Breast have not heard of the link even

Breast cancer is a very important health
issue for women. Consider the following facts: (1) breast cancer is the leading
cause of cancer death for women between the ages of 20 and 59; (2) one in 10 of
all new cancers are female breast cancers; and (3) the highest incidence of
breast cancer in the world is in North America (Lanfranchi et al. 110). In
light of these upsetting statistics, if studies had found a potential risk factor
that may substantially increase a women’s risk of developing breast cancer,
then women should be informed about the risk factor and the topic should be
researched more thoroughly. This is not simply a hypothetical scenario, rather,
a potential risk factor has been found that many women remain uninformed about.
The potential link some researchers believe to have found is between having an
induced abortion and an increased risk of developing breast cancer. The first
epidemiological study that claimed to find a positive link between abortion and
risk of breast cancer dates back to the late 1950s. Although when the theory
was first proposed is irrelevant to whether the abortion-breast cancer (ABC)
link is a reality or merely conjecture, some have not heard of the link even
though the hypothesis has been debated for 50+ years. A personal survey
conducted on November 28th, 2017 revealed that out of 100
respondents, only 60 had heard of the abortion-breast cancer link (Bertsch).

Despite the fact that the abortion-breast
cancer link theory has existed for so long, many are still asking the question:
“Does having an abortion actually increase a woman’s risk of developing breast
cancer?” Those who believe in the link’s existence state that because various studies
have concluded that women who have had one or more abortions have a
dramatically increased risk of breast cancer, women should be informed of the
ABC link. Conversely, others cite different studies that claim that no link
exists between having an abortion and developing breast cancer and suggest that
those who believe in the link are simply trying to support an anti-abortion
agenda. However, because there is strong scientific evidence to indicate that
having an abortion is a causal risk factor for developing breast cancer, professional
medical organizations should make informing patients of the abortion-breast
cancer link part of the standard of care before an abortion procedure, and the
abortion-breast cancer link should be taught in high school health classes.

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Abortion is a causal risk
factor in relation to developing breast cancer similar to the way in which
cigarettes cause lung cancer (Lanfranchi 95). Both put users at higher risk,
though the majority will not likely be affected. However, one major difference
is that information regarding the increased risk of developing lung cancer due
to cigarette smoking is widely circulated. In contrast, women who have
abortions may not know that they are increasing their risk of breast cancer. Cigarettes
cause lung cancer to form in approximately 15 percent of those who smoke;
abortion causes breast cancer in about five percent of women who have an abortion.
This results in approximately 10,000 cases of abortion-related breast cancer a
year. This is approximately the same number as is caused by the inherited breast
cancer susceptibility (BRCA) gene (Lanfranchi 95). The example of the roughly
10,000 women per year who will develop abortion-related breast cancers
demonstrates why it is important to inform women contemplating having an
abortion about the ABC link. Indeed, many may choose other options (such as
placing their child for adoption) rather than undergo a procedure that
increases their chances of getting breast cancer. Liz Townsend, a writer for
National Right to Life News, details the story of Charnette Messé, who was
diagnosed with advanced-stage breast cancer at the age of 31. Messé’s doctors
were shocked by the diagnosis, as she had absolutely no family history of the
disease. In fact, at first, her doctors did not even believe she truly had
breast cancer. Messé wants women to be informed of the risks of abortion and breast
cancer and expressed that, “If I had known before my abortion that I could
be increasing my risk of breast cancer, my choice may have been different”
(Townsend). Messé also believes it is very important for women with a history
of abortion to get screened for breast cancer, even if they are under the age
of 40. Charnette Messé provides powerful testimony showing that it is important
to inform women of the abortion-breast cancer link so they will know the risks
involved, and so that if they have already had an abortion, they can be
screened for breast cancer periodically.

