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Does an induced abortion prior to a woman's first full–term pregnancy (FFTP) increase her risk of developing breast cancer?
One of the main questions that people have when they hear or read that having an abortion at a young age increases a woman's risk of breast cancer is: Why? Two renowned researchers, Jose and Irma Russo, were among the first prominent scientists to offer a possible explanation of this phenomenon in their work with rats in the 1980s and l990s. The next question was: What is it about an abortion at a young age that leaves the human breast especially vulnerable to carcinogens (ie, an agent that causes cancer)?
If we look at Table 6A [data from Witt et al, 4], we note that women who experience a healthy pregnancy (eg, women considering induced abortion) have far higher hormone levels than women who are about to miscarry. As early as 1957, the first research study to formally show a link between abortion and breast cancer was published by a Japanese researcher named Segi. Since 1981 a number of studies from around the world, have continued to show that having an abortion at a young age is a significant risk factor for breast cancer [7, 8, 9, 10, 11, 12]. The paper by Brind and colleagues provided an extensive commentary on many of the previous studies and included a thorough historical review of the entire field. Women who had an induced abortion had a 30% increased risk of developing breast cancer, whereas parous women who had an induced abortion prior to their FFTP had a 50% increased risk of developing breast cancer, compared to women who did not have an induced abortion. In short, almost every study noted in Table 6B has a factor or factors (these factors are all reviewed in Chapter 5) which would have served to increase the relative risk markedly, had they been accounted for.
This central question will be addressed here, but first it would be helpful to review the history of this issue. That is, why would a woman's breast cells be left in a more vulnerable state if she were to have an induced abortion early in her life, instead of completing her pregnancy? Here we see that the levels of both of the sexual hormones, estradiol and progesterone, as well as hCG (human Chorionic Gonadotropin), all rise rapidly in early pregnancy. These hormones' among others, are critical for the full development and maturation of a woman's breast cells, especially in her first pregnancy. Do they increase the risk of breast cancer if a woman experiences one in her first pregnancy? Because hormone levels drop rapidly after an abortion or miscarriage, women who choose abortion will experience a greater change in hormone levels than women who miscarry.
During the years of 1953 to 1955 he and his group pooled most of the cancer patients from nearly all of Japan's major hospitals; 644 of the women had breast cancer.
A major development occurred in late 1994, after Janet Daling et al  revealed the results of a study which commanded the attention of both the medical and the lay realms. The meta–analysis led to a flurry of discussion but left few able to argue with its methods or results. One of the groups were rats that had one pregnancy in the past, the second group were virgin rats, and the third group were pregnant rats who underwent an abortion at a young age. Most authors have found that miscarriages increase the risk of breast cancer less than an induced abortion does (see Chapter 7 for details). Rosenberg argued that Daling's study might be limited by recall bias, as was discussed in Chapter 5. In their analysis, they reviewed 61 different studies ranging between the years 1957 to 1996.
Janet Daling, an epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle, defended Dr. Because, a closer look at each of the individual studies would have yielded an even higher risk, had they adjusted for the many factors which could affect the results. Each of these three groups was then subjected to a cancer producing agent called DMBA (7,12 dimethylbenz(a)anthracene). The combination of these hormones, as well as others, causes the cells of the breast to divide rapidly and start a maturing process that will continue over the next 9 months, after which the breast cells will be matured or differentiated.
Thus, we would expect that women who miscarry would have less risk than women who have induced abortions, although as Chapter 7 will show, women who miscarry before their first full–term pregnancy (FFTP) still appear to be at increased risk. Segi et al also noted a number of other important findings: 1) women who had an early pregnancy, 2) those who had a later age of the menarche (ie, the onset of a woman's menstrual cycles), and 3) those who had more children, all had lower rates of breast cancer than the norm.
In addition, Daling noted that women who had an abortion at a young age (before the age of 18) and who also had a positive family history for breast cancer, were at infinitely increased risk compared to young women who had no abortion and a positive family history for breast cancer (confidence intervals 1.8 to infinity)!
This was a remarkable claim, because Daling et al had taken great pains to address this issue, even going so far as performing a side study comparing abortion and cervical cancer, which would have specifically identified reporting bias [9, p.1590]. From those 61, they selected out the studies which did not adequately distinguish between induced and spontaneous abortion, leaving 28 studies, which were further reduced to 23 studies after combining the results of the studies that overlapped. A comprehensive review of those factors is presented at the end of this chapter but two of them stand out. As noted in Chapter 5, this is a serious error and one that results in a lower reported risk from abortion at a young age than would have been, had she designed the study properly.
They found that none of the 9 rats that had a full-term pregnancy deueloped breast cancer, 15 out of 22 of the virgin rats (de, 68%) developed breast cancer, and 7 out of 9 (77.7%) of the rats that had an abortion developed breast cancer. If the pregnancy goes to term, her breast cells will have undergone the natural maturation process and be less likely to become cancerous. He and his group also reviewed studies from around the world, including Japan, Russia, Yugoslavia, France, Denmark, Sweden, Norway, Greece, and many others including the U.S.
Brind et al reported from induced abortion prior to a FFTP is a very conservative estimate. It was further noted that when one looked microscopically at the breast tissue of each of the aforementioned groups, the full–term pregnancy group had many more mature (differentiated) breast cells than did the rats that had an abortion. If the natural process in a woman's first pregnancy is interrupted via an induced abortion, those same cells are left in a vulnerable state. This result sparked the medical world's continued study of both of these findings until the current time. Had the above–mentioned factors been properly adjusted for, the real risk from an abortion before a FFTP would almost certainly have been significantly higher. They found that the group of virgin rats who received the carcinogen DMBA and the pheromone hCG, developed breast cancer far less often than those that received the DMBA alone . It should again be emphasized that many of the studies that evaluated the risk of an abortion in young women took their data from the late 1970s or early 1980s. The implication is that in the human, a woman needs to complete her pregnancy in order for the breast cells to receive the full protective effect of the pheromone hCG. We noted earlier that the latent period for risk factors in breast cancer (eg, DES or radiation) could be 20 to 30 years or longer.
This implies that the full impact of having an abortion at a young age upon a woman's risk of developing breast cancer may only be fully appreciated in studies from the late l990s and the first decade of the next century.
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