Missing the link?

IN FEBRUARY 2002, CHARNETTE Messe found something many women search for but hope never to find: a lump under her arm. The Groton, Conn., mother of a preschooler quickly consulted her doctor. But because Mrs. Messe was only 30, and had no immediate family history of breast cancer, the doctor at first said a mammogram was unnecessary.

Mrs. Messe did not agree. In the past, she'd used Depo-Provera, a birth-control medication that elevates the risk of breast cancer. Also, at age 20, before marrying, she had had an abortion.

"I knew about the abortionÐbreast cancer link," said Mrs. Messe. "I demanded a mammogram." It was during the test, administered a month later, that she first knew something was profoundly wrong: "I was joking around with the technician, and the next thing I know, she's not smiling anymore."

After the test, a new doctor sat down with the Messes and broke the news: Mrs. Messe had breast cancer. She remembers how the conversation went after that: "I said to the doctor, 'I have a 3-year-old daughter at home. Am I going to get to see her grow up?' He looked at me and said, 'Possibly not.'"

This year, an estimated 211,000 women will be diagnosed with breast cancer. Apart from skin cancer, the disease is the most common type of cancer among American women, a fact cancer-researchers, clinicians, and survivors will emphasize during October, National Breast Cancer Awareness Month. Risk factors for breast cancer include smoking, genetics, late childbearing, and estrogen overexposure. Mrs. Messe believes estrogen overexposure, both from Depo-Provera and abortion, caused her cancer.

Dozens of medical research studies say she may be right. But leading cancer groups, including the National Cancer Institute (NCI) and the American Cancer Society, say there is no abortionÐbreast cancer link. The NCI, a division of the National Institutes of Health, states categorically on its website that "induced abortion is not associated with an increase in breast cancer risk."

That statement is the latest strike in what researcher Joel Brind calls a "cataclysmic battle" over women's right to accurate medical information about the risks of abortion, and the abortion industry's interest in keeping some information quiet. The NCI posted the statement following a February 2003 "consensus workshop" on the abortionÐ breast cancer (ABC) link. But it is a topic on which the "consensus" seems to lean in the other direction.

Researchers first tied abortion to breast cancer in 1957. The medical explanation for the link centers on the interruption of the hormonal flow that occurs in women's breast cells after an abortion. During pregnancy, a surge of estrogen-a known cancer-inducing substance-begins to differentiate breast cells to prepare them for lactation. During the second and third trimester, the differentiation becomes permanent. ABC link proponents believe that an abortion interrupts this breast maturation process, leaving countless cells in an "in-between" state in which they are more susceptible to cancer formation.

The 1957 study found that women who had induced abortions doubled their risk of breast cancer. Since then, 29 of 38 epidemiological studies, including 13 of 15 American studies, exploring an independent ABC link have reported elevated risks ranging from slight to-in the case of women with previous family history of the disease who aborted a first pregnancy before age 18-extremely high.

It is widely acknowledged that a full-term first pregnancy lowers a woman's risk of breast cancer, and that any premature birth before 32 weeks more than doubles breast cancer risk. But many cancer researchers refuse to acknowledge that this same biologic mechanism could link breast cancer with abortion.

That became acutely clear in 1996, when Mr. Brind, a professor of biochemistry at the City University of New York, completed a landmark comparison of all existing literature on the ABC link. He concluded that, overall, previous research showed that women who had an abortion before their first full-term pregnancy increased by 50 percent their risk of developing breast cancer. Women who had an abortion after their first full-term pregnancy had a 30 percent increased risk.

Coming as it did just when pro-life activists seemed to be turning the tide of public opinion on abortion, Mr. Brind's study touched off a political war. In one camp: clinicians, cancer survivors, and pro-life groups anxious to spread the news about what some call the single most avoidable breast cancer risk. In the other: pro-abortion groups, their media friends, and establishment cancer groups anxious to preserve the culture of "choice." Women's health was caught in the crossfire.

