Angela Lanfranchi, M.D., F.A.C.S. President

Breast Cancer Prevention Institute

Clinical Assistant Professor of Surgery

Robert Wood Johnson Medical School

1

Louise A. Brinton, Ph.D., M.P.H.

Chief Hormonal and Reproductive Epidemiology Branch Senior Investigator

2

3

Results “In analyses of all 897 breast cancer cases (subtypes combined): the multivariate-adjusted odds ratios for examined risk factors were consistent with the affects observed in previous

studies on younger women. Specifically, older age, family history of breast cancer, earlier menarche age, induced abortion and oral contraceptive use were associated with increased risk for breast cancer.”

Cancer Epidemiol Biomarkers Prev April 2009

4

Louise A. Brinton

Induced abortion RR 1.4 CI (1.1 to 1.8)

Cancer Epidemiol Biomarkers Prev April 2009

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The Globe and Mail January 8, 2010

An e-mail to Dr. Brinton on Friday was returned by an Institute spokesman named Michael Miller who said: "NCI has no comment on this study. Our statement and other information on this issue can be found at: http://www.cancer.gov/cancertopics/ere."

From 1957 to 2012 there are 70 studies differentiating induced from spontaneous abortion.

55 studies show a positive association and 33 studies are statistically significant to the 95th percentile.

6

In 1964, the US Surgeon General applied the newly developed Bradford Hill criteria for causality to the cigarette lung cancer link epidemiologic studies to warn the public.

These same criteria have been fulfilled by the world’s epidemiologic studies of the abortion breast cancer link.

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8

9 Criteria for drawing a causal inference

from an epidemiological association

1. Timing: The patient must be exposed to the risk before the cancer

2. Similar findings in many studies

55/70 studies worldwide; 18/24 in the US associate abortion and breast cancer

3. Statistically significant increases in risk

33 studies worldwide; 9 US are statistically significant

4. Dose effect: The risk should become higher with more

exposure to the risk

The longer the pregnancy before abortion, or the more abortions, the

higher the risk, e.g. 1994 Daling Study, 1997 Melbye Study

5. A large effect observed (RR>3)

e.g. 1994 Daling Study for subgroups of teens, over 30, and family history

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9 Criteria for drawing a causal inference

from an epidemiological association

6. Causal association is biologically plausible

Elevated estrogen levels in pregnancy leaves the breast with

increased numbers of Type 1 and 2 lobules where cancers form

without the benefit of full maturation to cancer resistant Type 3 lobules

7. Experimental studies

1980 Russo and Russo study on virgin, aborted and parous rats

8. Coherence natural history and biology of breast cancer

Breast cancers caused by abortion are found after 8 to 10 years and

average cancer cell growth takes 8 to 10 years to be clinically

detectable

9. Analogy – similar exposures associated with similar effects

Premature delivery before 32 weeks doubles breast cancer risk

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TIME October 15, 2007

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Journal of American Physicians and Surgeons Fall 2007

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In 9 countries with computerized cancer and abortion registries, abortion was the greatest predictor of breast cancer rates.

Journal of American Physicians and Surgeons Fall 2007

It is the biology of the breast lobule maturation that occurs during pregnancy which accounts for the abortion breast cancer link.

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If she chooses to continue her pregnancy and has a full-term pregnancy, or one that lasts at least 32 weeks, she will lower her risk of breast cancer.

OR If she chooses to end her pregnancy with an induced

abortion, she will necessarily have an increased risk of breast cancer because: 1. She will lose the benefit of a full-term pregnancy.

2. She will delay a full-term pregnancy or have no or fewer full-term pregnancies.

3. She may have a premature delivery before 32 weeks of another pregnancy.

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A woman has an unplanned first pregnancy.

15

0

30

60

90 Lob.1 Lob.2 Lob.3

Lobular Structures in the Human Breast

% o

f S

tru

ctu

res

After

Full-term

pregnancy

Before

full-term

pregnancy

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Type 1 Lobule (TDLUs)

85% of all breast

cancers arise

Type 1 Lobules

(Ductal cancer)

Type 2 Lobule

10-15% of all

breast cancers

arise in Type 2

Lobules (Lobular

cancer)

Type 3 Lobule

Cancer resistant

Types of Breast Lobules

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Induced abortion leaves the breast with more places for cancers to start.

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19

Age-adjusted SEER Incidence Rates by Year, Race, Age

1975 <50 3.78

Age-adjusted SEER Incidence Rates by Year, Race, Age

2007 <50 13.98

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Journal of Epidemiology and Community Health 1996;50:481-496

Induced abortion as an independent risk factor

for breast cancer: a comprehensive review and

meta-analysis

Joel Brind, Vernon M Chinchilli, Walter B Severs, Joan Summy-Long

Department of Natural Science, Baruch College

The City University of New York

17 Lexington Avenue

New York, NY 10010, USA

J Brind

Center for Biostatistics and Epidemiology and

Department of Pharmacology

Pennsylvania State University

The Milton S Hershey Medical Center

Hershey, PA 17033, USA

V M Chinchilli

W B Severs

J Summy-Long

Correspondence to:

Professor J Brind

Accepted for publication

April 1996

Journal of Epidemiology and Community Health 1996

Overall, 30% increase risk of breast cancer

20,000 breast cancer cases a year are

attributable to abortion

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