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Breast Cancer and the Politics of Abortion in the United States

Published online by Cambridge University Press:  26 July 2012

Patricia Jasen
Affiliation:
Department of History, Lakehead University, 955 Oliver Road, Thunder Bay, Ontario, Canada P7B 5E1
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Epidemiology, like any branch of medical science, functions within a social and historical context. That context influences what questions are asked, how they are investigated, and how their conclusions are interpreted, both by researchers and by the public. The international debate over whether abortion increases breast cancer risk, which has been the subject of many studies and much heated controversy in recent decades, became so intensely politicized in the United States that it serves as a particularly stark illustration of how elusive the quest for scientific certainty can be. Although a growing interest in reproductive factors and breast cancer risk developed after the Second World War, it was not until the early 1980s, after induced abortion had been legalized in many countries, that studies began to focus on this specific factor. In the US these were the years following Roe v Wade, when anti-abortionists mounted their counterattack and pro-choice forces were on the defensive. As a result, epidemiologists found themselves at the centre of a debate which had come to symbolize a deepening divide in American culture. This paper traces the history of the scientific investigation of the alleged abortion-breast cancer link, against the backdrop of what was increasingly termed an “epidemic” of breast cancer in the US. That history, in turn, is closely intertwined with the anti-abortion movement's efforts, following the violence of the early 1990s, to regain respectability through changing its tactics and rhetoric, which included the adoption of the “ABC link” as part of its new “women-centred” strategy.

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Articles
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Copyright © The Author(s) 2005. Published by Cambridge University Press

References

1 See Daniel de Moulin, A short history of breast cancer, The Hague, Martinus Nijhoff, 1983.

2 See Patricia Jasen, ‘Breast cancer and the language of risk, 1750–1950’, Soc. Hist. Med., 2002, 15: 17–43.

3 For differing views among nineteenth-century authorities, see Walter H Walshe, The nature and treatment of cancer, London, Taylor and Walton, 1846, p. 154; W Roger Williams, A monograph on diseases of the breast, their pathology and treatment, with special reference to cancer, London, John Bale, 1894, pp. 287–8; William Rodman, Diseases of the breast with special reference to cancer, Philadelphia, Blakiston, 1908, pp. 181–2; Willard Parker, Cancer: a study of three hundred and ninety-seven cases of cancer of the female breast, New York, Putnam, 1885, p. 22.

4 De Moulin, op. cit., note 1 above, pp. 89–90.

5 See Ira T Nathanson, ‘The relationship of hormones to diseases of the breast’, in G H Twombly and G T Pack (eds), Endocrinology of neoplastic diseases: a symposium by eighteen authors, New York, Oxford University Press, 1947, pp. 138–78.

6 M Segi, I Fukushima, S Fujisaku, M Kurihara, S Saito, K Asano, and M Kamoi, ‘An epidemiological study on cancer in Japan’, GANN: Japanese Journal of Cancer Research, 1957, 48 (Supplement), p. 42.

7 James Risen and Judy L Thomas, Wrath of angels: the American abortion war, New York, Basic Books, 1998, p. 36.

8 Cynthia Gorney, Articles of faith: a frontline history of the abortion wars, New York, Simon and Schuster, 1998, pp. 151–2.

9 Risen and Thomas, op. cit., note 7 above, pp. 15–16, 36, 106.

10 Ibid., pp. 37–9.

11 Ibid., pp. 19, 39–40.

12 Carol Mason, Killing for life: the apocalyptic narrative of pro-life politics, Ithaca, Cornell University Press, 2002, p. 2; see also Kerry N Jacoby, Souls, bodies, spirits: the drive to abolish abortion since 1973, Westport, CT, Praeger, 1998, p. 154.

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14 Ravnihar, et al., op. cit., note 13 above, p. 301.

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16 Jose Russo and Irma H Russo, ‘Susceptibility of the mammary gland to carcinogenesis’, Am. J. Pathol., 1980, 100: 497–512, on pp. 497–8.

