Letter to ACOG regarding abortion and breast cancer


	Letter to ACOG regarding abortion and breast cancer July 3, 2002 Charles Hammond, M.D. President The American College of Obstetricians and Gynecologists 409 12th Street, S.W. Washington, D.C. 20090-6920 Dear Dr. Hammond and ACOG Officers, We would like to express our congratulations to you, Dr. Hammond, as the new president of ACOG. We are aware of, and respect, your reputation as a physician, scientist and educator. We look forward to working with you in pursuit of the highest standards of health care for the women of this country. As the largest special interest group of ACOG we are concerned with aspects of women's healthcare relating to long-term implications of induced abortion. It has come to our attention that current ACOG educational material summarily dismisses the existence of any potential long-term complications of induced abortion. Specifically, the ACOG 2002 Compendium of Selected Publications, states on page 392, "Long term risks sometimes attributed to surgical abortion include potential effects on reproductive function, cancer incidence, and psychologic sequelae. However, the medical literature, when carefully evaluated, clearly demonstrates no significant negative impact on any of these factors with surgical abortion." Yet, with regard to breast cancer, 28 of 37 international studies, including 13 of 15 American studies (8 with statistical significance), suggest that there is a 30% increased risk of breast cancer for women who have had elective abortions. Therefore, 75% of the world's scientific studies on the subject (including 86% of the American studies) are at serious variance with this statement from ACOG. (See enclosed references). These study findings have frequently been dismissed on the basis of a presumed "recall bias" despite good evidence to the contrary. Breast cancer clearly represents a serious threat to women's health and well being, and is a condition of great concern to our patients. If, in fact, the preponderance of the world's scientific literature on this topic has any validity, the ACOG statement on this topic represents a most serious disservice to the very women it purports to serve. As a scientific College, ACOG can surely do a better evaluation of the data on this important topic. Fully 75% of the world's scientific literature on this subject suggests a real danger of increased breast cancer risk subsequent to induced abortion. Simply dismissing these concerns on the basis of a presumed recall bias is unfitting for a distinguished scientific organization such as ACOG. We urge you to insist upon the highest standards of scientific integrity in dealing with this body of literature as it pertains to ACOG publications and public statements. This is especially important in light of the current controversy surrounding this scientific data. Intellectual honesty calls for a thorough reevaluation of these studies by a balanced panel of individuals known for both integrity and skillful scientific analysis. The women whose health we serve deserve no less. Sincerely, Joseph L. DeCook, MD Vice President, AAPLOG Representing the AAPLOG Executive Committee and Board of Directors Copies to: ACOG Officers, Committee and Section Chiefs, AAPLOG membership. References Studies demonstrating an increased risk of breast cancer after elective abortion: * Andrieu N, Duffy SW, Rohan TE, Le MG, Luporsi E, Gerber M, Renaud R, Zaridze DG, Lifanova Y, Day NE. Familial risk, abortion and their interactive effect on the risk of breast cancer--a combined analysis of six case-control studies. Br J Cancer. 1995;72(3):744-51. * Brinton LA, Hoover R, Fraumeni JF Jr. Reproductive factors in the aetiology of breast cancer. Br J Cancer. 1983;47(6):757-62. * Bu et al. (1995) Am J Epidemiol 141:S85. (abstract) * Daling JR, Brinton LA, Voigt LF, Weiss NS, Coates RJ, Malone KE, Schoenberg JB, Gammon M. Risk of breast cancer among white women following induced abortion. Am J Epidemiol. 1996;144(4):373-80. * Daling JR, Malone KE, Voigt LF, White E, Weiss NS. Risk of breast cancer among young women: relationship to induced abortion. J Natl Cancer Inst. 1994;86(21):1584-92. * Dviorinin & Medvedev Meth Prog Breast Cancer Epidemiol Res, Tallin 1978. USSR Acad Sci pp 53-63 (Russian). * Ewertz M, Duffy SW. Risk of breast cancer in relation to reproductive factors in Denmark. Br J Cancer.1988;58(1):99-104. * Hirohata T, Shigematsu T, Nomura AM, Nomura Y, Horie A, Hirohata I.Occurrence of breast cancer in relation to diet and reproductive history: a case-control study in Fukuoka, Japan. Natl Cancer Inst Monogr. 