1

Anti-choice Claims About Abortion and Breast Cancer

Studies have shown that abortion is not associated
with breast cancer. Undaunted by the absence of
compelling evidence, anti-choice extremists insist on
making the connection anyway. Once more they are
using misinformation as a weapon in their campaign
against safe, legal abortion.

Anti-choice zealots have drawn highly questionable
conclusions to develop public education campaigns
such as the advertisements sponsored by Christs
Bride Ministries that appeared on public
transportation vehicles in Philadelphia warning that
women who choose abortion suffer more and
deadlier breast cancer (Slobodzian, 1999). These
misinformation campaigns have used many forms of
media and advertising to mislead women about
abortion, including television, billboards, bumper
stickers, and print ads (Simon, 2002).

Anti-abortion foes are also lobbying for legislation
that would require telling women who are considering
abortion that having one would place them at an
increased risk for breast cancer (Querido, 1999).

Anti-choice claims linking abortion and breast cancer
fly in the face of scientific evidence. The National
Cancer Institute (NCI), the American Cancer Society
(ACS), and the The American College of
Obstetricians and Gynecologists (ACOG) have all
refuted the reliability of such an association (ACS,
2003; ACOG, 2003; NCI, 2003).


Rigorous Studies Dismiss Association

In February 2003, NCI convened the Early
Reproductive Events and Breast Cancer Workshop
to provide an integrated scientific assessment of the
association between reproductive events and the risk
of breast cancer. After reviewing the body of
scientific literature, NCI concluded that Induced
abortion is not associated with an increase in breast
cancer risk (NCI, 2003).

In August 2003, after conducting its own review of
the scientific literature, ACOG issued a committee
opinion concluding that early studies of the
relationship between prior induced abortion and
breast cancer risk have been inconsistent and are
difficult to interpret because of methodologic
considerations. More rigorous recent studies argue
against a causal relationship between induced
abortion and a subsequent increase in breast cancer
risk (ACOG, 2003).


Reproductive Factors and Breast Cancer

While researchers do not know what causes breast
cancer, reproductive factors have been associated
with risk for the disease since the 17th century, when
breast cancer was noted to be more prevalent
among nuns. It is known that having a full-term
pregnancy early in a woman's childbearing years is
protective against breast cancer, and some studies
have also indicated that breastfeeding, especially in
women who are young when they give birth, may
reduce a woman's risk of developing the disease. A
woman's age at menarche and menopause also
influence her risk for breast cancer, with earlier onset
of regular menstrual cycles and later age at
menopause associated with higher risk (Kelsey &
Gammon, 1991). However, the best available
evidence from large population-based cohort
studies shows no net effect that induced abortion
places women at increased risk for developing breast
cancer (ACOG, 2003; ACS, 2003; Bartholomew &
Grimes, 1998; NCI, 2003).

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Hypothesis: Hormones Lead to Breast Cell
Differentiation

The theory linking pregnancy termination and breast
cancer is based on the hormonal disruption that
occurs when a woman's pregnancy is interrupted.
Pregnancy initiates a surge of sex hormones
(estrogen, progesterone, and prolactin), which leads
to differentiation of the cells in the breast glands in
preparation for lactation. The changing
concentrations of hormones during the second and
third trimesters of pregnancy lead to increased
differentiation. In a first pregnancy, the results of
these hormonal changes permanently alter the
structure of the breast. Adherents of this theory
claim that interruption of the first trimester of a first
pregnancy causes a cessation of cell differentiation
that may result in a subsequent increase in the risk
of cancerous growth in these tissues (Brumsted &
Riddick, 1990; Westhoff, 1997). Attempts to prove
this theory, however, have failed.