17 For an example of the continuing use of this study, see Barry Yeoman, ‘The scientist who hated abortion and did something about it’, Discover, Feb. 2003, 24: 54–9, on p. 56.

18 M C Pike, B E Henderson, J T Casagrande, I Rosario, and G E Gray, ‘Oral contraceptive use and early abortion as risk factors for breast cancer in young women’, Br. J. Cancer, 1981, 43: 72–6, on p. 72.

19 Ibid., pp. 75–6.

20 M P Vessey, K McPherson, D Yeates, and R Doll, ‘Oral contraceptive use and abortion before first term pregnancy in relation to breast cancer risk’, Br. J. Cancer, 1982, 45: 327–31, on p. 327.

21 Ibid., pp. 330–1, on p. 330.

22 M Ewertz and S W Duffy, ‘Risk of breast cancer in relation to reproductive factors in Denmark’, Br. J. Cancer, 1988, 58: 99–104, reported an increased risk in nulliparous women; and H Howe, R T Senie, H Bzduch, and P Herzfeld, ‘Early abortion and breast cancer risk of women under age 40’, Int. J. Epidemiol., 1989, 18: 300–4, reported an almost doubled risk among women with induced abortions. Studies which concluded that abortion did not result in a statistically significant elevation in risk include S P Helmrich, S Shapiro, L Rosenberg, D Kaufman, D Slone, C Bain, O Miettinen, P D Stolley, N Rosenshein, R C Knapp, T Leavitt Jr., D Schottenfeld, R. Engle Jr., and M Levy, ‘Risk factors for breast cancer’, Am. J. Epidemiol., 1983, 117: 35–45; C La Vecchia, A Decarli, F Parazzini, A Gentile, E Negri, G Cecchetti, and S Franceschi, ‘General epidemiology of breast cancer in northern Italy’, Int. J. Epidemiol., 1987, 16: 347–55; L Rosenberg, J R Palmer, D W Kaufman, B L Strom, D Schottenfeld, and S Shapiro, ‘Breast cancer in relation to the occurrence and time of induced and spontaneous abortion’, Am. J. Epidemiol., 1988, 127: 981–9; B-M Lindefors Harris, G Eklund, O Meirik, L E Rutqvist, and K Wiklund, ‘Risk of cancer of the breast after legal abortion during first trimester: a Swedish registry study’, Br. med. J., 9 Dec. 1989, 299: 1430–32; and F Parazzini, C La Vecchia, and E Negri, ‘Spontaneous and induced abortions and risk of breast cancer’, Int. J. Cancer, 1991, 48: 816–20. R S Paffenbarger Jr, J B Kampert, H-G Chang, ‘Characteristics that predict risk of breast cancer before and after the menopause’, Am. J. Epidemiol., 1980, 112: 258–68, found that risk was slightly lowered.

23 O C Hadjimichael, C A Boyle, and J W Meigs, ‘Abortion before first livebirth and risk of breast cancer’, Br. J. Cancer, 1986, 53: 281–4.

24 E White, J R Daling, T L Norsted, and J Chu, ‘Rising incidence of breast cancer among young women in Washington state’, J. Nat. Cancer Inst., Aug. 1987, 79: 239–43, on p. 241.

25 This misconception was later corrected; see P Velentgas and J R Daling, ‘Risk factors for breast cancer in younger women’, J. Nat. Cancer Inst. Monographs, 1994, 16: 15–24, on p. 15.

26 White, et al., op. cit., note 24 above, p. 239.

27 In 1989, two widely published studies reported conflicting results concerning younger women. See Lindefors Harris, et al., op. cit., note 22 above, p. 1430; Howe, et al., op. cit., note 22 above, p. 300.

28 N Krieger, ‘Social class and the black/white cross over in the age-specific incidence of breast cancer: a study linking census-derived data to population-based registry’, Am. J. Epidemiol., 1990, 131: 804–14, on pp. 804–5, 812.

