Breast Cancer Risks of

Induced Abortion &

Hormonal Contraception
Joel Brind, Ph.D.
Professor of Human Biology and Endocrinology
Baruch College, CUNY,
New York, NY
Cofounder, Breast Cancer Prevention Institute,
Somerville, NJ
President and CEO, Natural Food Science, LLC,
New Hamburg, NY
 Part 1:
Epidemiology of the
Abortion-breast cancer link
(ABC link) and
contraceptive steroid*-
breast cancer link
*Commonly referred to benignly as “the pill” or even incorrectly
as “hormonal contraception”, these compounds, whether administered
Orally or as an injection, patch or ring, are not hormones, but infertility-2
inducing steroid drugs.
 April, 1957
[GANN, Vol. 48, Supplement; April, 1957]

AN EPIDEMIOLOGICAL STUDY ON CANCER IN JAPAN

The Report of the Committee for Epidemiological Study on Cancer,

Sponsored by the Ministry of Welfare and Public Health
(Chairman: Dr. Tomosaburo Ogata)

Tabulated and analysed by

M. SEGI, I FUKUSHIMA, S. FUJISAKU, M. KURIHARA,

S. SAITO, K. ASANO and M. KAMOI
(Department of Public Health, Tohoku University Medical School, Sendai, Japan)
  1970, 43, 209-221
Bull. Org. mond. Santé
Bull. Wld Hlth Org.

Age for First Birth and Breast Cancer Risk *

B. MACMAHON, P. COLE, T. M. LIN, C. R. LOWE, A. P. MIRRA, B. RAVNIHAR,
E. J. SALBER, V. G. VALAORAS & S. YUASA

“Differences between cases and

controls with respect to frequency of
abortion were observed in only a few
centres and were in the direction which
suggested increased risk associated with
abortion — contrary to the reduction in
risk associated with full-term births.”
5
Epidemiological measures of relative risk
(RR; the relative likelihood of having a given
disease—such as breast cancer—if one has had a
particular exposure—such as induced abortion–
compared to those who have not had the exposure).

If a factor has a:

 RR 1.0 – there is no  or  in risk

 RR 1.5 – there is a 50%  in risk
 RR 2.0 – there is a 100%  in risk
 RR 0.5 – there is a 50%  in risk
6
 Br. J. Cancer (1981) 43, 72
ORAL CONTRACEPTIVE USE AND EARLY ABORTION AS RISK
FACTORS FOR BREAST CANCER IN YOUNG WOMEN
M. C. PIKE, B. E. HENDERSON, J. T. CASAGRANDE, I. ROSARIO AND G. E. GRAY
“OC use before first full-term pregnancy
From the Department of Family and Preventive Medicine, University of Southern California,
School of Medicine, Los Angeles, California, U.S.A. -- Received 27 August 1980 Accepted 14 October
1980
(FFTP) was associated with an elevated risk,
whichSummary.—
increased A with duration
case-control study wasof conducted
OC usein Los
Angeles
(relative riskCounty,
~ 2.2California, of 163 of
at 6 years veryuse,
youngP<0.01).
breast-cancer
cases (all aged 32 or less at diagnosis) to investigate the role, if
This increased risk could
any, of oral contraceptives notin be
(OC) the explained
development of the
by other risk
disease. OC factors.”
use before first full-term pregnancy (FFTP) was
associated with an elevated risk, which increased with duration
“Aoffirst-trimester
OC use (relative risk ~abortion
2.2 at 6 yearsbefore
of use, P<0.01).
FFTP, This
increased risk could not be explained by other risk factors. OC
whether spontaneous
use after FFTP was not associatedorwithinduced,
any change in was
risk. A
first-trimester abortion
associated with before FFTP, whether
2.4-fold spontaneous
increase in or
induced, was associated with 2-4-fold increase in breast-cancer
breast-cancer
risk (P<0.005). risk (P<0.005).” 7
 Br. J. Cancer (1982) 45, 327