Many Factors Contribute to Inconclusive Study
Results

At least 80 research studies worldwide have
collected data about breast cancer and reproductive
factors such as childbirth, menstrual cycles, birth
control pills, and abortion. Approximately 30 studies
have examined the risk of developing breast cancer
for women who have had abortions. Researchers at
the National Cancer Institute, the American Cancer
Society, the Royal College of Obstetricians and
Gynecologists, the World Health Organization, and
major universities say that the most reliable studies
show no increased risk, and they consider the entire
body of research inconclusive (ACS, 1999; NCI,
2002; Rosenfield, 1994?; RCOG, 2001; WHO, 2000).

A number of factors may render a study unreliable:

Miscarriages and induced abortion affect a
womans body differently but many studies
have not distinguished between them.

Many women do not report miscarriages
because they are unaware they have had
them.

Abortions are often unreported because of
the privacy of the decision to terminate a
pregnancy.

Some studies have not examined the
possibly different effects of abortion after or
before a full-term pregnancy.

Other studies have not been careful to
examine the impact of age at the time of
abortion and age at the time of first childbirth.

Many studies have been too small to be
statistically significant.
(Collaborative Group, 2004; NCI, 2002;
Wingo et al., 1997).


Three of the Strongest Studies Published to Date
Show no Overall Relationship Between Induced
Abortion and Breast Cancer

One of the most highly regarded studies on abortion
and breast cancer was published in the New England
Journal of Medicine in 1997. This study of 1.5 million
women found no overall connection between the two
(Melbye et al., 1997). This study benefited from its
size 1.5 million women and by linking data from
the National Registry of Induced Abortions and the
Danish Cancer Registry, thereby avoiding one of the
pitfalls observed in some case-control studies that
women with breast cancer were more likely to recall
having had an induced abortion than women without
breast cancer, particularly because abortion had
been illegal (Brody, 1997; Westhoff, 1997). An
accompanying editorial on the results of the study led
the writer to conclude that, in short, a woman need
not worry about the risk of breast cancer when facing
the difficult decision of whether to terminate a
pregnancy (Hartge, 1997).

Another large cohort study was done in Sweden. It
followed, for as long as 20 years beginning in 1966,
49,000 women who had received abortions before
the age of 30. Not only did the study show no
indication of an overall risk of breast cancer after an
induced abortion in the first trimester, but it also
suggested that there could well be a slightly reduced
risk. Among women who had given birth prior to
induced abortion, the relative risk
*
for breast cancer
was 0.58; for those who had never given birth, the
relative risk was 1.09; for the total sample, the
relative risk was 0.77 (Lindefors Harris et al., 1989).


'
1ho rlsk ol dlsoaso ln ono group, horo ln vomon vho oxporloncod
an lnducod abortlon, dlvldod by tho rlsk ol dlsoaso ln a control group.
ll tho rolatlvo rlsk ls 1, both groups havo tho samo llkollhood ol
dovoloplng tho dlsoaso. A numbor hlghor than 1 lndlcatos an
lncroasod rlsk and a numbor lovor than 1 lndlcatos a docroasod rlsk.
3

In 2004, an international collaborative analysis of
data about 83,000 women with breast cancer who
were involved in 53 studies that took place in
countries with liberal abortion laws found that
pregnancies that end in either induced or
spontaneous abortion do not increase a womans
risk of developing breast cancer (Collaborative
Group, 2004).


Studies Published During the Past 20 Years Offer
Mixed Results

Before Melbyes seminal study appeared in 1997 in
the New England Journal of Medicine, the body of
published research showed inconsistent and
inconclusive evidence some found abortion to
have a protective effect, others found a slightly
elevated risk. Many of these studies were hindered
by the small sample size, others failed to distinguish
between induced and spontaneous abortion, and
others did not take confounding factors into account
(NCI, 1999).

A 2001 population-based case-control study
of women in China sought to determine
whether there was an association between
induced abortion and breast cancer.
Abortion is common and well-accepted in
China, so women involved in this study
would not be prone to underreporting their
abortion histories a problem which has
rendered other studies unreliable. Because
of the small number of women in the study
who had never had a live birth, only women
who had at least one live birth were included
in the analysis. The study compared 1,459
women with breast cancer with 1,556
controls. No relation was found between
ever having an induced abortion and breast
cancer. Additionally, women who had three
or more induced abortions were not at
greater risk of breast cancer than other
women (Sanderson, et al., 2001).

