their second and/or third pregnancy had a 4.0 times increased risk. Howe HL, Senie RT, Bzduch H, Herzfeld P (1989) et al., Int. J. Epidemiol. 18:3004.
Another was in Washington State: Few studies on this issue receive media attention. This went worldwide and broke the defacto embargo on reporting the abortionbreast cancer link. Janet Daling did a very professional study that could not be discounted. It found:
- An induced abortion raises a woman’s chance of getting breast cancer before age 45 by 50%. If done before age 18, it increases 150%; if after age 30, it’s up 110%.
- A woman with a family member with breast cancer who had her first abortion after 30 years increased her risk 270%.
- All 12 women in the study with a family history of breast cancer, who aborted before age 18 — all 12 — got breast cancer before age 45. J. Daling, Risk of Breast Cancer Among Young Women, J. Nat. Ca. Inst., Vol. 86, No. 21, 11/2/94, pg. 1584
Other studies done since then include: Greece: An overall increased risk of 51% was reported in women who had abortions, compared to those who did not. It involved 850 patients in Athens. L. Lipworth, Int. J. of Cancer, April ’95 U.S.A.:
A statistically significant increased risk of 23% of breast cancer was shown to be attributable to induced abortion. For women over 60 years, the risk was 80%. P. Newcomb et al., Preg. Termination & Risk of Breast Cancer, JAMA 1/24/96, Vol. 275, No. 4, pg. 283
For a thorough explanation of the Newcomb study above, see Natl. RTL News, 2/6/96, by J. Brind. Paris: "Having at least two abortions if associated with an increased breast cancer risk" of 2.1 times. N. Andrieu, Role of Genetic & Repro. Factors in Br. Ca., Genetic Spidem. 11 (3): 285, 1994
There are, in addition, many competent studies done in the last 20 years which also confirm this linkage. See: Before You Choose, The Link Between Abortion & Breast Cancer; And: Legalized Abortion and the Sudden Increase of Breast Cancer, both by Scott Somerville, P.O. Box 159, Paeonian Springs, VA 22129.
These are comprehensive analyses citing 74 studies.

Has anyone investigated recurrences of previously treated breast cancer?
Yes, Dr. H. Ownby did this in 1983. This was a study of women who had breast cancer that had been treated and gone into remission. Ownby studied how many of these developed a recurrence of their cancer. His research showed that among women who had carried their first pregnancy to term, 10% had a recurrence of their cancer within three years. Of those women who had aborted their first pregnancy 20% had a recurrence. Among those who had aborted their second and/or third pregnancy also, 30% had recurrences. H. Ownby, Interrupted Pregnancy Poor Prognosis . . . in Breast Cancer, 1983 Breast Cancer Res. Treat. 3:339344

How about the aggressiveness of the tumor?
In 1991 H. Olsson studied the aggressiveness of, and the propensity to metastasize of diagnosed breast cancer. His study showed, if she had aborted her first pregnancy and later developed breast cancer, that her cancer was more aggressive and more quickly lethal than cancers among women who had carried their first pregnancy to term.
A marker gene associated with breast cancer, 1NT2, was shown to be eighteen times higher than the normal rate among those who had aborted. H. Olsson et al., Cancer 67:128590.

Are there ethnic differences?
Two studies have investigated this. In 1978, Choi in the U.S. and Israel, investigated the difference between groups of Protestant and Catholic women in Canada and found that the Protestant women had more breast cancer. Helmrich, in 1981, investigated the difference between Jewish and Catholic women and found that there was more breast cancer among the Jews.
Does this mean a difference due to ethnicity? Or could it be that the Catholic women had fewer abortions? Certainly no conclusions can be drawn, but this may be a bit of circumstantial evidence. N. Choi, An Epidem. Study of Br. Ca., Am. J. Epidemal. 107:510, 1978 S. Helmrich, Risk Factors for Br. Ca., Am. J. Epidemal. 117, 3545
Are there differences in economic classes?
There were two studies done in the state of Washington that are suggestive but again offer no hard proof.
That state legalized abortion in 1969 by state referendum. For the first 5 years it did not pay for welfare abortions, then in 1974, the state began to pay for welfare abortions. Bearing this in mind, the following has been shown. Women of higher social economic status had an increase in breast cancer during those first 5 years which then leveled off. Poor women did not experience a similar rise in breast cancer until after 1974 when their incidence rose up to the plateau earlier achieved by the rich.
There was a similar study by Krieger in 1990 in California showing similar results. Choi ’78, Denesa ’80, Kelsey ’81, Lowe ’70, Krieger ’90
If induced abortion is a problem, does spontaneous loss carry the same risk?
Early on, some thought yes, but more recent studies have shown dramatically lower levels of female hormone in those who miscarried. Among these studies were ones by B. Witt, Tulane Med. Sch. in 1990; a study in the Br. J. OBGyn. in 1976; one by D. Stewart, U. of CA Davis in 1993; one by A. Guilloume in NY City, and the well known one by Janet Daling in ’94. All have shown that miscarriages are not associated with an increased risk.

