ABORTION AND BREAST CANCER: THE UNMENTIONABLE RELATION
Nov. 6, 1994
Los Angeles Daily News

     Abortion should be safe, legal and "as rare as possible," President Clinton said at one point during his campaign, nicely capturing the moral ambivalence most Americans feel about this troubling issue.
     But suppose there is no way to make abortion "safe" for women? For a number of years, some cancer researchers have reported that having an abortion increases women's chance of developing breast cancer. Last week, the Journal of the National Cancer Institute published another such study, by Dr. Janet Daling and others at the Fred Hutchinson Cancer Research Center in Seattle. Daling's study estimated that the risk of breast cancer in those who had experienced an induced abortion was 50 percent higher than in other women, with the highest risks "when the abortion was done at ages younger than 18 years -- particularly if it took place after 8 weeks' gestation -- or at 30 years of age or older."
     The muted response, both by medical professionals and by the media, suggests that keeping abortion legal is a higher priority than informing women about the possible consequences of choosing to have one.
      "The overall results," said Lynn Rosenberg in an editorial appearing in the same issue of the Journal, "are far from conclusive, and it is difficult to see how they will be informative to the public."
      The New York Times, reporting on the study in an Oct. 27 story, quoted Rosenberg and others who said, in effect, not to worry.
      Women "should not give this study any weight in making a decision," said Dr. Noel S. Weiss, one of Daling's co-authors.
      An epidemiologist from the Harvard School of Public Health, Karin Michels, said the design of the study was flawed, because women who had breast cancer were more likely to disclose an abortion than the women in the control group. She had reviewed 40 studies on abortion and breast cancer, Michels said, and she didn't find evidence of a link.
      But the Times did not see fit to print the views of anyone disinclined to offer these soothing reassurances.
      Daling herself, interviewed by a reporter from the Seattle Post-Intelligencer, said that some other risk factors for breast cancer that have been widely popularized - for instance, a high-fat diet -- have less scientific support than the abortion link.
      "There is a portion of breast cancer that is associated with abortion," Daling said.
      Her research group did investigate whether a reluctance to talk about abortion (Michels' reason for discounting the study) might have influenced the results. Using similar methods, they found no comparable risk increase for cervical cancer. In the paper, the authors suggest that the reason for the link might well be that tissue in a woman's breast undergoes major changes in the early stages of pregnancy, which leave it more vulnerable to cancer if the pregnancy is terminated before breast development is complete.
      But even Daling expressed worry about the reaction to her work.
      "I'm concerned that this will be used to alarm people," she told the Post-Intelligencer.
      Well, perhaps women need to be alarmed -- not the ones who have already had abortions, about a quarter of the female population, but those who might someday have to make that decision.
      It's called "informed consent" -- before you decide to have a surgical procedure, or even to take a pill, you have the right to know everything your doctor knows about the consequences of your decision. Even if it's "inconclusive."
      I doubt it would have much influence on the choices of women who are already pregnant and don't want to be. As we remember from the era of back-alley abortions, many women in that situation are desperate enough to risk their lives. Just getting the operation, and surviving it, are worry enough.
      But women who have never been pregnant might decide to be a little more cautious about unintended pregnancy if they knew it might be a matter of life and death.
      Teenagers, especially, ought to know. According to Daling's study, the risk for them, especially if they wait a couple of months after they realize they are pregnant before deciding to have an abortion, is 2.5 times as high as it is for women in the control group.
      "Should you choose to have an abortion, the earlier (in the pregnancy) you get it, the better for your health," Daling told the Post-Intelligencer.
      For women with a family history of breast cancer, the risks are even greater.
      The information isn't new. Daling's bibliography cites studies offering evidence for a link going back as far as 1981. But it has scarcely been mentioned in the media. I didn't hear about it until a year ago, when a friend gave me an article he'd received from an anti-abortion group that disseminates information over the Internet. The author noted that journalists he had talked to were very uncomfortable with the issue.
      Maybe that's why other kinds of health risks get so much more publicity.
      The statistical data on the danger of second-hand smoke, for instance, are so ambiguous that a good many scientists aren't convinced the danger is real at all. Just the possibility, though, has prompted Congressional hearings and stricter regulations.
      Children as young as elementary school are being taught about the risks of contracting AIDS through unsafe sexual practices, as they probably should be. But the chance that a young woman will contract AIDS is much less than her lifetime risk of breast cancer, now about one in eight. Do any of the official sex-education curricula tell young girls that having an abortion might increase the likelihood that they would get breast cancer?
      I doubt it.