Another case-control study of women who
had at least one child was conducted in
Washington State to examine the
relationship between induced abortion and
breast cancer. A cohort of women who gave
birth between 1984 and 1994 were identified.
From this cohort, 463 women who developed
breast cancer were each matched with five
control women. Induced abortion was not
found to increase the risk of developing
breast cancer the relative risk for breast
cancer was 0.9 among women who had ever
had an induced abortion (Tang, et al., 2000).

A 1999 population-based case-control study
examined data from the Carolina Breast
Cancer Study to determine what, if any,
connections exist between induced abortion
and other reproductive events in
adolescence and the development of breast
cancer later in life. The authors reported that
neither induced nor spontaneous abortion
during adolescence was connected to an
increased risk of breast cancer. They did,
however, observe that breastfeeding
conferred some protection against breast
cancer (Marcus et al., 1999).

In 1996, Joel Brind and colleagues published
a meta-analysis of 28 published reports
describing 23 studies on induced abortion
and breast cancer. Based on these studies,
the authors calculated that induced abortion
places women at a slightly increased risk for
developing breast cancer (Brind et al., 1996).
This analysis has been criticized for
attempting to calculate the odds for
developing breast cancer from widely varying
studies (Blettner et al., 1997), some of which
have been criticized for methodological flaws
and for failing to calculate their results from
the raw data of the original studies (Melbye
et al., 1997).

A 1994 study, published in the Journal of the
National Cancer Institute, was a case-control
study of 845 women in Washington State
who were diagnosed with breast cancer from
1983 through 1990, and of 961 controls. The
study found that among women who had
been pregnant at least once, the risk of
breast cancer in those who had experienced
an induced abortion was 50 percent higher
than among other women. Highest risks
were observed when the abortion was done
at ages younger than 18. No increased risk
was associated with a spontaneous abortion.
However, the study was relatively small,
lacked objective measures for establishing
pregnancy duration, and was susceptible to
reporting bias, since a breast cancer
diagnosis may influence a woman's recall or
disclosure of her reproductive history. The
authors reported that the study's limitations
"argue against a firm conclusion at this time"
and called for further research (Daling et al.,
1994). An editorial that accompanied the
4

report said that "it is difficult to see how [the
study results] will be informative to the
public" (Rosenberg, 1994).

A 1989 study matched 1,451 women in New
York State whose breast cancer was
reported from 1976-1980 with controls of
equivalent age and residence (Howe et al.,
1989). The study examined state health
records for the prior incidence of abortion or
miscarriage. An odds ratio

of 1.9 was found

for cases with a history of only induced
abortions, 1.5 for only spontaneous
abortions, and 4.0 for repeated interrupted
pregnancies with no intervening births.
However, the cohort consisted only of
women under age 40 and the follow-back
search was restricted to events that occurred
since 1971. The authors believed that the
study was inconclusive.

In a 1987 study, researchers reported "little
relation of breast cancer risk with abortions
or miscarriages" (La Vecchia, 1987). Four
years later, the same researchers again
found no consistent relationship (Parazzini,
1991). Other researchers concluded in 1988
that the data "suggest that the risk of breast
cancer is not materially affected by abortion,
regardless of whether it occurs before or
after the first term birth" (Rosenberg, 1988).

A 1985 study examined the association
between spontaneous abortion prior to a first
birth and the risk of breast cancer among
3,315 Connecticut women who gave birth
between 1946 and 1965. Among women
who experienced one childbirth, a prior
miscarriage was associated with a 3.5-fold
increase in the risk of breast cancer. While
the study concluded that an abortion prior to
the first live birth may increase a woman's
risk of breast cancer, it examined only
spontaneous abortion. Among the questions
left open to speculation was whether a
hormonal imbalance may have resulted in
both the spontaneous abortion and the onset
of cancer (Hadjimichael et al., 1986).