What about the contraceptive pill? Certainly many who take the pill also get abortions. Could it be that the pill causes the cancer and not the abortion?
Good question! Many have asked it. At this time in history there is no definitive answer and the pill remains suspect. There are, however, a number of studies relevant here which seem to implicate abortion as a causative factor rather than the pill.
There are three major studies, from Russia, Estonia, and Soviet Georgia that were done prior to Russia’s opening to the West. During those years there were almost no contraceptive pills used in those nations. During those years abortion was the method of birth control. And what happened to breast cancer? It increased by approximately 300 percent. L. Remennick, Reprod . . . & Cancer Incidence in USSR, Intl. J. Epidemal., 18:498512, 1989
Incidentally, the above reasoning, such as it is, would also apply to the suggestion that food additives and street drugs are part of the cause of the increase in breast cancer. Prior to the lowering of the Iron Curtain, there were essentially no food additives used in the Soviet Union and neither were there many street drugs. The breast cancer rate however, as noted, skyrocketed in these countries. This would seem to implicate abortion as a cause and to see such additives as only aggravating factors, if indeed they are implicated at all.

What of breast feeding? If pregnancy is protective, does it add further protection?
It would seem logical that this would be so. If maturation of the breast is what causes the protection, and if lactation in any way completes the maturing of the milk glands, then logically breast-feeding should be an additive protective factor. In fact, sufficient studies have not been done on this, and so we cannot draw any firm conclusions. Newcomb, however, in the January 1994 New England Journal of Medicine, did find a decreased risk of premenopausal cancer among mothers who had nursed, but not among postmenopausal women. One such study, ambivalent as it is, is not enough to draw any conclusions.

What about differences between the black and white races?
There have been two studies out of Howard University in Washington, DC that have addressed this issue. They are the first ones to compare races. Laing, in her study, found that those with abortions had an increased incidence of breast cancer among black women, the increase centering largely among black women who were over 50 years old. He also found an increase in breast cancer among black women who used birth control pills. She found an increase in breast cancer after induced abortion, but not after spontaneous miscarriage, which was called a "protective factor." A. Laing, Br. Ca. Risk Factors in AfricanAmerican Women, J. Nat. Med. Assn., Dec. ’93, Vol. 85, No. 12, pg. 931
Is this a genetic ethnic difference, or might there be another explanation? It is difficult to ignore the fact that black women in the United States, where this study was done, have three abortions for every one that their white counterparts have. A high percent of these abortions cluster in the teen years which, by definition, means many of them are first pregnancies. If abortion is a causative factor, and if black women, particularly young black women, have three times as many abortions as white women, then it would seem logical that they should have a higher incidence of breast cancer, which in fact they do.
Sadly, black women die almost twice as often from breast cancer as whites. Eley et al., Racial Differences in Survival, JAMA 9/28/94, Vol. 272, No. 12, pg. 947
This study found a relatively increased risk of 50% up to age 40, increasing during the 40s to 180%, and to 370% to women over 50 years of age.

What about diet? It has been suggested as a causative factor.
Yes it has. Time magazine, in 1994, devoted the major subject matter of one issue to this, strongly suggesting that a high intake of fat and red meat might increase the incidence of breast cancer. It is a fact that the female hormone implicated in breast cancer, estrogen, is stored in fatty tissue. Therefore, obese women may be at greater risk. The concern, however, is not about obesity as such, but rather about dietary intake.
Again, there is no proof. But it is interesting to note that the breast cancer rate in Japan has gone up sharply and it has been suggested that, with their increased standard of living, it is due to their increasing consumption of red meat and fatty foods. In the U.S. the breast cancer rate has also gone up sharply, and this has continued during the last decade or two during which time the intake of red meat and fat has decreased sharply. We could compare to a third nation, the Soviet Union before its opening to the West. There the abortion rate rose even faster, but there the intake of red meat and of fat was minimal. To draw a conclusion is unscientific, as other factors undoubtedly play a part. But, if fat is causative one might surmise that it has gone up in Japan because they have increased such dietary intake; that it has gone up in the U.S. because of a decrease in this dietary intake, and that it went up even higher in the former Soviet Union because of a near deficiency of these dietary factors.

Can stress cause breast cancer?
Investigators at the University of Wisconsin have found no link at all. "Although women with breast cancer often attribute it to stress or depression, we found no evidence of such an association." They followed without and 258 with cancer for 5 years. P. Carbone, Relationship . . . Refuted, Primary Care & Cancer, July ’96, Vol. 16, No. 7, p. ll
These studies on the association of abortion with breast cancer are rather convincing. But if they are true, how do you explain the mechanism of the development of this cancer?
This is best understood by looking at the female breast in three different phases of maturity: Immature Phase: This is the 5 year old girl whose breast, under the microscope, is indistinguishable from that of her 6 year old brother. Her brother’s breast never matures. Her’s will.
Nulliparous Adult Stage: During adolescence there is a flood of female hormone which causes her breast to grow in size and shape. To external appearances her breast is mature but it can not yet produce milk, and the internal structure remains relatively undeveloped. Parous Breast: This is the third stage, the breast after being pregnant. Most women who have been pregnant remember that their breasts became swollen and tender very soon after missing their period. Also, by about 3 months, they no longer felt this very much. What happened was the last phase of growth and maturation of her breasts. During this phase the internal milk glands completed their development and readied her to produce milk.

