Abortion Raises Breast Cancer Risk A Resource for Crisis Pregnancy Centers

1. Abortion RaisesBreast Cancer RiskA Resource for Crisis Pregnancy Centers • Karen Malec, Coalition on Abortion/Breast Cancer, • www.AbortionBreastCancer.com • Angela Lanfranchi, MD, FACS, Breast Cancer Prevention Institute, www.BCPInstitute.org

2. Table of Contents • PART I • NARAL Pro-Choice America & Planned Parenthood Have Launched Attacks on Crisis Pregnancy Centers in Urban Areas • Cancer Authorities That Acknowledge or Deny An Abortion-Breast Cancer Link • Abortion Raises Breast Cancer Risk in Four Ways • What NARAL & Planned Parenthood Don’t Tell Women About the Birth Control Pill, the Protective Effect of Childbearing and Induced Abortion • Medical Texts and Authorities Recognize the Risk-Reducing Effect of Full Term Pregnancy • Biological Reasons for An Abortion-Breast Cancer Link • Why Abortion Is A Risk Factor for Having Premature Babies • Why Premature Birth Before 32 Weeks Increases Breast Cancer Risk • Why Most Miscarriages Do Not Raise Breast Cancer Risk

3. Table of Contents • The “Susceptibility Window”: The Most Cancer-Susceptible Time in A Woman’s Life • What Dr. Susan Love Reveals About the “Susceptibility Window” • Scientists Acknowledge Abortion Is A Risk For Breast Cancer In Recent Studies • U.S. National Cancer Institute Branch Chief Louise Brinton Admitted Abortion Raises Breast Cancer Risk in a 2009 Study • Most Epidemiological Studies Support an Independent Link Between Abortion and Breast Cancer • PART II • Why the U.S. National Cancer Institute Isn’t Reliable: The Agency’s 2003 Workshop, “Early Reproductive Events and Breast Cancer” • Parallels to the Tobacco-Cancer Cover-Up

4. Part I

5. NARAL Pro-Choice Americaand Planned Parenthood Have Launched Attacks on Crisis Pregnancy Centers in Urban Areas • Why? • Crisis Pregnancy Centers are bad for business. • They inform women about risks of breast cancer, premature birth and emotional harm.

6. NARAL & PLANNED PARENTHOODCITE CANCER AUTHORITIES THAT DENY AN ABORTION-BREAST CANCER LINK • U.S. National Cancer Institute(But, the agency also delayed warning the public about the risk of smoking for over 3 decades, and it was subjected to considerable political pressure from tobacco state Congressmen.) • National Breast Cancer Coalition(whose board of directors includes former NARAL activist and abortion provider, Cynthia Pearson) • American College of Obstetricians and Gynecologists(whose physicians perform abortions) • American Cancer Society(which delayed its recognition of the risk of smoking for over 3 decades)

7. NARAL& PLANNED PARENTHOOD DON’T TELL WOMENEight Medical Groups Have Issued Statements Acknowledging the Independent Link between Abortion and Breast Cancer(i.e. that abortion leaves the breasts with more places for cancers to start) • Catholic Medical Association • Breast Cancer Prevention Institute • Polycarp Research Institute • MaterCare International • Breast Care Center EAMC • Ethics & Medics • American Association of Pro-Life Obstetricians and Gynecologists • National Physicians Center for Family Resources

8. And ... theAssociation of American Physicians and Surgeons Issued a Statement In Support of Disclosing the Evidence • “The Association of American Physicians and Surgeons believes that patients have the right to give or withhold fully informed consent before undergoing medical treatment. This includes notification of potential adverse effects. While there is a difference of medical opinion concerning the abortion breast cancer link,there is a considerable volume of evidence supporting this link, which is, moreover, highly plausible.We believe that a reasonable person would want to be informed of the existence of this evidence before making her decision."Jane Orient, M.D., Executive Director, October 27, 2003

9. ABORTION RAISES BREAST CANCER RISK IN FOUR WAYS • By Causing the Mother to Lose the Risk-Reducing Effect of Childbearing (A Recognized Risk); • By Causing Her to Delay Her First Full Term Pregnancy (A Recognized Risk); • Through the “Independent Link,” meaning the abortion, by itself, raises risk, independently of the loss of the protective effect of childbearing, by leaving her with more places in her breasts for cancers to start (The Only Contested Risk); and • By Causing Her, in a Later Pregnancy, to Have a Premature Birth Before 32 Weeks Gestation (An Uncontested Risk).

