|March 26, 2016|
The controversial abortion-breast cancer (ABC) hypothesis posits a causality| causal relationship between having an induced abortion and a higher risk of developing breast cancer in the future. An increased level of estrogen in early pregnancy helps to initiate cellular differentiation (growth) in the breast in preparation for lactation. If this process is terminated, through abortion, before full differentiation in the third trimester, then more "vulnerable" undifferentiated cells will be left than there were prior to the pregnancy. It is proposed that this might result in an elevated risk of breast cancer. The majority of interview-based studies have indicated a link, and some have been demonstrated to be statistically significant, http://www.etters.net/cancerTP.htm#3 but there remains debate as to their reliability because of possible response bias.
Larger and more recent record-based studies, such as one in 1997 which used data from two national registry|registries in Denmark, found the correlation to be negligible to non-existent after statistical adjustment. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8988884 The National Cancer Institute conducted an official workshop with dozens of experts on the issue, between February 24-26, 2003, which concluded from its examination of various evidence that it is "well established" that "induced abortion is not associated with an increase in breast cancer risk." http://www.cancer.gov/cancerinfo/ere-workshop-report These findings and how the Denmark study statistically adjusted their overall results have been disputed by Joel Brind|Dr. Joel Brind, http://www.bcpinstitute.org/nci_minority_rpt.htm an invitee to the workshop and the leading scientific advocate of the abortion-breast cancer hypothesis. Nevertheless, gaps and inconsistencies remain in the research, and the subject continues to be one of political and scientific contention; although the current scientific consensus is there is no ABC link.
There are several different kinds of scientific studies involved in the ABC debate. Each has strengths and weaknesses and involve testing of rats, interviews (case-Control experiment|control), meta-analysis and http://servers.medlib.hscbklyn.edu/ebm/2400.htm cohorts. These are listed roughly in order of scientific significance and cover recent ABC research history, starting in 1980 when the first rat study was published. ABC studies have been conducted since 1957, and have advanced both in size and in methodology. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8944853
The majority of the results in epidemiologic scientific studies are calculated as a relative risk with 1.0 being 0% and a (95% confidence interval). This means a relative risk of 1.51 (0.93-1.87) is a 51% increased risk with a 95% chance that the actual risk is within the range given. With more data, the confidence interval becomes smaller, making it an indicator of the result's statistical reliability.
Confounding factors & hormones
There are many confounding factors for breast cancer. Genetics is a major factor which plays a role in the long list of socioeconomic factors. As Western society has modernized confounding factors such as natural environment|environmental carcinogens, delayed child rearing, less breastfeeding, hormone replacement therapy (HRT), oral contraceptives, early menarche and obesity have increased. If these were not accounted for, they would obscure any effect an individual factor would have. Examining the ABC issue is all the more difficult because induced abortions have increased during the same period.
http://www.guttmacher.org/pubs/fb_induced_abortion.html Premature birth adds further complications since an uncorroborated study has indicated it is associated with a history of induced abortion http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15777440&query_hl=8 and higher breast cancer risk. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10408874
One of the most significant controllable factors is parity, or the number of children a women has given birth to prior to the abortion. With each pregnancy (particularly the first) the breasts undergo growth and differentiation. All of these confounding factors have an effect, directly or indirectly, on hormones which impact breast cancer risk.
The controversial nature of abortion may introduce recall bias into interview studies; especially for studies done in decades past when abortion was less accepted. In the late 20th century there was some concern of an increase of breast cancer Incidence (epidemiology)|incidence. This was found to be partly due to women living longer, and better detection methods finding breast cancer earlier.
http://cis.nci.nih.gov/fact/5_6.htm It should be noted the overall incidence does not effect ABC studies with proper controls because the case and control subjects would be equally effected.