The first step in understanding the
abortion-breast cancer link is to study the anatomical and physiological
changes a woman’s breasts undergo during pregnancy and to understand what
happens to breast tissue if these changes are abruptly stopped, as is the case
with induced abortion (often abbreviated IA). In her scholarly article titled,
“Information for the Adolescent Woman and Her Parents: Abortion and the Risk of
Breast Cancer”,  Jane Anderson, a medical
doctor and member of the board of directors for The American College of
Pediatricians, insightfully details the changes a woman’s breasts undergo prior
to, during, and after pregnancy. During puberty, young women develop Type 1 and
Type 2 lobules in their breasts (100). Both Type 1 and Type 2 lobules are
susceptible to cancer because of their immaturity. During the first half of a
pregnancy, both Type 1 and 2 lobules increase under the influence of estrogen
levels. By the 20th week of pregnancy, the breasts have doubled in volume,
mainly due to the increase of Type 1 and Type 2 lobules. In the second half of
pregnancy, the Type 1 and 2 lobules mature into Type 4 lobules which can
produce milk. After 32 weeks, there are enough cancer-resistant Type 4 lobules to
help protect the mother from breast cancer. By 40 weeks, approximately 85
percent of a female’s lobules are mature Type 4 lobules. After giving birth, most
Type 4 lobules regress to Type 3, but fortunately, the cells maintain the
changes that help resist cancer growth.

            

Fig. 1: Breast lobule maturation
during first pregnancy. (http://www.compasscare.info)

However,
because abortion often ends a pregnancy prior to 32 weeks, Type 1 and Type 2
lobules have multiplied and been exposed to high levels of estrogen, but do not
progress to the cancer-resistant Type 3 or Type 4 lobules. Instead, the woman
has simply increased the amount of Type 1 and Type 2 lobules in her breast. Notably,
Type 1 lobules are where 80 percent of all breast cancers are formed, and about
15 percent of breast cancers are formed within Type 2 lobules.

Estrogen has also been listed as a
carcinogen by the National Toxicology Advisory Panel of the National Cancer
Institute since 2001 (Lanfranchi 99). It is now known that exposure to estrogen
and progesterone, such as with hormonal contraceptives, increases one’s risk of
developing breast cancer. Thus, it makes logical sense that a woman who is
pregnant and experiences an exponential increase of exposure to these hormones in
early pregnancy and then has an abortion has an increased risk of developing
breast cancer. After all, she has both increased the likely areas for cancer to
develop and exposed the tissue to a known carcinogen without the benefit of
converting the susceptible tissues to cancer-resistant Type 4 lobules later in
pregnancy. Another important fact to note is that there is a dose-related association
between having an abortion and an increased risk of breast cancer. Put in
layman’s terms, the more abortions a woman has, the greater her risk of
developing breast cancer. In the conclusion of her article Anderson states,
“The current studies demonstrating a dose-related association between pre-term
IA and breast cancer strongly suggest a causal effect. Although further study
is warranted, this risk must be known by adolescent females” (103). Anderson is
not alone in her belief that the ABC link is an important risk for females,
particularly adolescent females, to know. This opinion naturally flows from the
belief that women have the right to be informed of possible complications or
risk factors before undergoing any medical procedure, including an abortion.
One possible way to ensure that adolescent females are educated on the
abortion-breast cancer link is to include teaching about the link in high
school health classes.

            Scientific theories are helpful for
understanding how the abortion-breast
cancer link could theoretically work, but how is one to know whether what has
been hypothesized has actually happened? How can one know whether the ABC link
is highly probable, or merely possible? To see the effects of abortion on
breast cancer, one must move out of the realm of hypotheses and theories and
into the realm of concrete data. Such concrete data is presented in the book Complications:
Abortion’s Impact on Women, published by The de Veber Institute for Bioethics
and Social Research. In this book, the authors state, “There are now 56 studies
that show a positive association between abortion and breast cancer, of which
35 are statistically significant” (Lanfranchi et al. 121). Studying China
provides a good illustration of the abortion-breast cancer link. After the
one-child policy was enforced, there was a significant increase in abortions,
and a corresponding substantial increase in breast cancer rates (Lanfranchi et
al. 123). In 2012, a Chinese study found a dose-response association between
abortion and breast cancer, with an increased 33 percent risk for one abortion,
76 percent increase for two abortions, and 165 percent increased risk for three
or more abortions (Lanfranchi et al. 121). In addition, epidemiological studies
concerning the ABC link meet the Bradford-Hill criteria for “classifying abortion
as a causal risk for breast cancer” (Lanfranchi et al. 124). All of these facts
strengthen the overall argument that abortion should be considered a risk
factor for developing breast cancer, and that information regarding the link
should be widely circulated.

