Respected US breast surgeon Dr Angela Lanfranchi – pilloried in the Australian media for her lecture tour explaining the reasons behind various breast cancer risks such as delayed childbirth, smoking, hormonal contraception and abortion – gave a scholarly presentation at a FamilyVoice meeting in Adelaide yesterday. She will also deliver a lecture to a group of obstetricians, gynaecologists and other medical practitioners at 7.30 pm tonight at the Tennyson Conference Centre, 520 South Road, Kurralta Park.
Dr Lanfranchi decided to become a breast surgeon following the tragic death of her much-loved mother from breast cancer. When Dr Lanfranchi began practising in 1984, US breast cancer rates were already on the rise – but today those rates are even higher.
She told the packed FamilyVoice meeting yesterday that the increase is due to a number of factors following huge changes in Western culture in the last 50 years, including:
- Childbirth delay: having several children soon after early marriage, and breastfeeding them, provide significant protection against breast cancer. Now many women delay childbirth or don’t have children. Delaying childbirth increases a woman’s breast cancer risk by 5% each year after the age of 20.
- Smoking: tobacco is now acknowledged as a carcinogen contributing to cancers in the lung, mouth, throat, kidney, liver, breast and elsewhere. Tobacco companies targeted young women in the 1960s – 80s with ads saying: “You’ve come a long way, baby!” Many more women became addicted and are now suffering the consequences.
- The pill: introduced in the 1960s, its oestrogen/progestagen components were classified by the World Health Organisation as class 1 carcinogens in 2005. Prolonged use of hormonal contraception and hormone replacement therapy are now acknowledged risk factors for breast cancer.
- Abortion: legalised and normalised in the 1970s, now shown to be a risk factor for breast cancer – particularly when performed in the second trimester, or before the first full-term pregnancy. Early miscarriages, caused by insufficient oestrogen to maintain the pregnancy, do not pose a risk – but late miscarriages or very early premature birth (before 32 weeks) are acknowledged breast cancer risks. Cervix damage caused by a previous abortion can result in premature birth in a following pregnancy, thereby further increasing the breast cancer risk.
Dr Lanfranchi explained the physiological changes in the breast during pregnancy, when oestrogen levels soar – increasing the number of types 1 and 2 breast lobules which are vulnerable to carcinogens. It is not until the last two months of pregnancy that hormones change the lobules to types 3 and 4 which are cancer-resistant milk-producers. Interrupting the pregnancy before this stage leaves the lobules in a cancer-vulnerable state.
“I did not know about these risks back in 1984,” Dr Lanfranchi said. “I had a family history of breast cancer, but I did not know that delaying childbirth would add to that risk. I was married for 17 years before I had my first and only child at age 41. I could have had a child earlier, but no one told me why that would have been a good idea.”
Dr Lanfranchi said breast cancer rates have long been highest in older, post-menopausal women. Breast cancers can take up to 14 years to become a detectable lump. She became concerned when her patients began to include more women in their 30s or even younger. She began asking them about their medical history, including their reproductive history. She found that many of the younger women with aggressive forms of breast cancer had previously had multiple abortions.
She then looked at the medical literature – and discovered studies showing a link between abortion and breast cancer. A 1996 meta-analysis of all published studies since 1957 found a 30% average increase in cancer risk following an abortion. A study of female rats, specially bred to develop breast cancer when injected with a certain chemical, found that of three groups of rats – virgins, aborted rats, and rats that had given birth – only the rats that had given birth did not develop breast cancer, and the aborted rats had the highest cancer rate.
Some other studies have been cited, purporting to show no link between abortion and breast cancer – but on closer inspection have been found to be methodologically flawed.
A 2014 meta-analysis by Huang et al has found a clear link, with the breast cancer risk increasing in line with the number of abortions the woman has had.
This year a comprehensive review of the link between induced abortion and breast cancer by Dr Lanfranchi and Dr Patrick Fagan has been published in the peer-reviewed journal Issues in Law & Medicine, Vol 29 No 1.
“Women deserve to know if they have breast cancer risk factors,” Dr Lanfranchi said. “They are then more likely to have regular mammograms. If cancer does develop, it can be detected at an early stage when it is more easily treated.”
Such knowledge can save lives.
- Family and parenthood
- Human life and dignity