Studies of spontaneous abortions (miscarriages) have generally shown no increase in breast cancer risk, http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15767381&query_hl=1 although a study by Paolilli et al. concluded there is a "suggestion of increased risk" 1.2 (0.92 to 1.56) after 3 or more pregnancy losses. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12800205&query_hl=1 Some argue that this apparent lack of effect of miscarriages on breast cancer risk is evidence against the ABC hypothesis, and some pro-choice advocates have claimed it is proof that neither early pregnancy loss nor abortion are risk factors for breast cancer. http://www.prochoiceactionnetwork-canada.org/articles/abclink.shtml
One of the problems with comparing miscarriage to abortion is the issue of hormone levels in early pregnancy, a key point because the ABC hypothesis rests on hormonal influence over breast tissue development. Given the association of most miscarriages with abnormally low hormone levels it may not be analogous to an induced abortion of a healthy pregnancy, and a definitive conclusion about ABC risk based on miscarriage data alone is probably unsupported. While it is true most miscarriages are not caused by low hormones, most miscarriages are characterized by low hormone levels. http://www.st-marys.nhs.uk/specialist/miscarriage_clinic/causes.htm One of the first studies on hormone levels and spontaneous abortion by Kunz & Keller (1976)
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=60125&dopt=Abstract showed that when progesterone is abnormally low a miscarriage occurs 89% percent of the time. This is also reflected in studies published by Hertz et al. (1979)
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=60125&dopt=Abstract and in more detail by Stewart et al. (1993). http://jcem.endojournals.org/cgi/reprint/76/6/1470.pdf
A distinction should also be made for second trimester miscarriages as their hormonal characteristics are different from first trimester miscarriages.
The Russo & Russo (1980) study
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=6773421 of the http://www.fccc.edu/ Fox Chase Cancer Center in Philadelphia found that rats who received abortions had a "similar or even higher incidence of benign lesions" than virgin rats of matching age. A more thorough examination of the phenomenon was conducted in 1982
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=6216933, which confirmed the results. A later study in 1987
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3302534 further explained their previous findings. After differentiation of the mammary gland at the time of first full-term pregnancy of the rat, the rate of cell division decreases and length of the cell cycle increases, allowing more time for DNA DNA repair|repair. http://www.annieappleseedproject.org/addietrisofb.html
In a Discover Magazine|Discover article sidebar http://www.barryyeoman.com/articles/hatedabortion.html entitled Humans Are Not Rats, Dr. Gil Mor, the director of reproductive immunology at the Yale University|Yale University School of Medicine, disagrees with Dr. Brind and Drs. Russo & Russo on the importance of the rat studies findings. Dr. Mor emphasizes that rat studies are ideal for understanding basic processes but it would be scientifically "wobbly" to extrapolate those findings to humans.
Interview (case-control) based studies have been inconsistent on the ABC link. With the small numbers involved in each individual study and the possibility that recall bias skewed the results, recent focus has switched to meta-analysis and record based studies which are typically much larger.
http://www.religioustolerance.org/abo_canc.htm Here are a few interview studies of note.
Dr. Daling from the Fred Hutchinson Research Center headed two studies on the ABC issue looking at women in Washington state. The 1994 study results indicated a 50% (1.2-1.9) increased risk.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7932822 This was reflected in higher risks for women younger than 18 or older than 30 years of age who have had abortions after 8 weeks' gestation. Their conclusion emphasized that although this study supported the ABC link, the overall results from epidemiologic studies are inconsistent.
The Daling study in 1996 resulted in a relative risk of 1.2 (1.0-1.5).
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8712194 The risk was highest among women without children who had abortions prior to 9 weeks gestation. Dr. Daling et al. examined the possibility of response bias by comparing results from two recent studies on invasive cervical cancer and ovarian cancer. The results argued against significant response bias. The Rookus (1996) study
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8944006 noted that patients with cervical cancer may report differently than breast cancer patients.