10. NARAL & PLANNED PARENTHOOD DON’T TELL WOMEN • Medical Authorities and Textbooks Agree: • 1) Full term pregnancy reduces a woman’s lifetime risk of breast cancer; • 2) Each subsequent full term pregnancy reduces lifetime risk by 10%; and • 3) Every one year delay of a first full term pregnancy increases the risk of premenopausal breast cancer by 5% and postmenopausal breast cancer by 3%.Breast Cancer Epidemiology, LI CL, Ed. Chapter 6 Reproductive Factors, Pg. 122, Springer Science

11. IT’ INDISPUTABLE ABORTION RAISES RISK BY: • Causing the mother to lose the protective effect of full term pregnancy; • Causing her to have a smaller family or no full term pregnancies; and • Causing her to delay a first full term pregnancy.

12. For These Reasons, It’s Indisputable That: • The woman who has an abortion has a greater breast cancer risk than does the one who has a full term pregnancy. • Full term pregnancy reduces risk, but induced abortion does not.

13. NARAL & PLANNED PARENTHOOD DON’T TELL WOMEN: • Even a paid expert witness for Florida abortion providers represented by the Center for Reproductive Law and Policy, acknowledged under oath the risk-reducing effect of full term pregnancy. • During her testimony in a 1999 lawsuit challenging Florida’s parental notice or consent law, Boston Medical School epidemiologist Lynn Rosenberg answered, “Probably, yes,” after the defense attorney for the state asked her the following question: “A woman who finds herself pregnant at age 15 will have a higher breast cancer risk if she chooses to abort that pregnancy, than if she chooses to carry that pregnancy to term.” Rosenberg (1999) NW Women’s Health vs. State of FL, FL Circuit Ct., 2nd Circuit, videotape deposition of 11/18/99, pp. 77-78

14. Time Magazine October 15, 2007

15. “Much of the long-term underlying increase in incidence among women is due to historical changes in reproductive patterns, such as delayed childbearing and having fewer children.”American Cancer Society, Breast Cancer Facts & Figures 2005-2006

16. NARAL & PLANNED PARENTHOOD DON’T TELL WOMEN: • The World Health Organization lists the birth control pill with estrogen plus progestin in it (combined oral contraceptives) and combined hormone replacement therapy in the highest level of cancer-causing agents (Group 1) in 2005. Cogliano et al. Lancet Oncology 2005;6:552-553 • WHO scientists wrote, “Most combined oral contraceptives are taken orally, but they can also be delivered by injection, transdermal patch or vaginal ring.” Cogliano et al. Lancet Oncology 2005;6:552-553 • A Mayo Clinic meta-analysis found the use of oral contraceptives before a first full term pregnancy increases the risk of pre-menopausal breast cancer by 44%. Kahlenborn et al. Mayo Clinic Proceedings 2006;81(10):1290-1302 • Two studies in prominent medical journals have strongly linked use of the birth control pill with the aggressive, deadly, triple-negative breast cancer. Ma et al. Cancer Research 2010;70(2):575-587 and Dolle et al. Cancer Epidemiology Biomarkers & Prevention 2009; 18(4)1157-1166

17. NARAL & PLANNED PARENTHOOD DON’T TELL WOMEN: • Oral contraceptives (“the pill”) can specifically cause the particularly aggressive and deadly triple-negative breast cancer. • This form of breast cancer occurs frequently among women under age 50 and African Americans and is associated with high mortality. • In their 2009 study on oral contraceptives (“the pill”) and triple-negative breast cancer, Jessica Dolle and her colleagues, including National Cancer Institute branch chief Louise Brinton, reported that women who start using oral contraceptives before age 18 multiply their risk of developing triple-negative breast cancer by 3.7 times and recent users within the last 1 to 5 years multiply their risk of developing triple-negative breast cancer by 4.2 times.Dolle J et al. Cancer Epidemiology Biomarkers & Prevention 2009;18(4)1157-1166. See: http://www.abortionbreastcancer.com/download/Abortion_ Breast_Cancer_Epid_Bio_Prev_2009.pdf

18. NARAL & PLANNED PARENTHOOD DON’T TELL WOMEN: • The biological reasons for three breast cancer risks⎯abortion, combined oral contraceptives (the pill with estrogen + progestin), and combined hormone replacement therapy⎯are the same. • All three risks have to do with the effects of the hormone, estrogen, while it is in the presence of the hormone, progesterone, on immature, cancer-susceptible breast lobules. • Evidence that the pill & HRT raise risk provides further biological support for an abortion-breast cancer link. • Abortionists often “add fuel to the fire” by giving women the pill after performing abortions on them.

