Yesterday the Planned Parenthood Federation of America arranged a Pink Out Day on social media to promote their brand in the face of calls to defund the organisation and an unsympathetic Trump administration. What impact their noon “thunderclap” had is not clear, but there is no doubt that PPFA has many supporters who defend its claim to be an important women’s reproductive health provider.
However, the literal meaning of “reproductive health” is incompatible with two of Planned Parenthood’s main activities: abortion and the provision of hormonal contraception. For at least two decades researchers have been tracing a link between these birth control methods and the rising incidence of breast cancer – a link denied or ignored by the scientific and medical establishment.
But the international evidence continues to mount. A new British study by Patrick S. Carroll and colleagues, using readily available data on breast cancer and abortion from British official sources, shows that the lifetime risk of breast cancer for women in the UK keeps increasing: it is now around 1 in 7 women for malignant tumours and 1 in 6 for in-situ lesions, which also need treatment and therefore should be planned for. And this increased risk cannot be explained by increased screening – the usual explanation -- on its own.
Here is one reason: women do not enjoy being screened. It’s an uncomfortable business and there is always the thought in one’s mind that repeated x-rays may themselves cause trouble. So the raising of the cut-off age for screening from 65 to 75, as the UK has done, is unlikely, say the study authors, to increase the response rate among women who were screened between ages 50 and 65.
Another explanation of the risk trend is that childlessness has increased since the 1970s. It is widely acknowledged that a younger age at the birth of her first child reduces a woman’s risk of developing breast cancer, as do further full term pregnancies and longer breastfeeding of each of her infants. However, the authors find that neither childlessness nor increased age at first birth by themselves can predict breast cancer risk.
Baby boomer women and their daughters, of course, have had ways of delaying or avoiding childbirth that were not generally available to earlier cohorts, and these may bring their own risks. The authors state:
“Although still contested, there is significant literature that demonstrates that induced abortion, particularly of a woman’s first pregnancy, as well as hormonal contraceptives and HRT [hormone replacement therapy], also raise the risk of developing breast cancer.”
The reasons why this would be are now familiar. Abortion, especially of the first pregnancy, not only removes the protective maturing of the breasts during pregnancy and lactation, but actually leaves them in a more vulnerable state, while the estrogen in hormonal contraceptives increases cancer risk. A new study from Finland this month finds further evidence of a link between hormonal contraceptives (the IUD) and breast cancer.
British data, in fact, show a high positive correlation between abortion rates and breast cancer in women aged 50-54 (abortion was liberalised in the UK in 1967). This also seems to reflect the advent of hormonal contraception, say the authors. “When women were first having large numbers of induced abortions, their contemporaries were also starting to make extensive use of hormonal contraceptives.”
A remarkable social gradient
There is a further interesting angle on these links in the study – a “social gradient”. Data from the 1990s shows that women in the higher socio-economic groups have more breast cancer than those down the social scale. A possible explanation:
“Upper-class women and women who achieve upward social mobility are known to have children later and to make more use of hormonal contraceptives, and when they have pregnancies at a young age they are more likely to opt for nulliparous abortions. Lower-class single parents, who score highly as to deprivation, often have benefited from the breast cancer protection afforded by their first pregnancy taken to full term at a young age.”
No serious scientist is claiming that these factors are the only, or even the main cause of breast cancer, but the likelihood that they explain part of the largely unexplained current epidemic of the disease should at least receive some acknowledgement. Yet, as the authors point out, “While doctors are now more reluctant to prescribe HRT for reasons of the breast cancer risk they continue to prescribe hormonal contraceptive on a massive scale.”
It’s true that these doctors can cite some studies reporting no additional risk 10 years after a woman has ceased to use hormonal contraceptives. However, say Carroll and colleagues, “this risk is quite long-term and not apparent within such a time interval. Breast cancers discovered after age 50 are more reflective of these events in a woman’s reproductive history.”
The lack of official explanation for aspects of the epidemic such as the remarkable social gradient is a failure of public health education, of a piece with neglect of breast cancer prevention programmes, they conclude.
Indeed, women should be informed and the authorities should plan for an increasing breast cancer burden on the health system based on all known risk factors and not just politically correct ones.
Yet there is solid resistance to such moves in the UK. Patrick Carroll, who is neither a doctor nor a medical scientist but an actuary with the (UK) Pension and Population Research Institute, seems to have had no competition in using first class resources for a neglected, or rather, deliberately sidelined area of cancer research. However, getting his work published in medical journals is another matter.
Having failed on previous occasions, he submitted the paper discussed here to the (British) Journal of Epidemiology and Community Health last year. They sat on it for several months, he told MercatorNet, “offering no intelligent comments nor constructive criticism. They said they read it with great interest but found it unsuitable for their audience! They then suggested I try another of their journals, BMJ Open. Even though the editorial staff of the two journals are in the same building they did not offer a short process for submission to the second journal.”
Warned by another researcher that BMJ Open would inflict another delay of several months, he sent it to the independently minded Association of American Physicians and Surgeons (AAPS) who published it – as they had a previous paper -- in their journal.
The reasons for the establishment’s defensive attitude is not difficult to discern. Carroll and colleagues describe the situation in the UK in their published paper:
“Each prescription for hormonal contraceptives has a doctor’s signature. Every abortion notification form (HSA1), as required by the 1967 Abortion Act, needs two doctors’ signatures. In the UK, claims under medical professional liability insurance are largely in the area of obstetrics and gynecology. If women who experience breast cancer could make claims against doctors for prescribing hormonal contraceptives or approving induced abortions, there would be many more claims. For this reason it is understandable that British medical journals are reluctant to publish papers that report a link of breast cancer to induced abortions.”
Meanwhile, back in the United States, Planned Parenthood has tried selling itself as the household name that millions of women “turn to” for -- guess what? -- mammograms. In fact PPFA does not do mammograms but refers a small percentage of its clients (less than one percent) to specialised services after doing simple, routine breast checks.
But the irony of its claim only increases with this latest evidence that, even if it did do mammograms, it would be largely as a result of making its own work through the much more lucrative lines of abortion and contraception. And that applies to a significant part of the health sector internationally.
It must be time for a class action suit on this front.
Carolyn Moynihan is deputy editor of MercatorNet, from where this article has been adapted.