1. Abortion Raises Breast Cancer Risk A Resource for Crisis Pregnancy Centers Karen Malec, Coalition on Abortion/Breast Cancer, www.AbortionBreastCancer.com Angela Lanfranchi, MD, FACS, Breast Cancer Prevention Institute, www.BCPInstitute.org www.BCPInstitute.org

2. PART II

3. Table of Contents PART II Why the U.S. National Cancer Institute Isn’t Reliable: The Agency’s 2003 Workshop, “Early Reproductive Events and Breast Cancer” Parallels to the Tobacco-Cancer Cover-Up

4. U.S. National Cancer Institute’s 2003 Workshop “Early Reproductive Events and Breast Cancer” a political sham

5. One-hundred scientists attended a 3-day workshop on the abortion-breast cancer link, “Early Reproductive Events and Breast Cancer,” in February of 2003. They concluded: “Induced abortion is not associated with an increase in breast cancer risk.”

6. Leaders of the NCI’s sham Workshop

7. Dr. Andrew Von Eschenbach Director, U.S. National Cancer Institute in 2003

8. Dr. Andrew Von Eschenbach falsely told the New York Times Dr. Andrew Von Eschenbach falsely told the New York Times that scientists at the workshop had conducted a comprehensive review of the worldwide research. "A Conversation with Andrew Von Eschenbach; Director Tries to Untangle Web of Cancer Controversies," New York Times, March 11, 2003. The Truth The NCI’s online videocast shows that only studies showing no abortion- breast cancer link were reviewed. Scientists were not invited to present the opposing view that abortion raises risk. Video available at: http://www.videocast.nih.gov/PastEvents.asp

9. Leslie Bernstein, Ph.D. leader/moderator of NCI’s workshop Leading experts whose research had reported an abortion-breast cancer link (i.e. Janet Daling and Joel Brind) were not invited to present this view at the workshop. But Leslie Bernstein, Ph.D. (biostatistician and epidemiologist with the City of Hope) was invited to be the leading presenter on the abortion-breast cancer link, even though her area of expertise centers on the effects of exercise and obesity on breast cancer risk.

10. Leslie Bernstein, Ph.D. leader/moderator of NCI’s workshop After the workshop, Dr. Bernstein Told A Reporter at CancerPage.com why she didn’t want women to know the truth about the abortion-breast cancer link.

11. Leslie Bernstein, Ph.D. Told Journalist Rachel Lowe at CancerPage.com "The biggest bang for the buck is the first birth, and the younger you are, the better off you are. I would never be a proponent of going around and telling them that having babies is the way to reduce your risk.... I don't want the issue relating to induced abortion to breast cancer risk to be part of the mix of the discussion of induced abortion, its legality, its continued availability." Lowe RM, NCI scientific panel concludes abortion has no impact on breast cancer risk. CancerPage.com, March 3, 2003. Available at:.http://www.cancerpage.com/news/article.asp?id=5601

12. Abortion Providers’ Paid Experts Invited to the Workshop The NCI invited two experts who had previously testified on behalf of abortion providers in the most radical kind of pro-abortion litigation brought against the states of Florida and Alaska because their legislatures had passed parental notice or consent laws. Lynn Rosenberg, Ph.D. (Boston Medical School) testified on behalf of Florida abortion providers represented by the Center for Reproductive Law and Policy and was compelled under oath to admit that the 15-year-old who has an abortion has a greater risk than does the 15-year-old who has a baby. This was an acknowledgment of the risk-reducing effect of full term pregnancy only, not the independent link. Rosenberg (1999) NW FL Women’s Health vs. State of FL, FL Circuit Ct., 2nd circ., videotape deposition of 11/18/99, pp. 77-78

13. NCI Leaders Invited Abortion Providers’ Paid Experts to the Workshop The NCI invited Julie Palmer, Ph.D. (Slone Epidemiology Center, Boston University School of Public Health) to participate as an expert at the workshop. Palmer had served as a paid expert on behalf of abortion providers in a 2002 lawsuit they brought against the State of Alaska because its legislature had passed a parental notice law. Videotape deposition of Dr. Julie Palmer, Planned Parenthood et al. vs. State of Alaska, Superior Court for the State of Alaska, 3rd Judicial District, Case No. 3AN 97-6014 Civil Both Palmer & Rosenberg have authored research finding that abortion is linked to increased breast cancer risk, independently of the loss of the protective effect of full term pregnancy (meaning abortion leaves the breasts with more places for cancers to start.) Palmer et al. Cancer Causes Control 1997;8:841- 849. Rosenberg et al. Am J Epidemiol 1988;127:981-989.