19. Biological Reasons for an Abortion-Breast Cancer Link • In a normal pregnancy, there are physiological changes that take place in the breasts that cannot be undone by induced abortion. • After conception and before implantation, the embryo releases the hormone hCG (human chorionic gonadotropin) which immediately causes the mother’s ovaries to produce higher levels of estrogen and progesterone and change her breasts. • The mother’s breasts become sore and tender because of the multiplication of breast cells to produce more breast tissue in preparation for breastfeeding.

20. Biological Reasons for an Abortion-Breast Cancer Link • In the first months of pregnancy, the breasts grow under the influence of pregnancy hormones. • With the stimulation of pregnancy hormones estrogen and progesterone, the number of cells that are immature and cancer-vulnerable are markedly increased in number. • In short, if the mother has an abortion, a premature birth before 32 weeks gestation or a 2nd trimester miscarriage, she is left with more places (cells) for cancers to start.

21. Biological Reasons for an Abortion-Breast Cancer Link • It is only in the hormonal environment that occurs after the first 32 weeks of pregnancy - during which time hPL (human placental lactogen) has been very elevated - that these cells mature through specific genetic changes that cause them to become cancer-resistant.

22. Biological Reasons for an Abortion-Breast Cancer Link • Breast maturity influences a woman’s breast cancer risk. • The breasts mature during puberty and then again during full term pregnancy.

23. Biological Reasons for an Abortion-Breast Cancer Link • The Breasts Mature During Puberty and Full Term Pregnancy. • A breast lobule is a unit of tissue consisting of a milk duct with ductules (glands that make milk). • During puberty: Type 1 lobules mature into Type 2 as a result of exposure to the female hormones, estrogen and progesterone. Type 1 & 2 lobules are immature & cancer susceptible. • During full term pregnancy: Under the influence of fetal pregnancy hormones, the immature lobules mature into Type 4 lobules. Type 4 lobules contain the early milk, colostrum, and are cancer-resistant. When they no longer produce milk, they retain the protective genetic changes and become Type 3 lobules. • Lanfranchi, A. Normal breast physiology: The reasons hormonal contraceptives and induced abortion increase breast cancer risk. The Linacre Quarterly 2009;76:236-249. Available at: http://www.abortionbreastcancer.com/download/LQ_76_3_2_Lanfranchi.pdf

24. Breast lobule maturation before and after first full term pregnancy

26. Biological Reasons for an Abortion-Breast Cancer Link • After puberty, 75% of the lobules are Type 1 and 25% are Type 2. There are only a few Type 3. • Starting early in pregnancy, pregnancy hormones increase (mainly estrogen) and stimulate the lobules to multiply. The breasts grow larger and feel sore and tender under the influence of pregnancy hormones. During the first months of pregnancy, the mother grows more Type 1 and 2 lobules - more places for cancers to start.

27. Biological Reasons for an Abortion-Breast Cancer Link • By mid-2nd trimester, the breasts have doubled in volume. The breasts consist of 70% Type 4 cancer-resistant lobules and 30% cancer-susceptible lobules. • The longer she is pregnant before an abortion takes place, the more places she grows for cancers to start in her breasts. Her risk increases 3% per week of gestation at the time of the abortion. However, if she delivers the baby at 32 weeks of pregnancy or later, her breast cancer risk drops sharply.Melbye et al. Br J Cancer 1999;80:609-613. Hsieh et al. Lancet 1999;353:1239.

28. Biological Reasons for an Abortion-Breast Cancer Link • If she has an abortion, a premature birth before 32 weeks gestation, or a 2nd trimester miscarriage, she will be left with more places for cancers to start.

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30. Biological Reasons for an Abortion-Breast Cancer Link • By 32 weeks gestation, she has matured enough Type 4 lobules that she has acquired 90% of the protective effect of full-term pregnancy. • The unborn child and the placenta produce hormones hCG and HPL that are responsible for maturing most of mom’s breast lobules into cancer-resistant Type 4 lobules in the last months of pregnancy. This is called the “differentiation process” which helps protect the mother from exposure to high levels of estrogen and progesterone early in her pregnancy.Lanfranchi The Linacre Quarterly 2009;76:236-249

31. Biological Reasons for an Abortion-Breast Cancer Link • If she delivers her baby at 40 weeks gestation, then 85% of her lobules will be fully mature and permanently cancer-resistant. • She will be left with fewer places for cancers to start than she had before she became pregnant.