A 1981 study of women in Los Angeles
County looked at both oral contraceptive use
and early abortion as risk factors. The

1
1ho odds ol havlng a rlsk lactor ll a condltlon ls prosont dlvldod by
tho odds ol havlng tho rlsk lactor ll tho condltlon ls not prosont.
cohort consisted of 163 women diagnosed
with breast cancer between 1972 and 1978.
All of the women were aged 32 or younger at
the time of diagnosis. The study found that a
first-trimester abortion, whether spontaneous
or induced, before first full-term pregnancy
appeared to cause a relative risk of 2.4 for
subsequent development of breast cancer.
The extremely small cohort size and the age
restriction of the methodology rendered the
results inconclusive (Pike et al., 1981).


Risk Factors for Breast Cancer are Varied

In addition to the reproductive factors that affect a
woman's risk of developing breast cancer, a wide
variety of other considerations have been the subject
of continued research by epidemiologists. Of
particular concern are factors related to genetics,
nutrition (especially dietary fat intake), age, and the
environment (exposure to carcinogens) (Jones,
1990).

A family history of breast cancer is reported
to increase a woman's risk of developing the
disease twofold to threefold (Jones, 1990).
In one study (Sattin et al., 1985), women with
a first-degree relative (a mother or sister)
with breast cancer had a relative risk 2.3
times that of women without a family history
of breast cancer. For women with both an
affected mother and sister, the relative risk
was 14.

Of potential carcinogenic significance is the
finding that environmentally derived
chemicals are secreted into the breast fluid
and concentrated by the alveolar ductal
system. For example, five minutes after a
woman smokes a cigarette, nicotine appears
in her breast secretion. Although smoking
has not been linked to breast cancer, the
finding shows that almost anything to which
a woman is exposed may appear in her
breast fluid (Jones, 1990).

Nutritional considerations have focused on
dietary fat, with the exception of
monosaturated fat such as olive oil. While
Asian women show a lower incidence of
breast cancer than women in western
countries, women who move from areas of
low to high incidence, such as Japanese
women moving to Hawaii, show a slow but
definite increase in breast cancer over
5

successive generations (Wynder & Rose,
1984). Other research has investigated
certain metabolic conversions that are
affected by total body weight (Deslepeyre et
al., 1985).

Some studies have found that alcohol
consumption may be implicated in breast
cancer risk, and that the risk may increase in
women who consume greater than three
drinks of alcohol per week (Hiatt et al., 1984;
Willett et al, 1987; Schatzkin et al., 1987).


Planned Parenthood Promotes Women's Health

As the nation's largest provider of reproductive health
services, Planned Parenthood is concerned above all
with women's health and the risk factors for
reproductive health problems. PPFA health centers
adhere to strict, nationwide medical standards.
Screening and management of breast conditions are
integral components of Planned Parenthood
services. All clinicians providing routine reproductive
health services perform breast examinations and
instruct patients in breast self-examination. Breast
exams are performed regularly as part of a patient's
initial and annual examination, during an initial
prenatal visit, and during other non-routine visits. In
2003, Planned Parenthood health centers provided
951,761 examinations.

Although most Planned Parenthood centers do not
offer mammography, each affiliate must have a
physician available who is able to evaluate patients
identified with abnormal breast findings who have
been referred by clinicians, either on-site or by
referral, and each affiliate maintains a list of
radiologists and breast disease specialists to whom
Planned Parenthood patients can be referred. All
Planned Parenthood health centers also provide
abortion counseling and referral for or provision of
abortion services in 2003 Planned Parenthood
provided 244,628 abortions nationwide.


