Friday, March 16, 2012

Legislating Lies

This article in the Texas Observer has been making the rounds of late, highlighting one family's pain in the wake of Texas' controversial ultrasound law. It is a heart-wrenching story, but one part in particular jumped out at me:
"When the description was finally over, the doctor held up a script and said he was legally obliged to read me information provided by the state. It was about the health dangers of having an abortion, the risks of infection or hemorrhage, the potential for infertility and my increased chance of getting breast cancer."
I had to go back and re-read that just to make sure I had read it correctly. Sure enough, it said "increased chance of getting breast cancer."

"Well, that can't be right," I thought. So I took a look at the actual legislation. Sure enough, there it was in the Health and Safety Code, Title 2, Subtitle H, Chapter 171, Section 012:
Sec. 171.012.  VOLUNTARY AND INFORMED CONSENT. (a)  Consent to an abortion is voluntary and informed only if:
(1)  the physician who is to perform the abortion informs the pregnant woman on whom the abortion is to be performed of:
(iii)  the possibility of increased risk of breast cancer following an induced abortion and the natural protective effect of a completed pregnancy in avoiding breast cancer;
The thing is, that this is completely false. There is no medical evidence of an increased risk of breast cancer following an induced abortion. The following is from the National Cancer Institute's Fact Sheet "Reproductive History and Breast Cancer Risk" and hints at the origins of the abortion-breast cancer myth (emphasis added by me and citations re-numbered):
Is abortion linked to breast cancer risk? A few retrospective (case-control) studies reported in the mid-1990s suggested that induced abortion (the deliberate ending of a pregnancy) was associated with an increased risk of breast cancer. However, these studies had important design limitations that could have affected the results. A key limitation was their reliance on self-reporting of medical history information by the study participants, which can introduce biasProspective studies, which are more rigorous in design and unaffected by such bias, have consistently shown no association between induced abortion and breast cancer risk (1–6). Moreover, in 2009, the Committee on Gynecologic Practice of the American College of Obstetricians and Gynecologists concluded that “more rigorous recent studies demonstrate no causal relationship between induced abortion and a subsequent increase in breast cancer risk” (7). Major findings from these recent studies include the following:
  • Women who have had an induced abortion have the same risk of breast cancer as other women. 
  • Women who have had a spontaneous abortion (miscarriage) have the same risk of breast cancer as other women.
  • Cancers other than breast cancer also appear to be unrelated to a history of induced or spontaneous abortion.
The citations are for the following articles:
  1. Reeves GK, Kan SW, Key T, et al. Breast cancer risk in relation to abortion: results from the EPIC study. International Journal of Cancer 2006; 119(7):1741–1745. [PubMed Abstract]
  2. Michels KB, Xue F, Colditz GA, Willett WC. Induced and spontaneous abortion and incidence of breast cancer among young women: a prospective cohort study. Archives of Internal Medicine 2007; 167(8):814–820. [PubMed Abstract]
  3. Beral V, Bull D, Doll R, Peto R, Reeves G. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83,000 women with breast cancer from 16 countries. Lancet 2004; 363(9414):1007–1016. [PubMed Abstract]
  4. Henderson KD, Sullivan-Halley J, Reynolds P, et al. Incomplete pregnancy is not associated with breast cancer risk: the California Teachers Study. Contraception 2008; 77(6):391–396. [PubMed Abstract]
  5. Lash TL, Fink AK. Null association between pregnancy termination and breast cancer in a registry-based study of parous women. International Journal of Cancer 2004; 110(3):443–448. [PubMed Abstract]
  6. Rosenblatt KA, Gao DL, Ray RM, et al. Induced abortions and the risk of all cancers combined and site-specific cancers in Shanghai. Cancer Causes and Control 2006; 17(10):1275–1280. [PubMed Abstract]
  7. Committee on Gynecologic Practice. ACOG Committee Opinion No. 434: induced abortion and breast cancer risk. Obstetrics and Gynecology 2009; 113(6):1417–1418. [PubMed Abstract]
Then there is this. In Summary Report: Early Reproductive Events Workshop - National Cancer Institute under the section "Epidemiologic Findings":
  • Induced abortion is not associated with an increase in breast cancer risk. (1)
  • Recognized spontaneous abortion is not associated with an increase in breast cancer risk. (1)
The "(1)" at the end of each item is a rating of the strength of the evidence, with 1 meaning "Well-established." This is the highest rating.  And it isn't just the National Cancer Institute that maintains this position based upon the evidence:
Need I go on? Certainly, there are (usually) health benefits to carrying a pregnancy to full term, but the consensus of the medical community is that there is no link between abortion and an increased risk of breast (or any other) cancer. Yet, the Texas State Legislature has seen fit to require physicians to tell their patients that there is. In short, the law requires doctors to lie.

Yes, abortion is a divisive and controversial issue. And let us put aside for a moment the other atrocious aspects of this legislation. It is one thing for politicians to lie. They do so on a regular basis. But requiring others to do so? Has furthering a political agenda grown so important that it has come to this?

Way to stay classy, Texas Legislature.

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