29 A Laing, F M Demenais, R Williams, G Kissling, V Chen, and G Bonney, ‘Breast cancer risk factors in African-American women: the Howard University Tumor Registry experience’, J. Nat. med. Assoc., 1993, 85: 931–9.

30 J M McMullin, L R Chavez, F A Hubbell, ‘Knowledge, power and experience: variation in physicians’ perceptions of breast cancer risk factors', Med. Anthropol., 1996, 16: 295–317, on p. 306.

31 Risen and Thomas, op. cit., note 7 above, pp. 130, 241.

32 Mason, op. cit, note 12 above, p. 4.

33 Risen and Thomas, op. cit., note 7 above, p. 276.

34 David Garrow, Liberty and sexuality: the right to privacy and the making of Roe v Wade, Berkeley, University of California Press, 1998, pp. 705–14.

35 Risen and Thomas, op. cit., note 7 above, pp. 373–6.

36 For example, the president of Abortion Industry Monitor wrote that “Abortion…can explain many features of an otherwise mystifying worldwide breast cancer epidemic”. See Scott W Somerville, ‘Does abortion increase the risk of breast cancer?’, J. Med. Assoc. Georgia, 1994, 83: 209–10, p. 210.

37 P M Lantz and K M Booth, ‘The social construction of the breast cancer epidemic’, Soc. Sci. Med., 1998, 46: 907–18, on pp. 907–8; S E King and D Schottenfeld, ‘The “epidemic” of breast cancer in the US–determining the factors’, Oncology 1996, 10: 453–62; G Gigerenzer, Reckoning with risk: learning to live with uncertainty, London, Penguin, 2002, pp. 77–80. The National Cancer Institute confirmed that “No increases in breast cancer incidence were apparent in either black or white women less than 50 years old”; H L Howe, P A Wingo, M J Thun, L A G Ries, H M Rosenberg, E G Feigal, B K Edwards, ‘Annual report to the nation on the status of cancer (1973 through 1998), featuring cancers with recent increasing trends’, J. Nat. Cancer Inst., 6 June 2001, 93: 824–42, on p. 827.

38 Lantz and Booth, op. cit., note 37 above, pp. 910–17; see also D Lupton, ‘Femininity, responsibility, and the technological imperative: discourses on breast cancer in the Australian press’, Int. J. Health Services, 1994, 24: 73–89, on pp. 82–3.

39 Joel Brind, ‘Reading the data: defining a link between abortion and breast cancer’, Physician Magazine, July/August 2000, pp. 1–7, on pp. 2–4. This journal no longer has a printed version, and can only be found online; the address is: http://www.family.org/physmag/pastissues/A0012416.cfm (accessed 16 Oct. 2003). It was also circulated in pamphlet form by an organization called Focus on the Family. On the developing controversy involving Pike and others, see Troy Parkins, ‘Does abortion increase breast cancer risk?’, J. Nat. Cancer Inst., 15 Dec.1993, 85: 1987–8. Pike's research dealt with whether women could gain the protective effects of pregnancy through the use of hormones; for a critique, see Susan Rennie, ‘Imagine the profits if half the healthy population were put on yet another drug’, Ms., May/June 1993, 3: 42–6.

40 Joel Brind's web page, Department of Natural Sciences Faculty website, Baruch College, City University of New York, http://www.baruch.cuny.edu/wsas/departments/natural_science/faculty/brind.html (accessed 2 Nov. 2003).

41 J R Daling, K E Malone, L F Voigt, E White, and N S Weiss, ‘Risk of breast cancer among young women: relationship to induced abortion’, J. Nat. Cancer Inst., 2 Nov. 1994, 86: 1584–92, on p. 1584.

42 Ibid., pp. 1585–92.

43 Daling, et al., op. cit., note 41 above, p. 1592.

44 J R Daling, L A Brinton, L F Voigt, N S Weiss, R J Coates, K E Malone, J B Schoenberg, and M Gammon, ‘Risk of breast cancer among white women following induced abortion’, Am. J. Epidemiol., 15 Aug. 1996, 144: 373–80, on pp. 373, 375.