On September 28th, 1997 an interview with Dr. Daling was published by the Los Angeles Daily News. In it she made the following statement:
A 2001 study
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11351314 conducted in Shanghai, China by Dr. Sanderson from the University of South Carolina and South Carolina Cancer Center at Columbia, South Carolina|Columbia concluded that there was no ABC link and that multiple abortions did not put one at greater risk. Since induced abortion is common, legal, and even mandated by the government in China, the recall bias was minimized.
Critics of the Chinese studies have said that the same factors that make them ideal for reducing recall bias also makes them inappropriate for comparison to the West.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15150586 With the wide availability of abortion services, over 80% of them were done within the first eight weeks of gestation. In comparison only 55% of United States|American women had an abortion before the ninth week. http://www.guttmacher.org/pubs/fb_induced_abortion.html Due to China???s strict population control, the vast majority of the abortions in the Chinese study were done after the first full-term pregnancy, which had been relatively early. This is not reflected in North America.
Response bias occurs when women intentionally "underreport" their abortion history. Meaning they deny having an abortion or claim to have fewer abortions than they've actually had. This can happen because of the personal, and in some places controversial nature of abortion, some women may not want provide full disclosure. Furthermore, women in the control group are more likely to have no serious illnesses, and hence have less motivation to be truthful than those trying to diagnose their problem. If this occurred then it would artificially create an ABC link where none existed. Two major studies have been published examining abortion response bias. It should be noted recall bias is also examined in these studies, which is when women simply forget their abortion history.
The Lindefors-Harris (1991) study
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1951288 was the first major study to examine response and recall bias. It used the data of two independent Sweden|Swedish induced abortion studies, and concluded there was a 50% (1.1-2.1) margin of error due to recall bias. However, eight women (seven cases, one control) included in this error margin apparently "overreported" their abortions, meaning the women reported having an abortion that was not reflected in the records. It was decided that for the purposes of the study, these women did not have abortions.
Dr. Daling (1994) found it "reasonable to assume that virtually no women who truly did not have an abortion would claim to have had one,"
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8712194 and missing records could have occurred for a variety of reasons. With these eight women removed the error margin is reduced to 16% which severely limits its statistical significance. Subsequently the authors obliquely retracted the 50% conclusion in 1998
http://jech.bmjjournals.com/cgi/reprint/52/3/209, but reasserted since the Denmark (Melbye 1997) cohort study
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8988884, found no link the 30% increased risk in the Brind meta-analysis
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8944853 must be the accumulative result of recall bias. Dr. Brind believes the remaining 16% could have resulted from the Swedish fertility registry.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2876135 These women were interviewed as mothers, which could have increased the tendency to underreport, given that a mother might not want to appear unfit.
The Rookus (1996) study
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8944006 compared two regions in the Netherlands to assess the effect of religion on ABC results based on interviews. The secular (western) and conservative (southeastern) regions showed ABC relative risks of 1.3 (0.7-2.6) and 14.6 (1.8-120.0) respectively. Although this was a large variance, Dr. Brind et al. pointed out
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9106653 that it was attained with an extremely small sample size. (12 cases and 1 control)
Rookus et al. supported this finding with an analysis of how much recall bias existed with oral contraceptive use that could be verified through records. It corroborated the bias, but Brind's et al. letter clarifies it only indicated response bias between the two regions, not between case and control subjects within regions. Dr. Rookus et al. responded
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9106653 to the criticism by noting that there was 4.5 month underreporting difference between control and case subjects in the conservative region. This is indirect evidence for reporting bias since comfort with reporting oral contraception should be higher than induced abortion.
Rookus et al. also acknowledged the weakness in the Lindefors-Harris (1991) study, but emphasized that more controls (16/59 = 27.1%) than case patients (5/24 = 20.8%) did not report registered induced abortions. They concluded that finding a causal ABC link would be a disservice to the public, and epidemiologic research if "bias has not been ruled out convincingly."
A meta-analysis was conducted by Dr. Brind et al. (1997) with both pro-choice and pro-life scientists that examined 28 published studies.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8944853 It concluded that there was on average a 30% (1.2-1.4) increased risk of breast cancer. The meta-analysis was criticized for using studies with widely varying results, not working with the raw data from several studies, and including some studies that have alleged methodological weaknesses.
