The following is a testimony before the Massachusetts Joint Health Care Committee on June 11, 2003 by Angela Lanfranchi, M.D.
I, Angela Lanfranchi, M.D., testified on June 11, 2003 before
this Committee in support of H.R. 2960 an Act Relative to
Patient's Rights about the scientific and medical data regarding
the link between breast cancer and abortion. My testimony is
summarized herein for the benefit of those Committee members
absent from the hearing.
In May, 1975, I received my M.D. from the Georgetown
Medical
School in Washington D.C. I became Board Certified in General
Surgery in 1983 and was recertified in 1993. I am a fellow of the
American College of Surgeons. I have been in practice with
Surgical Associates of Central New Jersey for 18 years. I have
held an appointment as Clinical Assistant Professor of Surgery at
Robert Wood Johnson University Medical School since 1986. I
teach Family Practice residents surgery at my primary hospital,
Somerset Medical Center. I am a member of an Expert Advisory
Panel for the New Jersey Board of Medical Examiners.
I am co-director of the Breast Center at Somerset
Medical Center.
I have limited my elective practice of surgery to breast diseases, including
breast cancer, for approximately the past 8 years. I see approximately
1200-1300 patients with breast problems a year and perform over 500
breast surgeries a year. I regularly give Grand Rounds lectures on breast
topics to the Departments of Medicine and Family Practice at Somerset
Medical Center and speak to breast cancer survivor groups and volunteers
of the local chapter of the American Cancer Society. I have lectured
to lay and professional groups both nationally and internationally on
breast cancer risks and prevention and on the abortion breast cancer
link. A local non-profit organization, Women's Health and Counseling
Center, has recognized me, for my contributions to women's health in
my local
community.
It is my professional opinion, based upon my
professional
training, experience, and my study of the relevant peer-reviewed
medical literature, that an overwhelming preponderance of the
evidence indicates that induced abortion increases risk of breast
cancer. In short, interrupting a normal pregnancy with abortion
leaves a woman with an increase in the number of undifferentiated
breast cells [the Type 1 and 2 lobules] that are more susceptible
to carcinogens. These carcinogens include estrogen, a type of
hormone found in hormone replacement therapy and birth control
pills. Abortion of a first pregnancy is especially harmful and
most damaging to teenagers. Many times teenagers will hide their
pregnancy and undergo late term abortions which are even more
damaging to them. The longer one is pregnant before an abortion,
the higher the breast cancer risk. Women considering abortion
have a right to be informed about this evidence prior to
consenting to the procedure.
Therefore, I give all of my new patients an intake
form which
requests information about, among other things, reproductive
history, including number of abortions and age at first abortion.
The abortion breast cancer link is acknowledged in authoritative
textbooks that I use in my practice. The Breast, by Bland and
Copeland (1991 and 1998 editions), clearly states that "first
trimester abortion increases risk" of breast cancer.
Personal Conversations with Leaders in the Field of Breast Cancer
Often when I have asked leaders in the field
of breast cancer why
they don't talk about the abortion breast cancer link at their
meetings they have said, "It's too political." I have come
to
believe that what is meant by "too political" is the growing
influence of major womens' medical organizations. Now that very
soon over half of the physicians in this country will be women,
they will have a major influence in medicine. Just one example of
this is the American Medical Women's Association. This
organization and its foundation, the AMWA Foundation, had over 1
million dollars in revenue in the year 2000. Its corporate
sponsors include major pharmaceutical companies.
The AMWA has as its mission to provide and develop
leadership to
advance women in medicine and improve women's health. This is an
admirable goal and they have helped many women to achieve these
goals. However, I believe they are so committed to reproductive
rights and the protection of Roe v. Wade, as their position
paper on Abortion and Access to Comprehensive Reproductive Health Services
clearly states on their web site www.amwa-doc.org, that it has clouded
good medical judgment. They openly state they
oppose bills such as this one. And it would seem that allowing
the information that studies clearly show an increase risk of
breast cancer with abortion to be discussed in open medical
forums, is perceived as endangering the Roe v. Wade ruling. These
studies are kept buried in the literature. When someone such as
myself discusses them, instead of debating the issue with me and
other colleagues in the field, I am dismissed as a fearmonger.
An example of these extremist positions is the
AMWA's position
paper on Breast Cancer Prevention adopted in November 1993. It
states that women who have their first full term pregnancy (FFTP)
before the age of 18 have a 75% reduced breast cancer risk
compared to those who have their FFTP after age 30. Instead of
making this fact widely known to women considering abortion of
their FFTP, they state in this same paper, "Clearly reproductive
choice is a high priority in our society. If oral contraceptives
can be developed to prevent an unwanted pregnancy, a hormonal
equivalent of pregnancy could be developed that would confer
protection in women who choose to delay pregnancy." In other
words, you would not need to have a child to get the protective
effect of a full-term pregnancy. You could just take a pill. It's
clear to me why major drug manufacturers support their ideas. But
what about those young women who are already pregnant?