45 Lynn Rosenberg, ‘Induced abortion and breast cancer: more scientific data are needed’, J. Nat. Cancer Inst., 2 Nov. 1994, 86: 1569–70.

46 Christine Gorman, ‘Do abortions raise the risk of breast cancer?’, Time, 7 Nov. 1994, 144: 61.

47 Ibid.

48 Ibid.; R Rubin, ‘Linking abortion and breast cancer’, U.S. News and World Report, 7 Nov. 1994: 70.

49 Yeoman, op. cit., note 17 above, p. 59. The ads were removed in February 1996, but returned two years later following a higher court decision.

50 Bill Turque, ‘Aborted revolution?’, Newsweek, 12 Dec. 1994, 124: 38–40, on p. 40; Michael Castleman, ‘Abortion's risk,’, Mother Jones (March/April 1995), at http://www.motherjones.com/mother_jones/MA95/castleman.html (accessed 3 Nov. 2003). Neo-conservative Newt Gingrich became Speaker of the US House of Representatives in January 1995.

51 B M Lindefors-Harris, G Eklund, H O Adami, and O Meirik, ‘Response bias in a case-control study: analysis utilizing comparative data concerning legal abortions from two independent Swedish studies’, Am. J. Epidemiol., 1991, 134: 1003–8. See also E F Jones and J D Forrest, ‘Underreporting of abortion in surveys of U. S. women: 1976 to 1988’, Demography, 1992, 29: 113–26. Daling was involved in a later study which found no evidence of recall bias. See M T Tang, N S Weiss, J R Daling, and K E Malone, ‘Case-control differences in the reliability of reporting a history of induced abortions’, Am. J. Epidemiol., 2000, 151: 1139–43.

52 P A Newcomb, B E Storer, M P Longnecker, R Mittendorf, E R Greenberg, and W C Willett, ‘Pregnancy termination in relation to risk of breast cancer’, J. Am. med. Assoc., 1996, 275: 283–7, on p. 286; M A Rookus and F E van Leeuwen, ‘Induced abortion and risk for breast cancer: reporting (recall) bias in a Dutch case-control study’, J. Nat. Cancer Inst., 4 Dec. 1996, 88: 1759–64.

53 L Lipworth, K Katsouyanni, A Ekbom, K B Michels, and D Trichopoulos, ‘Abortion and the risk of breast cancer: a case-control study in Greece’, Int. J. Cancer, 1995, 61: 181–4, on p. 184; A Tavani, C La Vecchia, S Franceshci, E Negri, B D'Avanzo, and A Decarli, ‘Abortion and breast cancer’, Int. J. Cancer, 1996, 65: 401–5, on p. 404.

54 M D Gammon, J E Bertin, and M B Terry, ‘Abortion and the risk of breast cancer: is there a believable association?’, J. Am. med. Assoc., 24–31 Jan. 1996, 275: 321–2, on. p. 322.

55 See publications list, Joel Brind's website, op. cit., note 40 above.

56 W Wright, ‘The deceit behind RU-486: Who's really in control?’, Family Voice, Nov.–Dec. 2000, p. 2, at http://www.cwfa.org/familyvoice/2000-11/14-19.asp (accessed 5 Jan. 2002).

57 J Brind, V M Chinchilli, W B Severs, and Joan Summy-long, ‘Induced abortion as an independent risk factor for breast cancer: a comprehensive review and meta-analysis’, J. Epidemiol. Community Health, 1996, 50: 481–96. None of the authors was an epidemiologist. Severs and Summy-Long were endocrinologists and abortion opponents; Chinchilli was a statistician who later described how he tried to temper Brind's conclusions. See Yeoman, op. cit., note 17 above, p. 57.