32. Breast lobule maturation before and after first full term pregnancy

33. Biological Reasons for an Abortion-Breast Cancer Link • Most miscarriages do not raise breast cancer risk. Most miscarriages are abnormal first trimester pregnancies, but most abortions are normal pregnancies. • In a normal pregnancy, the levels of pregnancy hormones are elevated. The embryo produces hCG, which stimulates the mother’s ovaries to increase the levels of estrogen and progesterone for the purpose of maintaining the pregnancy. A fetal abnormality may result in a 1st trimester miscarriage because of insufficient levels of pregnancy hormones needed to maintain the pregnancy.Stewart D. et al., Journal of Clinical Endocrinology & Metabolism 76 1993;1470–1478.Williams Obstetrics, 21st ed. eds. F.G. Cunningham et al. (New York: McGraw- Hill, 2001), ch. 33, 856–869. • If the mother did not experience elevated levels of pregnancy hormones, then the breasts were not hormonally stimulated to grow. She was not left with more places for cancers to start and an increased breast cancer risk. Frequently, women will say they didn’t “feel” pregnant, and their breasts were not sore and tender.

34. NARAL & PLANNED PARENTHOOD DON’T TELL WOMEN: • Abortion raises breast cancer risk by increasing the rate of premature birth in the mother’s subsequent pregnancies. • Any premature delivery before 32 weeks increases breast cancer risk for the same biological reasons that abortion raises risk - by leaving the breasts with more places for cancers to start.

35. NARAL & PLANNED PARENTHOOD DON’T TELL WOMEN: • “Induced abortion is a recognized cause of premature birth often due to cervical incompetence, uterine infection, and scarring post-abortion. The cervix is the mouth of the uterus, and its muscle tightly holds the fetus and placenta inside during pregnancy. If the cervix is damaged during forced dilatation during an abortion, the situation becomes a vicious cycle in which induced abortion is a cause of prematurity, and prematurity more than doubles (the mother’s) breast cancer risk if it is before 32 weeks. The greater the number of previous abortions a woman has, the higher her risk of premature births in future pregnancies.”Lanfranchi A. The Linacre Quarterly 2009;76:236-249. See: http://www. abortionbreastcancer.com/download/LQ_76_3_2_Lanfranchi.pdf

36. NARAL & PLANNED PARENTHOOD DON’T TELL WOMEN: • The Institute of Medicine lists abortion as a risk factor for preterm birth in its book, Preterm Birth.Preterm Birth, Institute of Medicine 2005 Appendix B, Table 5, p. 519.

38. NARAL & PLANNED PARENTHOOD DON’T TELL WOMEN: • Three systematic reviews and meta-analyses in 2009 confirm elevated risks of premature birth for women who have abortions. • Shah P. et al. Induced termination of pregnancy and low birthweight and preterm birth: a systematic review and meta-analysis BJOG 2009;116(11):1425-1442. Available at: http://www3.interscience.wiley.com/journal/122591273/abstract • Swingle  HM,  et  al.    Journal  of  Reproductive  Medicine  2009;;54:95-­108.   • Van  Oppenraaij  RHF  et  al.  Human  Reproduction  Update  Advance  Access  7  March  2009;;1(a):1-­13.  Available  at:   http://humupd.oxfordjournals.org/cgi/content/abstract/15/4/409

39. NARAL & PLANNED PARENTHOOD DON’T TELL WOMEN: • Premature babies are known to be at risk for cerebral palsy, mental retardation, and neonatal deaths. • Rooney B, Calhoun M, Roche L. Does induced abortion account for racial disparity in preterm births, and violate the Nuremberg Code? J Am Phys Surg 2008;13:102-104.

40. NARAL & PLANNED PARENTHOOD DON’T TELL WOMEN: • Four studies show that the woman who has a premature birth before 32 weeks gestation increases her breast cancer risk. • Melbye M, Wohlfahrt J, Andersen A-M N, Westergaard T, Andersen PK. Preterm delivery and risk of breast cancer. Bri J Cancer 1999;80:609-13. • Hsieh C-c, Wuu J, Lambe M, Trichopoulos D, et al Delivery of premature newborns and maternal breast-cancer risk. Lancet 1999;353:1239. • Vatten LJ, et al. Pregnancy related protection against breast cancer depends on length of gestation. Br J Cancer 2002;87:289-90. • Innes K and Byers T. First pregnancy characteristics and subsequent breast cancer risk among young women. Int J Cancer 2004; 112:306-311.