Shouldn't they be told of the risk reduction benefits when considering abortion?
The AMWA is so concerned that abortion rights
are not eroded that
they oppose parental notification and support the D&X or partial
birth abortion procedure as again they show on their web site. In
other words, these are women physicians who
support taking a 13-year-old child for a partial birth abortion without
their mother's consent or knowledge. This despite the fact that it is
major gynecologic surgery which can result in permanent damage to this
child's reproductive organs and future fertility, not to mention her
death. Children need their mother's support when having an appendectomy,
much less an abortion such as a D& X procedure. I think most mothers
here today would agree with me on that.
Historical Precedence For The Lack Of Knowledge Of The Abortion Breast Cancer Link
Instances of resistance to new information are
not uncommon in
the history of medicine, especially when the new information
questions the safety of a practice long accepted by physicians
themselves. I am convinced that similar biases, rather than the
actual scientific facts, account for the failure of the medical
community at large to inform its members and patients about the
overwhelming body of evidence linking induced abortion with
increased breast cancer risk.
The most well-known example of this resistance
to new information
is the case of Vienna obstetrician Dr. Ignaz Semmelweis and "childbed
fever."
In the 1840's, Dr. Semmelweis noticed that the death rates were
10 times higher on the doctor 's maternity wards than the
midwives' wards and that the midwives washed their hands
frequently, as compared to the doctors, who did not. Semmelweis
felt it was lack of hand washing by doctors that caused the
deaths. Semmelweis' superiors posed all sorts of other theories
besides lack of hand washing as a cause (including overcrowding,
rough exams by medical students, and psychological causes). An
experiment was done wherein the doctors washed their hands in
chlorinated water and the death rate fell dramatically. Instead
of being honored for his contribution to women's health,
Semmelweis was ridiculed, his privileges were reduced, and he was
forced to leave the hospital. Only after his death was he
acknowledged to be correct.
Practical Use of the Recognition of the Abortion
Breast Cancer
Link
It is my practice to counsel regarding the link
between abortion
and breast cancer every one of my patients who indicates a
history of induced abortion on her intake form and who, after a
biopsy, is not diagnosed with cancer, or who asks about breast
cancer risks. I have thus counseled thousands of my patients
about the evidence linking abortion with increased breast cancer
risk over the last four years. I do this because there is a
critical need for women at a higher risk of breast cancer to be
informed of their higher risk so that they can have better and
more frequent screening, leading to earlier diagnosis, which will
increase their survival should they actually develop breast
cancer. Many patients perceive themselves to be at low risk
because they have no known family history of breast cancer. I
point out that 85% of all breast cancer patients have no family
history of breast cancer. Pointing out to women that they are at
higher risk encourages more regular screening mammograms which
can find small, more curable breast cancers thus increasing their
survival. These women also need to know that taking birth control
pills after an abortion will increase their risk even more. They
can use non-hormonal contraception instead. They should also be
advised that there is some evidence in one National Cancer
Institute commissioned study that having a child within 5 years
of an abortion will decrease their risk.
I have counseled pregnant patients with this
information. Some
have had abortions aware that they will be at higher risk,
prepared to have early screenings and aware of risk reduction
strategies. Some have decided not to have an abortion based upon
this information.
This information can also be reassuring to patients
with close
family members with breast cancer. For instance, I recently took care
of identical twin sisters. One had a history of several abortions
and no children. This twin developed breast cancer at the age of
35. The other twin had a child and no abortions. She had a
benign breast biopsy a year later at the age of 36. She was
relieved of her fear of breast cancer by knowing that she and her
twin had very different risks despite the fact they shared
identical genes.
As a physician, and an as a woman who lost her
mother to breast
cancer, I take this information very seriously. As the mother of
a preteen in a state that has no parental consent law, I worry
that a misguided, misinformed guidance counselor could arrange
for my daughter to have an abortion without my knowledge almost
guaranteeing she will develop breast cancer by the age of 45.
Mothers need this information to protect their teenagers who may
react to an unplanned pregnancy rashly, without thought of future, life
threatening medical complications.
I fully support the goal of the proposed legislation,
H.B. 2960,
which is to inform all women considering an abortion that there
may be an increased risk of breast cancer among women who have
had abortions. In my mind, there is no may be. Abortion does
increase the risk of breast cancer. This fact is borne out by 29 out
of 39 epidemiological studies done over the past 45 years,
experimental animal models, and well-known breast physiology. It
is no coincidence, that 30% of my patients with breast cancer who
are in their thirties do not have a family history of breast cancer
but they have had an abortion.
Women have a right to know.
Related web sites:
Breast Cancer Prevention Institute - http://www.BCPInstitute.org
Coalition on Abortion/Breast Cancer - http://www.AbortionCancer.com
Polycarp Research Institute - http://www.polycarp.org