58 Brind, et al., op. cit., note 57 above, p. 495. There was some evidence that patients were being advised of the possible risk. See M M Henderson and A McTiernan, ‘Clinical programs for breast cancer protection’, in Basil Stoll (ed.), Reducing breast cancer risk in women, Dordrecht, Kluwer Academic Publishers, 1995, p. 179; ‘Letters to the Editor’, regarding Lucille Canty, ‘Breast cancer risk: protective effect of an early first full-term pregnancy versus increased risk of induced abortion’, Oncol. Nurs. Forum, Nov.–Dec. 1997, 24: 1671–2.

59 K B Michels and W C Willett, ‘Does induced or spontaneous abortion affect the risk of breast cancer?’, Epidemiol., 1996, 7: 521–28, on p. 521. For a similar study by a team at the American Cancer Society, see P A Wingo, K Newsome, J S Marks, E E Calle, S L Parker, ‘The risk of breast cancer following spontaneous or induced abortion’, Cancer Causes and Control, 1997, 8: 93–108.

60 W J Cromie, ‘No sure link between abortion and breast cancer’, Harvard University Gazette, 24 Oct. 1996, http://www.news.harvard.edu/gazette/1996/10.24/NoSureLinkBetwe.html (accessed 24 March 2004).

61 D L Weed and B S Kramer, ‘Induced abortion, bias, and breast cancer: why epidemiology hasn't reached its limit’, J. Nat. Cancer Inst., 4 Dec. 1996, 88: 1698–99.

62 M Melbye, J Wohlfahrt, J H Olsen, M Frisch, T Westergaard, K Helweg-Larsen, and P K Andersen, ‘Induced abortion and the risk of breast cancer’, New Engl. J. Med., 9 Jan. 1997, 336: 81–5.

63 Ibid., p. 84.

64 P Hartge, ‘Abortion, breast cancer, and epidemiology’, New Engl. J. Med., 9 Jan. 1997, 336: 1278.

65 Melbye, et al., op. cit., note 62 above, p. 84.

66 L L Bartholomew and D A Grimes, ‘Focus on primary care: the alleged association between induced abortion and risk of breast cancer: biology or bias?’, Obstetric and Gynecological Survey, 1998, 53: 708–14.

67 Brind, op. cit., note 39 above, p. 5.

68 L Cannold, ‘Understanding and responding to anti-choice, women-centred strategies’, Reproductive Health Matters, May 2002, 10: 171–9.

69 Ibid., electronic version, pp. 4, 6.

70 ‘The development of the Breast Cancer Prevention Institute’, http://www.bcpinstitute.org/history.htm (accessed 2 Oct. 2003).

71 Breast Cancer Prevention Institute, ‘Breast cancer: risks and prevention’, http://www.bcpinstitute.org/booklet.htm (accessed 21 Oct. 2003).

72 Breast Cancer Prevention Institute, ‘Resources for breast cancer prevention’, http://www.bcinstitute.org/resources.htm (accessed 21 Oct. 2003).

73 Angela Lanfranchi, ‘Breast cancer and abortion: the facts’, The Age, 17 Feb. 2003, http://www.theage.com.au/articles/2003/02/16/1045330466585.html (accessed 22 March 2004).

74 Angela Lanfranchi, ‘Thirty years after Roe v. Wade, the abortion-breast cancer link, call to reason’, delivered at Georgetown University, 14 Nov. 2002, http://suewidemark.com/abclinkmdtalk.htm (accessed 16 Oct. 2003).

75 Coalition on Abortion/Breast Cancer, ‘About us’, http://www.abortionbreastcancer.com/About_Us.htm (accessed 10 Jan. 2004).

76 Coalition on Abortion/Breast Cancer, ‘The ABC summary: The coalition's history’, http://www.abortionbreastcancer.com/bc_summary.htm (accessed 23 June 2003).