NCI's February 2003 "consensus workshop" shows how. That event evolved after a dust-up between NCI, ABC-link proponents, Health and Human Services Secretary Tommy Thompson, and a confab of pro-abortion legislators led by U.S. Rep. Henry Waxman (D-Calif.). The problem: NCI's website, which in March 2002 stated: "The current body of scientific evidence suggests that women who have had either induced or spontaneous abortions have the same risk as other women for developing breast cancer." (NCI and others say studies that show an ABC link often have a "recall bias"-that women with cancer, seeking a cause for their illness, will be more likely than healthy women to admit to past abortions.)

Mr. Brind and five M.D.s, including former congressmen Tom Coburn and Dave Weldon, accused NCI of misleading the public, and provided data to Mr. Thompson on the numerous studies showing an ABC link. After Mr. Thompson ordered NCI to remove the erroneous statement, Rep. Waxman's group dashed off a report, "Politics and Science in the Bush Administration," that accused the administration of perverting science for political gain.

That's when NCI head Andrew von Eschenbach convened the workshop on the abortionÐbreast cancer link, telling reporters it was science, not politics, that led him to do so: "I will not permit our scientific integrity to be compromised," he said.

But according to Mr. Brind, what was advertised as a gathering of scientists who would weigh the evidence for the ABC link turned out to be the scientific equivalent of a kangaroo court. The promised "comprehensive review" of existing literature on the link did not occur. Many of the invited experts were dependent on grants from NCI or other federal agencies. The expert invited to make the formal ABC-link presentation had never published research on the topic. And a researcher who claimed to have new data showing no ABC link refused to make her data available for scrutiny.

Newspaper headlines following the NCI workshop seemed designed to end the debate once and for all: "Abortion-Breast Cancer Link Deemed Untrue" (Associated Press), "Study Discounts Link Between Abortion, Breast Cancer Risk" (The Washington Post), "Agency: No Link Between Abortions, Cancer" (New York Newsday).

Meanwhile, two studies supporting the ABC link fell into a media black hole. The first appeared, ironically, in a 2001 issue of the Journal of the National Cancer Institute. It tracked a rise in breast cancer among American women that began in 1973-the same year the Supreme Court declared abortion a constitutional right. Between 1973 and 1998, researchers concluded, the incidence of breast cancer among women in the United States increased more than 40 percent.

The other study, in the January 2003 Obstetrics and Gynecology Survey, concluded that existing research ties abortion to breast cancer. "We think, now," the authors wrote, "that clinicians are obliged to inform pregnant women that a decision to abort her first pregnancy may almost double her lifetime risk of breast cancer through loss of the protective effect of a completed first full-term pregnancy earlier in life. Additionally, we believe that women should be aware of the studies that support induced abortion as an independent risk factor for breast cancer." The researchers also noted that not informing women of the ABC link interfered with their reproductive autonomy-or "choice."

Legislators in some states are taking steps to protect that autonomy. In Louisiana, Kansas, and Minnesota, laws of various strengths require that abortionists disclose the ABC link to women considering abortion. The Massachusetts legislature is now considering similar legislation. Last month, the nation's strongest law took effect in Texas. That "informed consent" measure mandates that women considering abortion be provided with a variety of information on fetal development, abortion alternatives, and abortion risks, including breast cancer. A group of pro-life physicians is helping to prepare the literature that abortionists must disseminate.

Charnette Messe, now the mother of two, has made it her mission to provide such information both to women and to physicians. Now in remission after intensive chemotherapy and radiation, she speaks nationally to cancer survivors, clinicians, and researchers about both the reality and the politics of cancer.

"I'm not yelling and screaming that all women with breast cancer have had abortions," she said. "But we need to have a red flag, for when you do have those risk factors, and stop making it a political agenda. There is no room for politics when women are dying and losing their breasts, and when children are losing their mothers."