14. National Cancer Institute Branch Chief Louise Brinton, Ph.D., M.P.H., was the chief organizer of the NCI’s phony 2003 workshop. But in 2009, Dr. Brinton co-authored a study, led by Jessica Dolle, focusing on the link between the pill and triple- negative breast cancer. The authors reported a statistically significant 40% increased risk among women with abortions. Dolle et al. Cancer Epidemiology Biomarkers and Prevention 2009;18(4)1157-1166

15. Text The following known and suspected breast cancer risk factors were examined separately as potential confounders for the main effects of all other risk factors in age-adjusted models: age (at reference), race, education, annual income, family history of breast cancer, body mass index (BMI; kilogram per square meter) 1 year before reference, smoking history, alcohol consumption, age at menarche, number of live births, age at first birth (still or live), lactation history (among parous women), abortion history (among gravid women), and oral contraceptive use (never/<1 y versus z (less than or equal to) 1 year, oral contraceptive duration, age at first use, years since first use, and years since last use).

16. Text Results In analyses of all 897 breast cancer cases (subtypes combined), the multivariate- adjusted odds ratios for examined risk factors were consistent with the effects observed in previous studies on younger women (Table 1). Specifically, older age, family history of breast cancer, earlier menarche age, induced abortion, and oral contraceptive use were associated with an increased risk for breast cancer. Risk was decreased in relation to greater number of births and younger age at first birth.

17. What “They” - Dr. Brinton & the National Cancer Institute - Said at the 2003 Workshop One-hundred scientists attended a 3-day workshop on the abortion-breast cancer link, “Early Reproductive Events and Breast Cancer,” in February of 2003. They concluded: “Induced abortion is not associated with an increase in breast cancer risk.” One person - Professor Joel Brind - dissented. His minority report is available at the Breast Cancer Prevention’s website at: http://bcpinstitute.org/nci_minority_rpt.htm http://bcpinstitute.org/nci_minority_rpt.htm For the first month after the February 24-26 workshop, visitors to the NCI's website were led to believe that no dissent had taken place. There was no indication whatsoever that dissent had occurred. The NCI's updated March 25, 2003 web page included bare minimal information that an unnamed "participant" (Joel Brind, Ph.D.) had dissented. The dissenter's Minority Report was excluded from the web page altogether. As a result, women were being kept in the dark about the rationale behind his dissent.

18. The Truth In the 1930's, 100 scientists wrote a collection of essays, which disparaged Albert Einstein's theory of relativity. When a reporter asked the esteemed scientist for his comment, Einstein cleverly replied, "Why 100? If I were wrong, one would have been enough." The workshop’s conclusions contradicted 46 years of epidemiological, biological and experimental research. By the time of the workshop in February of 2003, 29 out of 38 epidemiological studies reported risk elevations. Thirteen of 15 American studies had reported increased risk. Sixteen of 17 statistically significant studies found risk elevations. The NCI’s leaders provided a videocast of the workshop on its website showing that NCI leaders welcomed only one viewpoint - that abortion does not raise risk. A comprehensive review of the research was not performed. The only research that was considered was research whose authors had concluded abortion did not raise risk. Video available at: http://www.videocast.nih.gov/PastEvents.asphttp://www.videocast.nih.gov/PastEvents.asp

19. The Truth Invited scientists were not independent of the federal government. Their careers depended on federal grants. Some scientists told Professor Joel Brind they feared the loss of their government grants if they spoke in favor of an abortion-breast cancer link. Three new studies were announced, but not given to scientists for an in-depth evaluation before the start of the workshop. The studies were non-peer reviewed, and their data were unpublished. Although scientists regularly share their data when asked to do so, requests for it were denied to the workshop's participants. New studies were presented on Day 2 of the workshop, the only day for which a videocast was not made available on the NCI's website until long after media attention had waned.

20. What “They” - Dr. Brinton & the National Cancer Institute - Said at the 2003 Workshop They concluded that early first term birth, increased childbearing and longer duration of breastfeeding reduce risk. But they contradicted themselves by stating, “Induced abortion is not associated with an increase in breast cancer risk.”