The Royal College of Obstetrics and Gynaecology in March 2000 published evidence-based guidelines on women requesting induced abortion. The review of the available evidence at the time was "inconclusive" regarding the ABC link. They also noted "Brind's paper had no methodological shortcomings and could not be disregarded."
In March 2004, Dr. Beral et al. published a study in The Lancet as a "collaborative reanalysis" on Breast cancer and abortion.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15051280 This meta-analysis of 53 epidemiologic studies undertaken in 16 countries did not find evidence of a relationship between induced abortion and breast cancer, with a relative risk of 0.93 (0.89-0.96). Many organizations and media outlets have referenced it as the latest and most comprehensive overview of the ABC evidence. Dr. Brind disagrees with this assessment.
The 1989 study
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2767842 by Dr. Holly Howe et al. at the New York State Department of Health examined young women with breast cancer in the state of New York (1,451 breast cancer cases – 1,451 controls). The results indicated a significant 90% (1.2-3.0) increased risk for induced abortion, an insignificant 50% (0.7-3.7) increase for spontaneous abortion, and 300% (1.5-13.6) increase for multiple abortions with no intervening births. The authors believed that the study was inconclusive, but raised new questions for continuing research as women's recorded contraceptive histories grew.
The study is significant evidence that the positive ABC results in interview studies were not purely a result of recall bias. According to Scott Somerville of Accuracy in Media it took a long time for Howe's study to be published due to a number of American journals that rejected the article. Eventually in Britain, the International Journal of Epidemiology published it in 1989.
Another cohort study by Dr. Lindefors-Harris et al. (1989)
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2514825 was done looking at 49,000 women who had received abortions before the age of 30 in Sweden (65 breast cancer cases – compared with estimate of occurance in general population). Although reported by some sources as being a "large" cohort study the actual number of breast cancer cases is a fraction of most other studies. The risk for women who'd given birth previous to the abortion was 0.58 (0.38-0.84), whereas women with no births had an insignificant risk increase of 1.09 (0.71-1.56). Overall, the relative risk was 0.77 (0.58-0.99), making for a 23% reduced risk in comparison to "contemporary Swedish population with due consideration to age."
According to Scott Somerville, the Lindefors-Harris study is flawed because their control group isn't well defined. The study combines women both with and without children. It also makes no attempt to compensate for the fact most women in Sweden, unlike America, already have children at the time of abortion. Thus the protective effect seen in the study is likely from earlier pregnancies rather than abortion. Additionally a large part of the funding for the study came from "Family Health, International," which is allegedly a research arm of the abortion industry.
A large, highly regarded ABC study was published by Dr. Melbye et al. (1997)
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8988884 of the Statens Serum Institute in Copenhagen, had 1.5 million Denmark|Danish women in the database (1,338 breast cancer cases – 8,908 controls). Of those, 280,965 women had induced abortions recorded in the computerized registry, which was started in 1973 when having an induced abortion through 12 weeks was fully legalized. The relative risk after statistical adjustment came to 1.00 (0.94 to 1.06). This led to the conclusion that "induced abortions have no overall effect on the risk of breast cancer." The Melbye study's conclusions garnered great attention from the media and many organizations such as the NCI and Planned Parenthood, who use it as a foundation to argue that the best scientific evidence does not support an ABC link.
However, Drs. Brind and Chinchilli had concerns about the Melbye study database and how they statistically adjusted their overall relative risk.
The Melbye study used women born from 1935 to 1978, but the computerized registry of induced abortions only started in 1973. <!--busted link removed--> As a result Dr. Brind found more than 30,000 women had been misclassified as having no abortion because the induced abortion occurred prior to 1973. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2178889 Dr. Melbye et al. responded that if the misclassified older women had their risk underestimated, it would be expected that the younger groups would have a higher risk. Their statistically adjusted relative risks indicated this was not the case.
