New England Journal of Medicine. Journal of the American Medical Association. Annals of Internal Medicine. Journal of American Physicians and Surgeons.
[O]ne of these things is not like the others, one of these things just doesn’t belong. But how can most laypeople differentiate between these medical journals? The dry, pithy titles seem to tell you exactly what’s underneath their covers. So if I told you that, according to a study in the Journal of American Physicians and Surgeons, abortion increases risk for breast cancer, would you believe me? Well, why not? The Association of American Physicians and Surgeons (AAPS), which publishes the journal, sounds legit.
Health decisions must be guided by reliable evidence, and when agenda-driven policies misinform, patients cannot make informed decisions.
Except that AAPS is infamous for its agenda-driven views, and its journal is used to deny climate change and the dangers of secondhand smoking, promote the debunked idea that vaccines cause autism, advocate for closed borders in overtly racist anti-immigration pieces, reject the causal relationship between HIV and AIDS, and perpetuate a far-right political worldview. The organization opposes any government involvement in health care, including the FDA, Medicare, the Affordable Care Act, and regulation of the medical profession.
Medical journals, like all scientific journals, are where researchers share and critique each other’s work. Before anything is published it undergoes “peer review,” in which experts evaluate studies for quality — good study design, reasonable interpretation of results, etc. The Journal of American Physicians and Surgeons, however, has been criticized for placing ideology over the presentation of meticulously gathered scientific evidence, and is not indexed in academic databases like MEDLINE. In 2007, AAPS joined conservative organizations in filing a lawsuit against the FDA, arguing against emergency contraception’s over-the-counter status. So, when the journal publishes articles purporting a link between abortion and breast cancer, we should all be raising our eyebrows in collective skepticism.
You might have heard abortion opponents’ claims that abortion can raise one’s risk for breast cancer later in life. So let’s get something out of the way right now: The very best scientific evidence does not support a link between abortion and breast cancer. Prominent medical organizations, including the National Cancer Institute, the American Cancer Society, the American Congress of Obstetricians and Gynecologists, and the World Health Organization, have all examined the entirety of the research and found that the largest and most methodologically sound studies fail to reveal a link between abortion and breast cancer. Yet still opponents of abortion include this factoid in misinformation campaigns to instill fear into people making difficult, private decisions, often during periods of vulnerability.
The hypothesis that abortion can increase breast-cancer risk arose from observations that pregnancy can lead to cell changes in breasts. Perhaps, some hypothesized, interrupting this process can somehow affect cells in such a way as to increase risk for breast cancer down the line. Experiments failed to uncover evidence of a connection between the two, however, and the hypothesis never got off the ground.
But abortion opponents were able to cherry-pick studies that favored their preconceived views. Prior to 1997, the body of evidence was inconclusive on a link between breast cancer and abortion. However, back then, most studies were severely flawed: They only looked at small numbers of women, lumped elective abortion with miscarriage, or weren’t careful about making fair comparisons between groups of people. Small sample sizes, for example, are always problematic in a scientific study, because flukes can distort the results.
This changed in 1997, with the publication of a seminal study in the New England Journal of Medicine. The study’s authors examined the records of an astounding 1.5 million women and found no statistical link between abortion and breast cancer. Other major studies include one that followed 49,000 Swedish women for 20 years (British Medical Journal, 1989), an analysis of 53 studies of a total of 83,000 women with breast cancer (The Lancet, 2004), a 10-year study of 105,716 American women (Archives of Internal Medicine, 2007), a nine-year study of 109,893 California educators (Contraception, 2008), and a 12-year study of 25,576 Danish women (Acta Obstetricia et Gynecologica Scandinavica, 2013). None of these studies found evidence of a cause-and-effect relationship between abortion and breast cancer; nor does the preponderance of scientific evidence as a whole.
Despite the robust evidence gathered from large, methodologically sound studies, abortion opponents continue to tout studies claiming to demonstrate a link between abortion and breast cancer. They might reference studies with small sample sizes or methodological weaknesses, ignoring stronger contrary evidence. One oft-cited study is a 1996 meta-analysis that examined the combined results from 23 earlier studies; although the authors found that abortion increased risk for breast cancer, their analysis received criticism for serious methodological flaws. Indeed, that study’s results have been regularly contradicted by well-done studies.
That criticized study’s lead author, Joel Brind, is an open opponent of abortion rights; in 1996, he testified before the FDA that the abortion pill should not be made available in the United States, claiming that its use would cause “thousands upon thousands of women [to] get breast cancer.” More recently, Brind has been perpetuating the discredited abortion-breast cancer connection in the pages of the Journal of American Physicians and Surgeons. In a 2005 article, he wrote that such information “should be part of the informed consent process for abortion.”
“Informed consent” is terminology that abortion opponents use to frame their misinformation as politically neutral. The Tucson Weekly quoted Jane Orient, the managing editor of the Journal of American Physicians and Surgeons (which is, ironically, headquartered a stone’s throw away from Margaret Sanger’s old residence in Tucson), as saying that abortions lead to a “30 percent higher risk [for breast cancer]. Shouldn’t women want to know about that?” It is under the guise of providing seemingly accurate information that abortion opponents use junk science to promote their agenda.
But informed consent holds that patients must be given full, accurate information in order for their consent to medical treatments to be meaningful. Those of us concerned with patients’ bodily autonomy see access to scientifically accurate information as paramount in their ability to make informed decisions. For abortion opponents to paint their deception as “informed consent” is a perversion of the concept.
Take the deceptively named Kansas Women’s Right to Know Act. Earlier this year, Kansas, where only 3 percent of counties have abortion providers, passed House Bill 2253. An expansion of the Kansas Women’s Right to Know Act, HB2253 instituted massive restrictions on abortion in the state. One of its many harmful provisions was the requirement that abortion providers tell patients that abortion causes breast cancer. Critics point out that the legislation has nothing to do with the “right to know” — not when it mandates the dissemination of health claims that have no basis in fact.
But these types of claims gain credence when they’re picked up in mainstream publications whose editors did not do due diligence on the source material. They also find their way into the literature offered to clients of crisis pregnancy centers, which present the abortion-cancer link as real: “A number of reliable studies have concluded that there is an association between abortion and later development of breast cancer,” says one pamphlet. And, perhaps most heinously, this misinformation makes its way into law: Currently, five states mandate that pre-abortion counseling include discredited claims about a link between abortion and breast cancer. (In addition to Kansas, these states are Alaska, Mississippi, Oklahoma, and Texas.)
Under the pretext of promoting “informed consent,” abortion opponents are doing just the opposite. Health decisions must be shaped by the best available evidence, and when advocates of a political agenda hijack science in order to misinform patients, these patients cannot make informed decisions. Responsible abortion providers, such as Planned Parenthood, have always practiced informed consent when counseling patients considering abortion. But this informed consent is evidence-based, not driven by a political agenda, and is done so that the patient can evaluate the real risks — not made-up risks. Informed consent and accurate information is a cornerstone of good health care.
You can find more information on Planned Parenthood’s website, as well as from the National Cancer Institute, the American Cancer Society, the American Congress of Obstetricians and Gynecologists, and the World Health Organization.
Excellent, and very important, article that is worth sharing.
Thanks so much, Malinda!
Fantastic piece Anna!
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