1985;69:187-90. * Howe HL, Senie RT, Bzduch H, Herzfeld P. Early abortion and breast cancer risk among women under age 40. Int J Epidemiol. 1989;18(2):300-4. * Laing AE, Bonney GE, Adams-Campbell L, et al. Reproductive and lifestyle factors for breast cancer in African-American women. Genet Epidemiol 1994;11:300 (abstract). * Laing et al. Breast cancer risk factors in African-American women: the Howard University Tumor Registry experience. J National Med Assoc. 1993;85:931-9. * Lazovich D, Thompson JA, Mink PJ, Sellers TA, Anderson KE.Induced abortion and breast cancer risk. Epidemiology. 2000;11(1):76-80. * Le M-G, Bachelot A, Doyon F, Kramar K, Hill C. Oral contraceptive use and breast or cervical cancer: Preliminary results of a French case-control study. In: Wolff F-P, Scott JS, eds. Hormones . . . in human cancer aetiology. Am sterdam:Elsevier, 1984; 139-47. * Lipworth L, Katsouyanni K, Ekbom A, Michels KB, Trichopoulos D. Abortion and the risk of breast cancer: a case-control study in Greece. Int J Cancer. 1995;61(2):181-4. * Luporsi (1988) "unpublished" and referenced in Br J Cancer 72-744-51. * Marcus PM, Baird DD, Millikan RC, Moorman PG, Qaqish B, Newman B. Adolescent reproductive events and subsequent breast cancer risk. Am J Public Health. 1999;89(8):1244-7. * Newcomb PA, Storer BE, Longnecker MP, Mittendorf R, Greenberg ER, Willett WC. Pregnancy termination in relation to risk of breast cancer. JAMA. 1996;275(4):283-7. * Nishiyama (1982) Shikoku Ichi 38:333-43 (In Japanese). * Palmer JR, Rosenberg L, Rao RS, Zauber A, Strom BL, Warshauer ME, Stolley PD, Shapiro S. Induced and spontaneous abortion in relation to risk of breast cancer (United States). Cancer Causes Control. 1997;8(6):841-9. * Pike MC, Henderson BE, Casagrande JT, Rosario I, Gray GE. Oral contraceptive use and early abortion as risk factors for breast cancer in young women. Br J Cancer. 1981;43(1):72-6. * Robertson C, Van Den Donk M, Primic-Zakelj, MacFarlane T, Boyle P. The association between induced and spontaneous abortion and risk of breast cancer in Slovenian women aged 25-54. Breast 2001;10:291-8. * Rohan TE, McMichael AJ, Baghurst PA. A population-based case-control study of diet and breast cancer in Australia. Am J Epidemiol. 1988;128(3):478-89. * Rookus MA, van Leeuwen FE. Induced abortion and risk for breast cancer: reporting (recall) bias in a Dutch case-control study. J Natl Cancer Inst. 1996;88(23):1759-64. * Rosenberg L, Palmer JR, Kaufman DW, Strom BL, Schottenfeld D, Shapiro S. Breast cancer in relation to the occurrence and time of induced and spontaneous abortion. Am J Epidemiol. 1988;127(5):981-9. * Segi M, et al. An Epidemiological Study on Cancer in Japan. GANN, Vol 48, Supplement: April, 1957. * Talamini R, Franceschi S, La Vecchia C, Negri E, Borsa L, Montella M, Falcini F, Conti E, Rossi C. The role of reproductive and menstrual factors in cancer of the breast before and after menopause. Eur J Cancer. 1996;32A(2):303-10. * Wataname & Hirayama (1968) Nippon Rinsho 26:1853-9 (Japanese). * Wu AH, Ziegler RG, Pike MC, Nomura AM, West DW, Kolonel LN, Horn-Ross PL, Rosenthal JF, Hoover RN. Menstrual and reproductive factors and risk of breast cancer in Asian-Americans. Br J Cancer. 1996;73(5):680-6. Studies which did not demonstrate an increased risk of breast cancer after elective abortion: * Adami HO, Bergstrom R, Lund E, Meirik O. Absence of association between reproductive variables and the risk of breast cancer in young women in Sweden and Norway. Br J Cancer. 1990;62(1):122-6. * Burany (1979) Jugosl Genekol Opstet 19:237-47 (Serbo-Craot). * Goldacre MJ, Kurina LM, Seagroatt V, Yeaates. Abortion and breast cancer: a case-control record linkage study. J Epidem Comm Health 2001;55:336-7. * La Vecchia C, Negri E, Franceschi S, Parazzini F. Long-term impact of reproductive factors on cancer risk. Int J Cancer. 1993;53(2):215-9. * Melbye M, Wohlfahrt J, Olsen JH, Frisch M, Westergaard T, Helweg-Larsen K, Andersen PK. Induced abortion and the risk of breast cancer. N Engl J Med. 1997;336(2):81-5. * Moseson M, Koenig KL, Shore RE, Pasternack BS. The influence of medical conditions associated with hormones on the risk of breast cancer. Int J Epidemiol. 1993;22(6):1000-9. * Newcomb PA, Mandelson MT. A record-based evaluation of induced abortion and breast cancer risk (United States). Cancer Causes Control 2000;11:777-81.1. * Sanderson M, Shu X-O, Jin F, Dai Q, Wen W, Hua Y, Gao Y-T, Zheng W. Abortion history and breast cancer risk: results from the Shanghai breast cancer study. Int J Cancer 2001;92:899-905. * Zaridze et al. (1988) "unpublished" and referenced in Br J Cancer 72:744-51.