In a large cohort study it is necessary to account for confounding factors that may have increased over time. For example, if the pill affected breast cancer rates 40 year old women in 1990 (young birth-cohort) would have a higher incidence of breast cancer than 40 year olds in 1970 (older birth-cohort), as they had little to no access to the pill during their reproductive years. Typically this is corrected by having case-control matching, but instead the Melbye study statistically adjusted out observed birth-cohort increases. Dr. Brind argues that Dr. Melbye et al. adjusted out induced abortion from the overall results because it is one of the confounding factors which has increased over the same time period, and the finding of exactly 1.00 agrees with that assertion. Dr. Melbye et al. found the point to be self-contradictory, considering Dr. Brind wanted birth-cohort matching, then argued against "taking birth-cohort differences into account." It is unclear how this is a contradiction, since Dr. Brind is against the use of just statistical adjustment, and in favor of case-control cohort matching to account for birth-cohort differences.
Drs. Senghas and Dolan did not understand why a statistically significant result for induced abortions done after 18 weeks gestation was not in the results section of the Melbye study abstract. Dr. Melbye et al. explained that even though the result was in line with the hypothesis of Russo and Russo, they deemed the number of cancer cases small, and did not want to overstate the finding.
Here is the first section of Table 1 in the Melbye study:
<nowiki>*</nowiki>The relative risks were calculated separately for each of the five variables, with adjustment for women's age, calendar period, parity, and age at delivery of a first child. CI denotes confidence interval.<br>
???Values were adjusted for women's age, calendar period, parity, age at delivery of a first child, and the other variables shown in the table.<br>
???The women with this characteristic served as the reference group.
Other sections listed age at induced abortion, number of induced abortions, time since induced abortion, and time of induced abortion and live-birth history. There was an indication of an elevated risk of 1.29 (0.80-2.08) for 12-19 year olds (relative to 20-24 subcohort), and a protective effect 0.74 (0.41-1.33) for women with an induced abortion before and after their first live birth (relative to induced abortion after 1st live birth subcohort).
The National Cancer Institute (NCI) conducted a workshop to evaluate the scientific evidence regarding the ABC link. This was done in response to alterations to the NCI website by the George W. Bush|Bush administration in November 2002. http://democrats.reform.house.gov/features/politics_and_science/example_breast_cancer.htm The workshop concluded that the evidence was "well established" against an abortion increasing a woman's risk of breast cancer. http://www.cancer.gov/cancerinfo/ere-workshop-report Recently some organizations have changed their position to be in line with the NCI workshop findings.
Dr. Brind was invited to the workshop and he alleges the chairperson exercised "major" control over who was to be invited, and many of the invited scientists were dependant on the NCI or other federal agencies for grants. http://www.bcpinstitute.org/abc_nci.htm The main expert who made the formal ABC presentation primarily had expertise in obesity and exercise in relation to breast cancer. Dr. Daling, who had published on the ABC issue, was asked to present on another topic. Preterm delivery was listed as an epidemiological "gap" even though there was evidence of a correlation with breast cancer. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10408874 No minority or dissenting report was requested but Dr. Brind did file a dissenting opinion. http://cancer.gov/cancer_information/doc.aspx?viewid=15e3f2d5-5cdd-4697-a2ba-f3388d732642
When anti-abortion advocates link abortion to breast cancer, some claim that the goal is to stop women from having an induced abortion. Because breast cancer illicits disproportionate fear
http://www.junkscience.com/news/brody.html in women, there exists the concern that anti-abortionists could use it as scare tactic. ABC advocates who oppose abortion have been accused of focusing on positive and/or averaged results, ignoring caveats and low-risk subgroups. These advocates rebut by stating that their ABC information is for the benefit of women's health and to provide informed consent.