21. The Truth Logically, Abortion Raises Breast Cancer Risk By Causing the Mother to: Lose the protective effect of full term pregnancy; Have a smaller family or no full term pregnancies; Delay a first full term pregnancy.

22. What “They” - Dr. Brinton & the National Cancer Institute - Said at the 2003 Workshop The workshop statement falsely labeled the relationship between pre-term birth and increased breast cancer risk as an "epidemiologic gap" in the research.

23. The Truth By the time of the workshop, three studies had provided ample support for a link between premature birth and increased breast cancer risk. 1) Melbye M, Wohlfahrt J, Andersen A-MN, Westergaard T, Andersen PK. Preterm delivery and risk of breast cancer. Br J Cancer 1999;80:609-13. 2) Hsieh C-c, Wuu J, Lambe M, Trichopoulos D, Adami H-O, Ekbom A. Delivery of premature newborns and maternal breast-cancer risk. Lancet 1999;353:1239. 3) Vatten LJ, et al. Pregnancy related protection against breast cancer depends on length of gestation. Br J Cancer 2002;87:289-90. Melbye et al. 1999 found a more than two-fold risk elevation among women having pre-term births before 32 weeks gestation. Because a pre-term birth is essentially the same biological event for a woman as an abortion, these studies also provide support for the ABC link. Whether the baby is dead or alive, the changes that take place in the mother’s breasts during pregnancy are identical.

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25. The Truth ★ As of 2011, four studies show that premature birth is linked with increased breast cancer risk. ★ 1) Melbye M, Wohlfahrt J, Andersen A-MN, Westergaard T, Andersen PK. Preterm delivery and risk of breast cancer. Br J Cancer 1999;80:609-13. ★ 2) Hsieh C-c, Wuu J, Lambe M, Trichopoulos D, Adami H-O, Ekbom A. Delivery of premature newborns and maternal breast-cancer risk. Lancet 1999;353:1239. ★ 3) Vatten LJ, et al. Pregnancy related protection against breast cancer depends on length of gestation. Br J Cancer 2002;87:289-90. ★ 4) Innes K and Byers T. First pregnancy characteristics and subsequent breast cancer risk among young women. Int J Cancer 2004; 112:306-311.

26. What “They” - Dr. Brinton & the National Cancer Institute - Said at the 2003 Workshop ★ Reporting Bias - They told women to ignore retrospective studies (showing an abortion-breast cancer link) which relied on women’s self-reports of their abortion histories. ★ Although scientists often use this study design where other controversial risk factors are being examined, the NCI & Brinton pointed to an hypothetical problem in the design of retrospective studies called “reporting bias” (also called “response bias” or “recall bias”). ★ They falsely claimed the only reason why there are studies reporting an abortion-breast cancer link is not because there really is such a link, but because breast cancer patients are more likely to tell the truth about their past abortions than are healthy women.

27. The Truth ★ Reporting Bias - One study, Howe et al. 1989, ruled out any possibility of Reporting Bias because its researchers relied on medical records of past abortions, not women’s reports of abortion histories. Howe et al. Int J Epidemiol 1989;18:300- 304. ★ Howe et al. 1989, a prospective study conducted on New York women, whose authors matched fetal death records with patients’ medical records, reported a statistically significant 90% increased risk for women with abortions. It avoided the problem of reporting bias because its authors did not rely on women’s reports of their past abortions. Howe et al. Int J Epidemiol 1989;18:300-304. ★ Since the 2003 workshop, a 2007 study on 8 European countries has also avoided any chance of reporting bias by using national data from nations believed to have nearly complete abortion counts. In his study, Patrick Carroll found that induced abortion was the “best predictor” of future breast cancer rates. He proved he could successfully predict future breast cancer rates for England and Wales for 2003 and 2004 with nearly 100% accuracy. Caroll P. J Am Phys Surg Vol. 12, No. 3 (Fall 2007) 72-78.