            Yet, for as long as the theory of
the ABC link has existed, there have been those who vehemently oppose the
proposition. Indeed, a 2010 article published by Daily Mail detailing the
fourth epidemiological study to support the ABC link within a 14 month period
included a quote by Dr. Kat Arney of Cancer Research UK. In the article, Arney
noted that the new study claiming to have found an association between abortion
and breast cancer was very small and likely to have statistical errors. Arney
followed up this assertion by stating, “Much larger studies involving tens of
thousands of women have shown no significant links” (Caldwell). One of the studies
most often referenced in an attempt to cast doubt on the abortion-breast link
was done in 1997. This study of approximately 1.5 million Danish women claimed
to find absolutely no link between induced abortion and breast cancer, and even
20 years later is still hailed by most skeptics of the ABC link as the definitive
answer to the question: “Does abortion increase breast cancer risk?” The study
decisively stated, “Our study of a population-based cohort uncovered no overall
increased risk of breast cancer among women with a history of induced abortion”
(Melbye et al. 83).

This, then, would seem to be the end of
the ABC link theory. However, research continues to be done and studies continue
to find evidence that the link exists. One of the reasons that research
continues to be done on the ABC link is because a careful examination of the
Danish study by Melbye reveals serious flaws. First of all, the study misclassified
60,000 women who had abortions as never having had abortions at all (Lanfranchi
et al. 132). This is a major oversight by the authors, who used abortion
registries starting in 1973 rather than 1940. In addition, authors of the
Danish study “violated the Bradford Hill criterion of temporality by collecting
breast cancer cases starting in 1968 while collecting data on abortions using
records that started in 1973” (Lanfranchi et al. 132-133). Finally, a breast
cancer cell takes eight to ten years to grow into a clinically detectable mass of
one centimeter in diameter. Therefore, if an abortion were to cause breast
cancer in an 18-year-old female, it would not be detectable until the woman was
at least 26 years of age. However, about one-quarter of the women in the Melbye
study were under 25 years of age and only accounted for eight cases of breast
cancer. None of the young women should have been included in the study because
of what is known about the time needed to develop breast cancer. Despite these and
other flaws, “The study showed a statistically significant risk in women who
have had abortions performed over eighteen weeks’ gestation” (Lanfranchi et al.
133). Notably, these results were not included in the conclusion of the paper.
But perhaps more troubling is the fact that the paper is not only often cited
as conclusive, but is also used in major textbooks to supposedly prove that the
abortion-breast cancer link does not exist (Lanfranchi et al. 133).

Advocates and skeptics of the
abortion-breast cancer link understandably have conflicting views about the
theory, and therefore understandably reach different conclusions about steps to
be taken regarding the link. Nevertheless, this does not mean that they cannot
agree on certain points. Both groups obviously consider breast cancer research
to be extremely vital. Consequently, one principle that both promoters and
opponents of the ABC link should be able to agree on is that politics should be
left out of the abortion-breast cancer link debate. As van Gend helpfully
points out in his article, social progressives need not maliciously attack
those who support the link; because the link, “If it exists, would be just
another prudential calculation of risk and benefit for the patient”, similar to
the calculated risk women take who use birth control methods that are linked to
increased risks of breast cancer, though the risk for abortion is calculated to
be much greater than for birth control (132). Similarly, social conservatives
should not think that a link between abortion and breast cancer could or should
be a valid argument against abortion as a whole. Van Gend then proposes,
“Having all chilled out, let this plausible but unproven factor in the
increased breast cancer rates of recent decades be given ongoing cool
consideration by experts, free of ideological filters and far from the
maddening crowd” (132). This is a lofty goal to strive for, as all interested
parties, whether they acknowledge it or not, have some sort of bias. Hopefully,
better dialogue between both parties about the link may yield more
comprehensive and helpful results in years to come.