The Planned Parenthood Position is That
Abortion Poses no Demonstrated Health Risks

The link between induced abortion and breast cancer
is a theory whose principal promoters oppose
abortion regardless of its safety. The theory has not
been borne out by research. While Planned
Parenthood believes that women should have
access to information about all factors that influence
the risk of disease, PPFA also believes that women
deserve information that is medically substantiated
and untainted by a political agenda.

Cited References
ACS American Cancer Society. (2003, accessed 2004,
February 4). Can Having an Abortion Cause or Contribute to
Breast Cancer? [Online].
_____. American Cancer Society. (1999, accessed November 2).
Breast Cancer : Prevention and Risk Factors [Online].
http://www3.cancer.org/cancerinfo/load_cont.asp?st=pr&ct=5
http://www.cancer.org/docroot/CRI/content/CRI_2_6x_Can...
ACOG American College of Obstetricians and Gynecologists.
Committee Opinion: Induced Abortion and Breast Cancer
Risk. Obstetrics and Gynecology, 102, 433435.
Bartholomew, Lynne L. & David A. Grimes. (1998). The Alleged
Association Between Induced Abortion and Risk of Breast
Cancer: Biology or Bias? Obstetrical and Gynecological
Survey, 53(11), 708714.
Blettner, Maria, et al. (1997). Comment on Brind et al., Induced
Abortion as an Independent Risk Factor for Breast Cancer.
Journal of Epidemiology and Community Health, 51, 465
468.
Brind, Joel, et al. (1996). Induced Abortion as an Independent
Risk Factor for Breast Cancer: A Comprehensive Review and
Meta-Analysis. Journal of Epidemiology and Community
Health, 50, 481496.
Brody, Jane E. (1997, January 9). Big Study Finds No Link in
Abortion and Cancer. New York Times, p. A12.
Brumsted, John R. & Daniel H. Riddick. (1990). The
Endocrinology of the Mammary Gland. In William H. Hindle,
ed., Breast Disease for Gynecologists. Norwalk, CT:
Appleton & Lange.
Collaborative Group on Hormonal Factors in Breast Cancer.
(2004, March 27). Breast Cancer and Abortion: Collaborative
Reanalysis of Data from 53 Epidemiological Studies,
Including 83,000 Women with Breast Cancer from 16
Countries. The Lancet, 363, 10071016.
Daling, Janet R., et al. (1994). "Risk of Breast Cancer Among
Young Women: Relationship to Induced Abortion." Journal of
the National Cancer Institute, 86(21), 15841592.
Deslepeyre, J.P., et al. (1985). "Fat tissue: A Steroid Reservoir
and Site of Steroid Metabolism." Journal of Clinical
Endocrinology and Metabolism, 61, 564.
Hadjimichael, O.C., et al. (1986). "Abortion Before First Livebirth
and Risk of Breast Cancer." British Journal of Cancer, 53,
281284.
Hartge, Patricia. (1997). Abortion, Breast Cancer, and
Epidemiology. New England Journal of Medicine, 336(2),
127128.
Hiatt, R.A. & R.D. Bawol. (1984). "Alcoholic Beverage
Consumption in Breast Cancer Incidence." American Journal
of Epidemiology, 120, 676.
Howe, Holly L., et al. (1989). "Early Abortion and Breast Cancer
Risk among Women Under Age 40." International Journal of
Epidemiology, 18(2), 300304.
Jones, Ronald C. (1990). Epidemiology Risk Factors. In
William H. Hindle, ed., Breast Disease for Gynecologists.
Norwalk, CT: Appleton & Lange.
Kelsey, Jennifer L. & Marilie D. Gammon. (1991). The
Epidemiology of Breast Cancer. Atlanta, GA: American
Cancer Society.
La Vecchia, Carlo. (1987). "General Epidemiology of Breast
Cancer in Northern Italy." International Journal of
Epidemiology, 16, 347355.
Lindefors Harris, Britt-Marie, et al. (1989). "Risk of Cancer of the