41. Biological Reasons for an Abortion-Breast Cancer Link • For the mother, induced abortion and an early premature birth are biologically identical events that result in the same hormonal changes to the mother’s breasts. Whether the baby is dead or alive, the mother’s breasts are still left with more places for cancers to start. • Evidence of a premature birth-breast cancer link provides biological support for an independent link between abortion & breast cancer (i.e., that abortion, apart from the loss of the protective effect of childbearing, raises breast cancer risk). • Scientists do not contest the premature birth-breast cancer link; but when the evidence has to do with an abortion-breast cancer link, many are quick to challenge it.

42. Biological Reasons for an Abortion-Breast Cancer Link • The more months she spendsbreastfeedingher babies during her reproductive life, the lower her breast cancer risk is. Here are the biological reasons why: • 1. Mammary glands remain in a state of near complete differentiation as Type 4 lobules. • 2. Breastfeeding suspends menstruation, thereby avoiding monthly exposure to peaks of estrogen & progesterone. Experts agree estrogen is a cancer-causing agent and that women with fewer menstrual cycles have a reduced breast cancer risk. • 3. Some cycles may be anovulatory, meaning that she was not exposed to an elevated level of estrogen that is necessary to stimulate the release of an ovum (egg) from the ovary. • Lanfranchi The Linacre Quarterly 2009;76:236-249

43. Biological Reasons for an Abortion-Breast Cancer Link • The “Susceptibility Window” - The most cancer-susceptible time in a woman’s life takes place between the onset of menstruation and first full term pregnancy. • That is when she has the highest number of Type 1 lobules. • That is worst time in a woman’s life to be exposed to a cancer-causing agent (i.e. abortion, the birth control pill, radiation, cigarette smoking, etc.).

44. Lobular Structures in the Human Breast 90 Lob.1 Lob.2 Lob.3 60 % of Structures 30 0 Before full-term pregnancy After Full-term pregnancy

45. Biological Reasons for an Abortion-Breast Cancer Link • Dr. Susan Love’s Breast Book reveals her knowledge of the susceptibility window. It shows that breast cancer risk increases with: • The number of menstrual cycles a woman has during her life; and • The length of time that elapses between the onset of menstruation and “first pregnancy.” • More menstrual cycles mean increased exposure to the hormone, estrogen (recognized as a cancer-causing agent).

46. Susan Love’s Breast Book

47. Biological Reasons for an Abortion-Breast Cancer Link • But, a short pregnancy isn’t protective. The truth is, only a full term pregnancy of at least 32 weeks duration is protective against breast cancer. Melbye et al. Br J Cancer 1999;80:609-13 • Use of the term “first pregnancy” is misleading. Dr. Love makes it sound as if a pregnancy lasting 24 hours has the same risk-reducing effect as a full-term pregnancy.

48. Scientists from Several Countries Acknowledge Abortion is a Risk for Breast Cancer in Recent Studies • There is acknowledgement that abortion is a risk for breast cancer made by scientists from several countries in recently published studies concerning all breast cancer risks. • In order for a study concerning breast cancer risk to be accurate, all known risks must be controlled for in the study (or case) group which has the risk to be studied and the control group which is used for comparison. This is the basis for controlled studies.

49. Scientists from Several Countries Acknowledge Abortion is a Risk for Breast Cancer in Recent Studies • For example, if a study was to look at whether candy increased breast cancer risk or not, the study group who ate candy and the control group who did not eat candy would have to be similar in all other known cancer risks. • Thus if the case group had more women in it with a family history of breast cancer than the control group, the study would come in for merited criticism if it found that candy increased breast cancer risk. • In short, for a study to be valid, the study group and control group of women have to be equal in all known risks.

50. Scientists from Several Countries Acknowledge Abortion is a Risk for Breast Cancer in Recent Studies • If scientists did not know and agree that induced abortion was a known risk factor for breast cancer, they would not refer to it in their studies and analyses. • Induced abortion is specifically acknowledged as a known risk factor in the performance of their studies as well as in the methodology and discussion sections of the published papers.