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Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
Angela Lanfranchi - Abortion as a Cause of Breast Cancer
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Angela Lanfranchi - Abortion as a Cause of Breast Cancer

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  • 1. Angela Lanfranchi, M.D., F.A.C.S. President Breast Cancer Prevention Institute Clinical Assistant Professor of Surgery Robert Wood Johnson Medical School 1
  • 2.  Louise A. Brinton, Ph.D., M.P.H. Chief Hormonal and Reproductive Epidemiology Branch Senior Investigator 2
  • 3. Cancer Epidemiol Biomarkers Prev April 2009Results“In analyses of all 897 breast cancer cases(subtypes combined): the multivariate-adjustedodds ratios for examined risk factors wereconsistent with the affects observed in previousstudies on younger women. Specifically, olderage, family history of breast cancer, earliermenarche age, induced abortion and oralcontraceptive use were associated withincreased risk for breast cancer.” 3
  • 4. Cancer Epidemiol Biomarkers Prev April 2009 Louise A. BrintonInduced abortion RR 1.4 CI (1.1 to 1.8) 4
  • 5. The Globe and Mail January 8, 2010An e-mail to Dr. Brinton on Friday wasreturned by an Institute spokesmannamed Michael Miller who said: "NCI hasno comment on this study. Our statementand other information on this issue can befound at:http://www.cancer.gov/cancertopics/ere." 5
  • 6.  From 1957 to 2012 there are 70 studies differentiating induced from spontaneous abortion. 55studies show a positive association and 33 studies are statistically significant to the 95th percentile. 6
  • 7.  In1964, 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. 7
  • 8. 9 Criteria for drawing a causal inferencefrom an epidemiological association1. Timing: The patient must be exposed to the risk before the cancer2. Similar findings in many studies 55/70 studies worldwide; 18/24 in the US associate abortion and breast cancer3. Statistically significant increases in risk 33 studies worldwide; 9 US are statistically significant4. 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 Study5. A large effect observed (RR>3) e.g. 1994 Daling Study for subgroups of teens, over 30, and family history 8
  • 9. 9 Criteria for drawing a causal inferencefrom an epidemiological association6. 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 lobules7. Experimental studies 1980 Russo and Russo study on virgin, aborted and parous rats8. 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 detectable9. Analogy – similar exposures associated with similar effects Premature delivery before 32 weeks doubles breast cancer risk 9
  • 10. TIME October 15, 2007 10
  • 11. Journal of American Physicians and Surgeons Fall 2007 11
  • 12. Journal of American Physicians and Surgeons Fall 2007In 9 countries with computerized cancerand abortion registries, abortion was thegreatest predictor of breast cancer rates. 12
  • 13. It is the biology of the breast lobulematuration that occurs duringpregnancy which accounts for theabortion breast cancer link. 13
  • 14. A woman has an unplanned first pregnancy. 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. 14
  • 15. Lobular Structures in the Human Breast 90 Lob.1 Lob.2 % of Structures Lob.3 60 30 0 Before After full-term Full-term pregnancy pregnancy 15
  • 16. Types of Breast LobulesType 1 Lobule Type 2 Lobule Type 3 Lobule (TDLUs) 10-15% of all85% of all breast Cancer resistant breast cancerscancers arise arise in Type 2Type 1 Lobules Lobules (Lobular(Ductal cancer) cancer) 16
  • 17. 17
  • 18. Induced abortion leaves the breast with moreplaces for cancers to start. 18
  • 19. Age-adjusted SEER Incidence Rates by Year, Race, Age1975 <50 3.78Age-adjusted SEER Incidence Rates by Year, Race, Age2007 <50 13.98 19
  • 20. JournalEpidemiology and Community and Community Health 1996 Journal of of Epidemiology 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-LongDepartment of Natural Science, Baruch CollegeThe City University of New York Overall, 30% increase risk of breast cancer17 Lexington AvenueNew York, NY 10010, USAJ BrindCenter for Biostatistics and Epidemiology and 20,000 breast cancerDepartment of PharmacologyPennsylvania State UniversityThe Milton S Hershey Medical Center cases a year areHershey, PA 17033, USAV M ChinchilliW B SeversJ Summy-LongCorrespondence to: attributable to abortionProfessor J BrindAccepted for publicationApril 1996 20
  • 21. 1-866-622-6237 (1-86 NO CANCER)www.bcpinstitute.org Copyright 2012, all rights reserved. 21

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