At the same time anti-abortionists lobby to increase obstacles to abortion (such as mandated counseling, waiting periods, and parental notification) http://www.guttmacher.org/pubs/fb_induced_abortion.html, and some feel that anti-abortionists treat ABC as simply another weapon in their arsenal. In enacting these obstacles it takes longer for a women to get an abortion; and as a result this increases the risk of complications. The ongoing and incremental legal challenges to abortion by pro-life groups is documented in Frontline_(PBS_TV_series)|Frontline's http://www.pbs.org/wgbh/pages/frontline/clinic/ The Last Abortion Clinic.
See Breast Cancer: Its Link to Abortion and the Birth Control Pill by Chris Kahlenborn, MD (ISBN 0966977734) for an extended argument from the pro-life perspective.
In January of 2000 Amy Jo Kjolsrud (n??e Mattson), a pro-life counselor, sued the http://www.redriverwomensclinic.com/ Red River Women's Clinic in Fargo, North Dakota|Fargo, North Dakota alleging false advertising. The suit alleged the clinic was misleading women by distributing a brochure quoting a National Cancer Institute fact sheet on the ABC issue which stated:
The case was originally scheduled for September 11, 2001 attacks|September 11th, 2001 but was delayed as a result of the terrorist attacks. On March 25, 2002 the trial started and after four days of testimony Judge Michael McGuire ruled in favor of the clinic. In his decision he said:
The judge noted it was their "intent" to provide accurate information because the brochure used an outdated fact sheet. http://www.worldnetdaily.com/news/article.asp?ARTICLE_ID=27027 Linda Rosenthal, an attorney from the http://www.crlp.org/ Center for Reproductive Rights characterized the decision thusly: "The judge rejected the abortion-breast cancer scare tactic. This ruling should put to rest the unethical, anti-choice scare tactic of using pseudo-science to harass abortion clinics and scare women." http://crlp.org/pr_02_0328ND.html John Kindley, one of the lawyers representing Ms. Kjolsrud stated: "I think most citizens, whether they are pro-choice or pro-life, believe in an individual's right to self-determination. They believe people shouldn't be misled and should be told about procedural risks, even if there is controversy over those risks." http://www.womenspress.com/main.asp?Search=1&ArticleID=1580&SectionID=1&SubSectionID=1&S=1
On September 23rd, 2003 the North Dakota Supreme Court ruled the http://www.state.nd.us/lr/cencode/t51c12.pdf false advertising law should not have been used by Ms. Kjolsrud. This was because she personally had suffered no injury and hence had no standing (according to North Dakota jurisprudence) to file the lawsuit on behalf of others. In the appeal, Ms. Kjolsrud "concedes she had not read the brochures before filing her action." http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=nd&vol=20030023&invol=1 However, the appeal also noted that after the lawsuit was filed the abortion clinic updated their brochure to the following:
As of November 2004, women seeking abortions in Mississippi must first sign a form indicating they've been told abortion could increase their risk of breast cancer. In Texas, Louisiana, and Kansas, state law requires women receive a pamphlet that suggests a cancer link with abortion. Similar legislation requiring notification has also been introduced, and is pending, in 14 other U.S. state|states.
http://www.boston.com/news/nation/articles/2004/11/10/questions_on_states_abortion_warnings/?rss_id=Boston%20Globe%20--%20National%20News These state laws circumvent federal abortion laws and put up further barriers to elective abortion; http://www.motherjones.com/news/feature/2001/09/abortion.html and it has the real potential to misinform women of the risks. Although full disclosure could be beneficial in mitigating possible future lawsuits involving informed consent; http://www.piercelaw.edu/risk/vol2/winter/merz.htm as women may contend they should have been told of the possibility of an ABC link prior to having an abortion.
Despite claims that the ABC issue has been resolved, the scientific consensus is that the evidence is inconclusive. This is due to conflicting studies and even contradictory results within studies, which could be occurring because the effect being sought is too small, does not exist, and/or as a result of flaws in the studies. It is worth considering that when a correlation is indicated the relative risk or the data is usually statistically insufficient to conclude a causal link according to epidemiological standards.
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