28. The Truth ★ Although reporting bias is a legitimate hypothesis, it has been tested in many studies around the world. There are no scientists at the present time who claim to have found credible evidence of it. ★ Brind J. J Am Phys Surg 2005;10(4)105-110. ★ Daling JR, Malone DE, Voigt LF, White E, Weiss NS. Risk of breast cancer among young women: relationship to induced abortion. J Natl Cancer Inst 1994;86:1584-92. ★ Lipworth L, Katsouyanni K, Ekbom A, Michels KB, Trichopoulos D. Abortion and the risk of breast cancer: a case- control study in Greece. Int J Cancer 1995;61:181-4. ★ Lindefors-Harris BM, Eklund G, et al. Response bias in a case control study analysis utilizing comparative data concerning legal abortions from two independent Swedish studies. Am J Epidemiol 1991; 134:1003-1008. ★ Meirik O, Adami H-O, Eklund G. Letter Re: Relation between induced abortion and breast cancer. J Epidemiol Community Health 1998;52:209. ★ Brind J, Chinchilli VM, Severs WB, Summy-Long J. Reply to letter Re: Relation between induced abortion and breast cancer. J Epidemiol Community Health 1998;52:209-11.

29. Dr. Brinton Showed She Doesn’t Believe in Reporting Bias Either! In their 2009 study, Louise Brinton, Jessica Dolle and their colleagues used data from two 1990s studies that Brinton and the National Cancer Institute had falsely claimed at the 2003 workshop were flawed because of the supposed problem of reporting bias.

30. The Truth ★ Two of the studies that Dr. Brinton and the NCI had claimed were flawed because of Reporting Bias, were studies conducted in the 1990s by Dr. Janet Daling’s team. Daling et al. J Natl Cancer Inst 1994;86:1584-1592. Daling, Brinton et al. Am J Epidemiol 1996;144:373-380. ★ The studies from the 1990s reported risk increases of between 20%-50% for women with abortions. Brinton co-authored one of those studies  Daling et al. 1996. ★ In 2007, medical journals first described triple-negative breast cancer. ★ In their 2009 study on use of the birth control pill and triple-negative breast cancer, Drs. Brinton, Dolle and their colleagues used the data from those supposedly flawed 1990s studies. By doing so, they relied on women’s self-reports of past abortions, not medical records. ★ In their 2009 study, Brinton and Dolle’s team tested 897 specimens of cancerous breast tissue that had been saved from study subjects participating in the 1990s studies. They tested the tissue samples for triple-negative breast cancer. Then, they matched their results with the study subjects’ reproductive history - including women’s self-reports of their abortion histories.

31. Tell us the truth, Dr. Brinton! If the studies relying on women’s self-reports of their past abortions are flawed because of “reporting bias,” as you claimed at the 2003 NCI workshop, then why did you use data from two of those studies published in the 1990s?

32. What “They” - Dr. Brinton & the National Cancer Institute - Said at the 2003 Workshop “Breast cancer is transiently increased after a full term pregnancy.”

33. The Truth The NCI’s statement is a is a half-truth. A small, temporary increase in risk after a full term pregnancy only exists among women who delayed their first full term pregnancies until after age 25. The risk is not more than 18% for women delaying FFTP until after age 25 and as much as 40% for women delaying FFTP until after age 30. The risk lasts up to 10 years after birth. 1) Cummings et al. Br Med J 1994;308:1672-1674. 2) Vatten et al. Eur J Cancer 1992;28A:1148-1153. 3) Lambe et al. N Engl J Med 1994;331:5-9. The transient increase in risk is eliminated almost completely among women with two children. There is a non-significant risk increase of up to 16% among women who have a second child after age 35. Lambe et al. N Engl J Med 1994;331:5-9. Abortion causes many women to delay their first full term pregnancies and limit the size of their families.

34. The Truth The NCI misleads women into believing childbearing is unsafe in comparison to not being pregnant. The Truth - In comparison to the risk of remaining childless, having a full term pregnancy always lowers lifetime breast cancer risk. The younger a woman is when she has her first full term pregnancy, the lower her lifetime risk is. 1) MacMahon, B, Cole P, Lin TM, Lowe CR, Mirra AP, Ravnihar B, Salber EJ, Valaoras VG, Yuasa S. Age at First Birth and Breast Cancer Risk. Bull WHO 1970;43:209-221. 2) Trichopoulos D, Hsieh C, MacMahon B, et al. Age at any birth and breast cancer risk. Int J Cancer 1983;31:701-704. The transient increase in risk that occurs among women who have late first full term pregnancies is significantly less than the long term risk associated with having an abortion.

