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Angela Lanfranchi - Abortion as a Cause of Breast Cancer

  1. 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. 2.  Louise A. Brinton, Ph.D., M.P.H.  Chief Hormonal and Reproductive Epidemiology Branch Senior Investigator 2
  3. 3. Cancer Epidemiol Biomarkers Prev April 2009 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.” 3
  4. 4. Cancer Epidemiol Biomarkers Prev April 2009 Louise A. Brinton Induced abortion RR 1.4 CI (1.1 to 1.8) 4
  5. 5. 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." 5
  6. 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. 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. 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 8
  9. 9. 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 9
  10. 10. TIME October 15, 2007 10
  11. 11. Journal of American Physicians and Surgeons Fall 2007 11
  12. 12. Journal of American Physicians and Surgeons Fall 2007 In 9 countries with computerized cancer and abortion registries, abortion was the greatest predictor of breast cancer rates. 12
  13. 13. It is the biology of the breast lobule maturation that occurs during pregnancy which accounts for the abortion breast cancer link. 13
  14. 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. 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. 16. Types of Breast Lobules Type 1 Lobule Type 2 Lobule Type 3 Lobule (TDLUs) 10-15% of all 85% of all breast Cancer resistant breast cancers cancers arise arise in Type 2 Type 1 Lobules Lobules (Lobular (Ductal cancer) cancer) 16
  17. 17. 17
  18. 18. Induced abortion leaves the breast with more places for cancers to start. 18
  19. 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 19
  20. 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-Long Department of Natural Science, Baruch College The City University of New York Overall, 30% increase risk of breast cancer 17 Lexington Avenue New York, NY 10010, USA J Brind Center for Biostatistics and Epidemiology and 20,000 breast cancer Department of Pharmacology Pennsylvania State University The Milton S Hershey Medical Center cases a year are Hershey, PA 17033, USA V M Chinchilli W B Severs J Summy-Long Correspondence to: attributable to abortion Professor J Brind Accepted for publication April 1996 20
  21. 21. 1-866-622-6237 (1-86 NO CANCER) www.bcpinstitute.org Copyright 2012, all rights reserved. 21

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