Breast after Legal Abortion during First Trimester: A Swedish
Register Study." British Medical Journal, 299(December 9),
14301432.
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Marcus, Pamela M., et al. (1999). Adolescent Reproductive
Events and Subsequent Breast Cancer Risk. American
Journal of Public Health, 89(8), 12441247.
Melbye, Mads, et al. (1997). Induced Abortion and the Risk of
Breast Cancer. New England Journal of Medicine, 336(2),
8185.
NCI National Cancer Institute. (2003, accessed 2004, February
4). Summary Report: Early Reproductive Events and Breast
Cancer Workshop [Online]. http://cancer.gov/cancerinfo/ere-
workshop-report
_____. (2002, March 6, accessed May 21). Cancer Facts:
Abortion and Breast Cancer. [Online]
http://cis.nci.nih.gov/fact/3_53.htm
Parazzini, Fabio. (1991). "Spontaneous and Induced Abortions
and Risk of Breast Cancer." International Journal of Cancer,
48, 816820.
Pike, M.C., et al. (1981). "Oral Contraceptive Use and Early
Abortion As Risk Factors for Breast Cancer in Young
Women." British Journal of Cancer, 43, 7276.
Querido, Melissa. (1999). State of the States: A Selection of
Legislative Initiatives around the Country. Reproductive
Freedom News, 8(3), p.3.
Rosenberg, Lynn. (1988). "Breast Cancer in Relation to the
Occurrence and Time Of Induced and Spontaneous
Abortion." American Journal of Epidemiology, 127, 981989.
_____. (1994). Induced Abortion and Breast Cancer: More
Scientific Data are Needed. Journal of the National Cancer
Institute. 86(21), 15691570.
Rosenfield, Allan. (1994?). Breast Cancer and Abortion
Comments by Allan Rosenfield, M.D., Dean, Columbia
University School of Public Health. Photocopy.
RCOG Royal College of Obstetricians and Gynecologists.
(2001, May, accessed 2002, May 21). What You Need to
Know About Abortion Care. [Online].
http://www.rcog.org.uk/print.asp?PageID=701&Type=main
Sanderson, Maureen, et al. (2001). Abortion History and Breast
Cancer Risk: Results from the Shanghai Breast Cancer
Study. International Journal of Cancer, 92, 899905.
Sattin, R.W., et al. (1985). "Family History and the Risk of Breast
Cancer." Journal of the American Medical Association,
253(13), 19081913.
Schatzkin, A., et al. (1987). "Alcohol Consumption and Breast
Cancer in the Epidemiologic Follow-Up Study of the First
National Health and Nutrition Examination Survey." New
England Journal of Medicine, 316, 11691174.
Simon, Stephanie. (2002, March 24). Abortion Foes Seize on
Reports of Cancer Link in Ad Campaign. Los Angeles
Times.
Slobodzian, Joseph A. (1999, April 1). Philadelphia Transit
Authority, Religious Group Settle over Pulled Ads.
Philadelphia Inquirer.
Tang, Mei-Tzu, et al. (2000). Induced Abortion in Relation to
Breast Cancer among Parous Women: A Birth Certificate
Registry Study. Epidemiology, 11, 177180.
Westhoff, Carolyn. (1997). Abortion and Breast Cancer: Good
Data at Last. IPPF Medical Bulletin. 31(2), 12.
Willett, W.C., et al. (1987). "Moderate Alcohol Consumption and
the Risk of Breast Cancer." New England Journal of
Medicine, 316(19), 11741180.
Wingo, Phyllis A., et al. (1997). The Risk of Breast Cancer
Following Spontaneous or Induced Abortion. Cancer
Causes and Control, 8, 93108.
WHO World Health Organization. (2000, June, accessed 2002,
May 21). Induced Abortion Does Not Increase the Risk of
Breast Cancer. [Online]. http://www.who.int/inf-
fs/en/fact240.html
Wynder, E.L. & D.P. Rose. (1984). Diet and Breast Cancer.
Hospital Practice, 19(4), 7378, 8388.





Lead Author Susanne Pichler






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