So what has this to do with later cancer?
Perhaps a lot. We don’t know all the causes that trigger the growth of cancer but we call such causes carcinogenic agents. We know that the immature breast cells are relatively resistant to such agents. We know that after the first phase of growth the cells are more susceptible and that after a pregnancy and full maturation the cells are again more resistant. In early pregnancy there is a rapid growth and change of these cells. If this is suddenly interrupted, the breast is left with many transitional cells in a state of change, half way between immature and mature, cells in intermediate stages. It is thought that these cells are more unstable and less resistant to carcinogenic insult — to the triggering of cancer.

What if she has a baby and then aborts the next one?
According to this reasoning this should not increase the risk. In fact, some studies do show a further increase in risk.
If all of this is true, how many women will actually die of breast cancer?
There are approximately 1.5 million induced abortions annually in the United States. Over half, or 800,000 of these, are first pregnancies. At a conservative estimate one in ten of these women will get breast cancer. This is 80,000 cases. About onefourth of those who develop breast cancer, that’s 20,000 women, will die from the disease. If in fact, abortion of her first pregnancy increases her chance of breast cancer from 1.0 to 1.5 then we should see, not 80,000 but 120,000 cases of cancer among this target population. If the death rate among them remains at 25 percent, (and it could be higher), then not 20,000, but 30,000 women will die. Among this group, however, if instead of aborting their first pregnancy, these 800,000 women would have carried to term and delivered. They would have reduced their chance for breast cancer from 1.0 to .75. Accordingly, the 80,000 expected cases would be reduced to three-fourths of that or 60,000 cases, and the 20,000 deaths would have been reduced to 15,000 deaths.
Continuing this comparison we see that, if abortion is in fact causative, then it is responsible for 10,000, plus 5,000, or a total of 15,000 deaths annually from breast cancer that would not have occurred if the women, who had aborted their first pregnancies, had instead carried those pregnancies to term.
A major study that refutes your thesis is the Lindeford Harris study from Sweden. What of it?
It is poorly done from a scientific standpoint, and its authors’ conclusions do not accurately reflect some of its actual findings. Dr. Brind, mentioned above, has called it the "Swedish data massage." It compared Swedish women with breast cancer, to the entire Swedish population, which contains all of the same Swedish women who have breast cancer. Therefore, this comparison to the control group is invalid. Even in this study however, there is proof of the very thing its authors deny. In their article’s conclusion, the authors state that there is no overall risk of breast cancer from abortion. However, within the report, a table of results shows that women who aborted after having a live birth had 58% of the average risk of breast cancer, while women who aborted before their first live birth had 109% of the average risk. This is an 88% increase in breast cancer, and it is clearly shown in the heart of this study, a study that is routinely held up as proving exactly the opposite.

But there are many other studies that tend to disprove your claims.
So they claim, but, with few exceptions, these were flawed by: inappropriately crude age matching or adjusting of controls (the main problem); interpreting as statistically insignificant some retrospective case controls with low statistical power; minimizing the actual results obtained in their conclusions; and attributing results to patient’s "recall bias," even though a close exam refutes such a claim. 178 B. M. LindeforsHarris et al., Response Bias. . . . Abortions. . . . Two Swedish Studies, Am. J. Epidemal. 1991, Vol. 134, No. 9, Pg. 1003
But I haven’t seen such criticisms in any public reports.
There has been a true conspiracy of silence by the media and also by many researchers who, like the Swedish study, bury actual findings and conclude otherwise, e.g., editorials in journals, listing exhaustively multiple possible causes of breast cancer and never even listing abortion, e.g., JAMA, July 21, 1993, and New England Journal of Medicine, Jan. 1994, as well as Time magazine on Jan. 14, 1991. Dr. Remennick concluded "an initial attitude of researchers toward abortion usually determines the way they interpret results." 10 Remennick LI (1989) Int. J. Epidemiol. 18:498510.

Has anyone compared all the studies?
Yes, happily a comprehensive metaanalysis examined 61 published studies and subjected them to critical comparative analysis. Its conclusion was: "The results support the inclusion of induced abortion among significant independent risk factors for breast cancer, regardless of parity or timing of abortion relative to the first term pregnancy. Although the increase in risk was relatively low, the high incidence of both breast cancer and induced abortion suggest a substantial impact of thousands of excess cases per year currently, and a potentially much greater impact in the next century, as the first cohort of women exposed to legal induced abortion continues to age." J. Brind et al., "Induced abortion as an independent risk factor for breast cancer: a comprehensive review and meta-analysis," Hershey Med. Center, J. Epidemol. Community Health, 1996

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