Does having an abortion increase one’s
risk of developing breast cancer? The answer to that question is not
definitive. However, there are strong scientific reasons to believe that it
does. One important point is that the anatomical and physiological changes that
the breast tissue undergoes during pregnancy indicate that the ABC link theory
is certainly plausible. Another important point is that many scientific studies
regarding the ABC link confirm a positive association between abortion and
breast cancer. Importantly, this issue is not just an abstract debate, but
rather a real-world issue that can have devastating consequences in the lives
of women such as Charnette Messé. Because of these and other facts, it is
important for women to hear about the abortion-breast cancer link so that they
know all potential risks associated with having an abortion. Possible measures
to ensure that women hear about the link prior to having an abortion include
informing patients about the link as part of the standard care before abortion
procedures, and teaching about the link in health classes. If women know about
the abortion-breast cancer link, they can be proactive regarding their health,
not just reactive.

Works Cited

Anderson,
Jane. “Information for the Adolescent Woman and Her Parents: Abortion and the
Risk of Breast Cancer.”  Issues in Law & Medicine, vol. 32
no. 1, Spring 2017, pp. 99-104. MasterFILE
Premier, fortwayne.libproxy.ivytech.edu.allstate.libproxy.ivytech.edu/login?url=http://search.ebscohost.com.fortwayne.libproxy.ivytech.edu.allstate.libproxy.ivytech.edu/login.aspx?direct=true&db=f5h&AN=123117258&site=ehost-live&scope=site.
Accessed 14 Nov. 2017.

Bertsch,
Brianna. Personal Survey. 28 Nov. 2017.

Caldwell,
Simon. “Abortion ‘Triples Breast Cancer Risk’: Fourth study Finds Terminations
Linked to Disease.” Daily Mail, 23 June
2010, www.dailymail.co.uk/health/article-1288955/Abortion-triple-risk-breast-cancer.html.
Accessed 11 Nov. 2017.

Lanfranchi,
Angela. “The Science, Studies and Sociology of the Abortion Breast Cancer Link.”

Issues
in Law & Medicine, vol. 21 no. 2, Fall 2005, pp. 95-108. Academic Search Premier, fortwayne.libproxy.ivytech.edu.allstate.libproxy.ivytech.edu/login?url=http://search.ebscohost.com.fortwayne.libproxy.ivytech.edu.allstate.libproxy.ivytech.edu/login.aspx?direct=true&db=aph&AN=19074447&site=ehost-live&scope=site.
Accessed 11 Dec. 2017.

Lanfranchi,
Angela, et al. Complications: Abortion’s
Impact on Women. The deVeber Institute for Bioethics and Social Research,
2013.

Melbye,
Mads, et al. “Induced Abortion and the Risk of Breast Cancer.” The New England Journal of Medicine,
vol. 336, no. 2, Jan. 1997, pp. 81-85, www.nejm.org/doi/full/10.1056/NEJM199701093360201#t=article.
Accessed 10 Dec. 2017.

Townsend,
Liz. “Abortion and Breast Cancer Charnette’s Story: Finding Healing after Abortion.”
National Right to Life, National
Right to Life News, June 2003, www.nrlc.org/archive/news/2003/NRL06/abortion_and_breast_cancer_charn.htm.
Accessed 10 Dec. 2017.

Van
Gend, David. “Politics Should Be Taken Out of the Abortion-Breast Cancer
Debate.”

Opposing
Viewpoints: Breast Cancer, edited by Dedria Brfonski, Greenhaven
Press, 2016, pp. 126-132.