ORAL CONTRACEPTIVE USE AND ABORTION BEFORE FIRST

TERM PREGNANCY IN RELATION TO BREAST CANCER RISK
M. P. VESSEY, K. McPHERSON, D. YEATES AND R. DOLL
From the Department of Community Medicine and General Practice and the Imperial Cancer Research Fund
Cancer Epidemiology and Clinical Trials Unit, Radcliffe Infirmary, Oxford OX2 6HE

“TheSummary.—A
results are entirely reassuring,”
Received 6 November 1981 Accepted 20 November 1981

recent publication from California in this

journal has suggested that both prolonged oral contraceptive

“Only a handful
use and abortion before first term pregnancy increase the risk of
breast cancer in young women. Data was presented on 1176
women aged 16-50 years with breast cancer, interviewed in
London or in Oxford, together with a like number of matched

of women…”
control subjects. The results are entirely reassuring, being, in
fact, more compatible with protective effects than the reverse.
Possible reasons for the differences between the 2 sets of data
are discussed.

8
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10
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 Journal of the National Cancer Institute, Volume 86, No. 21, Nov. 2, 1994

“Results: Among women who had been

pregnant at least once, the risk of breast
cancer in those who had experienced an
induced abortion was 50% higher than
among other women.”
 EDITORIALS
Induced Abortion and Breast Cancer:
More Scientific Data Are Needed

Lynn Rosenberg

“…the overall results as well as

“A
themajor concern,
particulars areespecially
far from because
the observedand
conclusive, effect
it iswas small,tois the
difficult
possibility
see how theyof reporting bias.”
will be informative
to the public.”
But note that the authors invented the term “overreporting”, that breast
cancer patients had imagined abortions that had never taken place!

“Analysis demonstrated … an observed ratio of 22.4 (p

< 0.007) between underreporting of previous induced
abortions among controls relative to overreporting
among cases.”
Also note how those who deny the ABC link still rely on this
Swedish study to support the reporting bias explanation, but
ignore the fact that the preposterous claim of “overreporting”
was retracted in 1998!
The fact is that retrospective studies are relied upon all the time in
epidemiology, with effective safeguards in place. For example,
those who interview the study subjects to collect the data on
reproductive history other variables are blinded as to the status of
the subjects. That is, they do not know, at the time of the interview,
whether they are interviewing a patient or a control.

Moreover, the most well done prospective ABC link study—the

study by Howe, et al. in 1989—reported a significant 90% risk
increase:

Odds ratios (OR) were significantly elevated among

those with an induced abortion (OR=1.9)
Journal of Epidemiology and Community Health 1996;50:481-496 481

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
17 Lexington Avenue
New York, NY 10010, USA
J Brind

Center for Biostatistics and Epidemiology and

Department of Pharmacology
Pennsylvania State University
The Milton S Hershey Medical Center
Hershey, PA 17033, USA
V M Chinchilli
W B Severs
J Summy-Long

Correspondence to:
Professor J Brind
Accepted for publication
April 1996
 “In 1973, the legal right to an induced
abortion through 12 weeks’ gestation was
established for women with residence in
Denmark … The induced abortions included in
this analysis (were) those occurring between
1973 and 1992”.

“Follow-up for breast cancer for all the women

began on April 1, 1968 or on their 12th birthday,
whichever came later.”
22
British Journal of Cancer (1999) 20(3/4), 600-613
©1999 Cancer Research Campaign
Article no. bjoc.1990.0399

Preterm delivery and risk of breast cancer

M Melbye, J Wohlfahrt, A-MN Andersen, T Westergaard and PK Andersen

Danish Epidemiology Science Centre, Statens Serum Institut, 5 Artiltervej, DK-2300 Copenhagen S, Denmark

24
Table 2 Adjusted relative risk of breast cancer in 474, 158 parous women
According to gestational age at delivery

Gestational No of cases Person-years RR (95% CI)

Age (weeks (in thousands)

<29 7 9 2.11 (1.00-4.45)