35. The Truth Biological Reasons for the Transient Increase in Risk: The most cancer-vulnerable time in a woman’s life takes place during period between the onset of menstruation and first full term pregnancy - known as the “susceptibility window” - when nearly all of the breast lobules are immature and cancer-susceptible Type 1 and 2 lobules.

36. Breast lobule maturation before and after first full term pregnancy

37. The Truth Biological Reasons for the Transient Increase in Risk: The longer the susceptibility window is prolonged by delaying a first full term pregnancy, the more mutations she can accumulate due to the effects of cancer- causing substances on her cancer-susceptible Type 1 and 2 lobules. During the “the susceptibility window,” her estrogen stimulates her Type 1 and 2 lobules during every monthly menstrual cycle. Estrogen causes her cells to multiply through cell division and can directly damage DNA. When she delays a FFTP, she extends the susceptibility window and can accumulate more abnormal cells. When she does get pregnant, these cells may be provoked into growing into cancer cells because of the influence of increased estrogen during pregnancy. But, full term pregnancy is always protective over the long term. The “differentiation” process during the last months of a full term pregnancy protects the mother from estrogen overexposure early in pregnancy and switches off the ability cells to divide. It leaves her with fewer places in her breasts for cancers to start. 1) W. Boecker, et al., “The Normal Breast,” in Preneoplasia of the Breast: A New Conceptual Approach to Proliferative Breast Disease, ed. W. Boecher (Munich: Elsevier Saunders, 2006), 1–28. 14) J. Russo et al., “Full-Term Pregnancy Induces a Specific Genomic Signature in the Human Breast,” Cancer Epidemiology Biomarkers and Prevention 17 (2008): 51–66.

38. Parallels to the Tobacco- Cancer Cover-Up Many parallels can be drawn between the abortion-breast cancer link and the tobacco-cancer link. Although evidence of a tobacco-cancer link dated from 1928, the U.S. National Cancer Institute and the American Cancer Society delayed acknowledging the risk until the 1960s. According to journalist Richard Kluger’s 1996 book, Ashes to Ashes, the American Cancer Society’s leaders “had long hesitated to antagonize millions of their contributors by denouncing their cherished smoking habit as arrant folly,” and they were reluctant to “tangle with a major U.S. industry, especially one with great influence over the media” through its purchase of cigarette advertising. Ashes to Ashes: America’s Hundred-Year Cigarette War, the Public Health, and the Unabashed Triumph of Philip Morris, Alfred A. Knopf, New York, 1996, p. 203. Kluger wrote that tobacco-state Congressmen pressured National Cancer Institute’s leaders. He said, “Jesse Steinfeld, deputy NCI director at the end of the Sixties, remembered accompanying NCI director Kenneth M. Endicott to congressional appropriations sessions where they were confronted by tobacco-state lawmakers who demanded to know just how much the institute - and the HEW Department overall - was spending on ‘anti-smoking propaganda.’ To Steinfeld, ‘the covert, if not overt, message was that if you wanted your budget passed, you’d better go easy on smoking and health.’” p. 424-425.

39. Parallels to the Tobacco- Cancer Cover-Up According to former FDA chief Dr. David Kessler, the Tobacco Institute hired prominent scientist and American Cancer Society leader Clarence 'Pete' Little as the first science director of the Council for Tobacco Research. Experts at the CTR “were assigned specifically to find loopholes in arguments being advanced in litigation. Researchers were pressured not to publish critical findings....” A Question of Intent: A Great American Battle with a Deadly Industry, Public Affairs, New York, 2001, p. 200-202. Kessler said tobacco executives bought the silence of the American Medical Association, Harvard, Sloan Kettering Medical Center, UCLA and others by giving these organizations funds for research on the tobacco-cancer link. Tobacco executives considered purchasing United Press International. Kessler said tobacco industry funding purchased the silence of influential women's groups too. Kessler, pp. 207-208, p. 275. Unlike tobacco, however, abortion and its health risks are a doctors' industry.

40. For More Information Contact: Karen Malec, Coalition on Abortion/Breast Cancer, www.AbortionBreastCancer.com Angela Lanfranchi, MD, FACS, Breast Cancer Prevention Institute, www.BCPInstitute.org www.BCPInstitute.org