Subject to Debate | April 16, 2001
KATHA POLLITT 
This Warning May Be Hazardous to Your Health
A woman two months pregnant goes to see her Ob-Gyn for prenatal care.
As required by law, her doctor informs her that her condition places her
at greater risk for a wide range of medical problems: hypertension and
diabetes if she is overweight; complications of surgery if, like one in
four women, she has a Caesarean section; permanent weight gain with its
attendant problems, including heart disease; urinary tract infections and
prolapsed uterus if she has had multiple pregnancies; postpartum depression
or psychosis, leading in rare cases to suicide or infanticide; not to mention
excruciating childbirth pain, stretch marks and death. There are ominous
social possibilities, too, the doctor continues, reading from his state-supplied
script: increased vulnerability to domestic violence; being or becoming
a single mother, with all the struggles and poverty that entails; job and
housing discrimination; the curtailment of education and professional training;
and lowered income for life.
No state legislature would compel doctors to confront patients with
the statistical risks of childbearing, serious though they are; a doctor
who did so on his own would strike many as intrusive, offensive and out
of his mind. Should a woman seek abortion, however, anti-choicers are pushing
state laws requiring that she be informed of a risk most experts do not
believe exists: a link between abortion and breast cancer. Like the supposedly
widespread psychological trauma of abortion, which even anti-choice Surgeon
General Dr. C. Everett Koop was unable to find evidence of, the abortion-breast
cancer connection is being aggressively promoted by the anti-choice movement.
(Even Mother Jones, always quick to take feminists down a peg, leapt
on this bandwagon, with an April/May 1995 piece entitled "Abortion's Risk.")
"It's yet another example of efforts to encumber this legal choice and
make it more difficult and painful for women," says Dr. Wendy Chavkin,
professor of public health and clinical obstetrics and gynecology at New
York's Columbia Presbyterian Hospital, and editor in chief of the Journal
of the American Medical Women's Association. It's also an attempt by
anti-choicers to reframe their opposition to abortion as concern for women's
health, something not usually high on their list. These are, after all,
the same people who fight health exceptions to "partial birth" abortion
bans and who have successfully prevented poor women from receiving medically
necessary abortions with Medicaid funds.
Nonetheless, such is the power of the anti-choice movement that laws
have been passed in Montana and Mississippi, and bills are pending in fifteen
other states, mandating a breast cancer warning (and in some cases, a waiting
period for it to sink in). Along with laws come lawsuits: In Fargo, North
Dakota, the Red River Women's Clinic is being sued for failing to give
such a warning; a 19-year-old Pennsylvania woman is suing a New Jersey
clinic for her abortion two years ago, which left her, she claims, with
an overwhelming fear of contracting breast cancer. In ferociously anti-choice
Louisiana, a new law permits women to sue for damages--including damages
to the fetus!--up to ten years after their abortion. Given today's high
rates of breast cancer, a deluge of litigation is in the making.
Does abortion cause breast cancer? Some studies have appeared to suggest
a connection: Dr. Janet Daling, for example, an epidemiologist who says
she is pro-choice, compared the abortion histories of 1,800 women with
and without breast cancer and found that, among those who had been pregnant
at least once, the risk of breast cancer was 50 percent higher for those
who had abortions--but her cancer-free sample was obtained through telephone
interviews with women chosen at random from the phone book. Not everyone
has a phone, of course, which raises questions about the comparability
of the samples, and besides, how many women would volunteer information
about their abortion history to a voice on the phone? Like other studies
showing a link, this one was marred by "recall bias": Cancer patients are
more likely to volunteer negative information about themselves than healthy
people. They are looking for an explanation for a disease--and one many
feel must somehow be their fault. Demographic studies, which are free from
recall bias, produce different results: Lindefors Harris, analyzing the
national medical database of Swedish women in 1989, found that women did
deny their abortions, that breast cancer patients were less likely to do
so--and that women who had had abortions were less likely to get
breast cancer. The largest study to date, of 1.5 million Danish women,
found no correlation.
"The supposed link between breast cancer and abortion is motivated by
politics, not medicine," says Dr. David Grimes, clinical professor of obstetrics
and gynecology at the University of North Carolina. "The weight of the
evidence at this time indicates no association. To force this on women
is just cruel." Indeed, the National Cancer Institute, the American Cancer
Society and the World Health Organization, none of which have an ax to
grind, reject the notion. The standard medical textbook, Diseases of
the Breast, concurs. The main figure advocating the link is Dr. Joel
Brind, professor of biology and endocrinology at Baruch College, who has
done no original research on this issue but is a tireless anti-choice propagandist--plug
"abortion breast cancer" into a search engine and the top half dozen sites
are his.
Abortion is just about the only medical procedure in which doctors and
patients are hemmed about by lawmakers. No other operation has legally
mandated waiting periods, although many are dangerous, life-altering and
irreversible; with no other operation are doctors legally required to give
specific information--certainly not information that the vast preponderance
of medical opinion believes to be false or at best unproven. Good medical
practice calls for discussion of the pros and cons of particular courses
of treatment, not burdening the patient's choice with unsubstantiated fears.
Will we ever see a law requiring doctors to tell pregnant patients that
abortion is statistically safer than carrying to term--which it is? Sure,
the day state lawmakers put a waiting period on Viagra prescriptions, to
let male patients really consider whether an erection is worth a heart
attack. |