29-31 13 17 2.08 (1.20-3.50)
32-33 11 26 1.12 (0.62-2.04)
34-35 22 58 1.08 (0.71-1.56)
36-37 82 214 1.04 (0.83-1.32)
38-39 350 949 1.02 (0.89-1.17)
40 552 1526 1
>40 326 985 1.03 (0.90-1.18) 25
*Adjusted for age, calendar period, parity and age at first childbirth.
 Lancet, March 27, 2004

Breast cancer and abortion: collaborative reanalysis of

data from 53 epidemiological studies, including 83,000
women with breast cancer from 16 countries
Some reasons for eliminating 10 previously
published studies showing an ABC link
1. “Principal investigators…could not be traced”
2. “original data could not be retrieved by the principal investigators”
3. “researchers declined to take part in the collaboration”
4. “principal investigators judged their own information on induced
abortion to be unreliable” (even though it had been vetted by peer
review and published in a prominent medical journal).
Leslie Bernstein, Ph.D., of the Keck School of Medicine at the
University of Southern California, presented the findings. In an
interview with reporters after the advisory board briefing, she said
even though the findings clearly show that “the biggest bang for
the buck is the first birth and the younger you are the better off
you are, ” women should not necessarily make life-altering
decisions based on these findings.
“There are so many other messages we can give women about
lifestyle modification and the impact of lifestyle and risk that I
would never be a proponent of going around and telling them that
having babies is the way to reduce your risk.”
(To listen to Bernstein's remarks, click here.)

“I don’t want the issue relating to induced abortion to breast

cancer risk to be part of mix of the discussion of induced abortion,
its legality, its continued availability. I think it should not be part of
the argument,” Bernstein says. (To hear more of Bernstein's
remarks, click here) http://www.cancerpage.com/news/article.asp?id=5601 29
 We surveyed several thousand early and
mid-career scientists, who are based in the
United States and funded by the National
Institutes of Health (NIH), and asked them
to report their own behaviours. Our findings
reveal a range of questionable practices that
are striking in their breadth and prevalence.
10. Changing the design, methodology or results of a study in response to
pressure from a funding source. 30
2/25/14
Dr. Howard Koh, M.D.
Assistant Secretary for Health
Dear Howard:
I am writing to resign my position as Director,
Office of Research Integrity, ORI/OASH/DHHS
…Second, the organizational culture of OASH’s immediate office is
seriously flawed, in my opinion. The academic literature over the last
twenty-five years on successful organizations highlights several
characteristics: transparency, power-sharing or shared decision-making
and accountability. If you invert these principles, you have an
organization (OASH in this instance), which is secretive, autocratic and
unaccountable.
…I’m offended as an American taxpayer that the federal bureaucracy—
at least the part I’ve labored in—is so profoundly dysfunctional.
…Sincerely,
David (David Wright, Director, Office of Research Integrity)
Cancer Causes Control. 2014 Feb;25(2):227-36.
doi: 10.1007/s10552-013-0325-7. Epub 2013 Nov 24.

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 OR = 1

Burany 1979 Ilic 2013

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 OR = 1

Wu 2014

Burany 1979 Ilic 2013

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Conclusions re: epidemiology of the ABC and OCBC links:
1) The ABC link has been established by close to 100 peer- reviewed studies world-
wide, dating back as far as 1957. The OCBC link was first observed in 1981, and
acknowledged by the WHO in 2005.
2) New evidence of the ABC link published during the last few years includes:
a) a 2013 meta-analysis of 36 studies in China, showing an average risk increase of
44% among women who’ve had any abortions.
b) Since 2007, at least 17 studies in west, central and south Asia (9 in India alone)
have reported on ABC: All have reported increased risk (15 statistically significant),
with ORs averaging >4; one (in Bangladesh) exceeding 20-fold increased risk!
3) The Chinese meta-analysis not only reinforces the reality of the ABC link, but also
the evidence and epidemiological basis for the link’s being masked by high
prevalence of induced abortion in the general population of countries like China and
Serbia, where abortion is used as birth control to limit family size.
4) The strong associations reported from Asia further reinforce the reality of the ABC
link, eliminating the very plausibility of explanations such as reporting bias.
5) The new studies from Asia are chilling in their implication: Literally millions of women
will likely die of breast cancer in India and China alone because they had an abortion.
6) The most influential agencies in the world—especially the US National Cancer
Institute (NCI)—continue to deny the reality of the ABC link citing research that has
been debunked in the peer-reviewed literature, and on evidence retracted years ago.
While such scientific misconduct in the US should be stopped by the Office of
Research Integrity, the ORI is a “profoundly disfunctional” agency, in the words of46its
last Director, who resigned this year in disgust.
Prediction:

As the overwhelming evidence of the ABC link piles up in the

“third world” Watch for a slew of studies done in areas where
induced abortion has become commonplace among the general
population—to show no ABC link. They will be published for the
purpose of “disproving” the link, but the key to debunking such
studies will be to understand a few very simple tricks:
Case-control (retrospective) studies:
1) Study is run in areas of very high prevalence of abortion (>60%).
2) Study is restricted to parous women.
Cohort (prospective) studies:
1) Study allows for as little as zero follow-up time (no time after
abortion for cancer to develop.
2) Cases of in situ carcinoma (which show up first) are excluded.
47
Part 2:
Biological basis of the
Abortion-breast cancer
link (ABC link)

48
Am J Pathol 1980:497-512
Biological Facts
 Most breast cancers start in Type 1 and
2 lobules
 Breast cancers do not start in Type 3
and 4 lobules
 Induced abortions result in increased
numbers of Type 1 and 2 lobules
 Full-term pregnancies result in
increased numbers of Type 3 and 4
lobules
 Types of Breast Lobules

Type 1 Type 2 Type 3 Lobule

Lobule Lobule
(TDLUs) 10% of all breast Cancer resistant
85% of all breast cancers arise in when they are the
cancers arise Type 2 Lobules result of regression
Type 1 Lobules (Lobular cancer) of Type 4 lobules
(Ductal cancer) 52
January 2007

53
 Breast lobule maturation
before and after first pregnancy

54
The “susceptibility window”
 The period between puberty and a full-term
pregnancy
 The time the breast is most susceptible to
forming cancer
 i.e., when the woman’s breast
is composed primarily of
Type 1 and 2 lobules.

55
The breast maturation process through a
normal full-term pregnancy
By the end of the 1st trimester:
 During the maturation of Type 1 lobules
into Type 2, the actual numbers of these
lobules will increase while the surrounding
tissue (stroma) decreases.
 The breast now has more
places for cancers to start.

56
The breast maturation process through a
normal full-term pregnancy
By the end of the 3rd trimester:
 The breast is now:
 85% Type 4 lobules
 15% immature cancer
susceptible lobules
 There are now fewer places for
cancer to start.

57
J. KUNZ
and
P.J. KELLER
Department of Gynaecology and
Obstetrics,
University of Zurich, Switzerland
British Journal of Obstetrics and
Gynaecology
August 1976. Vol 83
pp 640-644

58
Conclusions re: the biology of the ABC link:
1. Termination of the pregnancy before 32 weeks
gestation deprives a woman of the risk-lowering
effect of full-term pregnancy.
2. The burst of growth stimulation during the
pregnancy before it is terminated leaves a post-
abortive woman with more places for cancer to start.
3. Abortion leaves a woman with a higher risk of very
premature delivery (before 32 weeks) in subsequent
pregnancies, which increases risk in the same way
as induced abortion.
4. A woman’s risk of subsequent breast cancer is lowered
by breastfeeding, which does not occur after a pregnancy
terminated by abortion.
5. Spontaneous abortions (miscarriages), which
generally occur in the first trimester, do not increase
a woman’s subsequent risk of breast cancer. 59
Overall Conclusions:
At least three causal connections between induced abortion
and breast cancer incidence have been well established by
over 50 years of published epidemiological evidence,
supported by every other line of published biological and
medical evidence. Such evidence has resulted in a very
detailed understanding of the role of pregnancy in normal
breast development and the development of cancer.
 www.bcpinstitute.org
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