77 Catherina Hurlburt, Concerned Women for America, ‘Spreading the truth about abortion’, 8 Dec. 2000, http://www.cwfa.org/articledisplay.asp?id=1454&department=CWA&categoryid=life (accessed 22 March 2004); People for the American Way, Right Wing Watch, Right Wing Organizations, http://www.pfaw.org/pfaw/general/efault.aspx?oid=3151 (accessed 10 Jan. 2004); Margaret A Woodbury, ‘Judge to rule on abortion, breast cancer link’, Women's eNews, 17 Feb. 2002, http://www.womensenews.org/article.cfm/dyn/aid/818/context/over/ (accessed 17 Jan. 2004).

78 ‘About us’, op. cit., note 75 above; see also John Kindley, ‘Abortion, breast cancer, and informed consent’, Issues in Law and Medicine, 2000, 15: 243–90.

79 Catherina Hurlburt, ‘If only she knew’, Concerned Women for America—Family Voice, Sept.–Oct. 2000, 1, http://www.cwfa.org/familyvoice/2000-09/16-21.asp (accessed 17 Feb. 2004).

80 ‘The ABC Summary’, op. cit., note 76 above.

81 Brind, op. cit., note 39 above, p. 6.

82 Breast Cancer Prevention Institute, pamphlet titled ‘The single most avoidable risk factor for breast cancer is…elective abortion’, n.d. http://www.bcpinstitute.org/brochure.htm.

83 R M Clark and T Chua, ‘Breast cancer and pregnancy: the ultimate challenge’, Clin. Oncol., 1989, 1: 11–18.

84 See E M Murray and I D Werner, ‘Pregnancy and abortion in breast cancer patients: two case reports and a literature review’, S. Afr. med. J., 1997, 87: 1538–9; K M Gwyn and R L Theriault, ‘Breast cancer during pregnancy’, Curr. Treat. Options Oncol., 2000, 1: 239–43; N A Pavlidis, ‘Coexistence of pregnancy and malignancy’, Oncologist, 2002, 7: 279–87. The fiction that women “who have full term pregnancies after a diagnosis of breast cancer have a far better survival rate than those who do choose to abort” is maintained on the Abortion/Breast Cancer Coalition website, see http://www.abortionbreastcancer.com/news/031029/ (accessed 7 Jan. 2004).

85 Life Lines News Archives, ‘Pro-Life group urges boycott of breast cancer postage stamps’, 1 March 2002, http://tennesseerighttolife.org/news_center/archives/03012002-01.htm (accessed 7 Jan. 2004).

86 Sexuality Information and Education Council of the United States, ‘Former congressman Tom Coburn scheduled to co-chair presidential AIDS council’, http://www.siecus.org/policy/PUpdates/Arch02/arch020001.html (accessed 22 Jan. 2004).

87 Lauren Slater, ‘Did abortion cause my breast cancer?’, Health, 6 Feb. 2004, 17: 142–5, on pp. 144–5.

88 Beth Jordan, ‘Weird science: if you want the truth about abortion and breast cancer, beware of the National Cancer Institute’, Ms. Magazine (June 2003), http://www.msmagazine.com/june03/jordan.asp (accessed 2 Oct. 2003); Oregon Right to Life, Life in Oregon, ‘Abortion/breast cancer link’, April–May 2003, 11, 1, http://www.ortl.org/life_in_oregon/03_04/abortion_cancer_link.html (accessed 2 Oct. 2003). See also National Cancer Institute, ‘Early reproductive events and breast cancer: workshop agenda, February 24–26, 2003’, http://www.cancer.gov/cancertopics/ere-workshop-agenda; Aaron Zitner, ‘Health research being politicized, critics charge’, Los Angeles Times, 23 Feb. 2003; Sally Squires, ‘Study discounts link between abortion, breast cancer risk’, Washington Post, 28 Feb. 2003, p. A11. For the NCI fact sheet as published after the conference, see National Cancer Institute, ‘Abortion, miscarriage, and breast cancer risk,’ Cancer Facts 03/21/2003, http://cis.nci.nih.gov/fact/3_75.htm.

89 B Yeoman, ‘The quiet war on abortion’, Mother Jones (Sept.–Oct. 2001), http://www.motherjones.com/news/feature/2001/09/abortion.html (accessed 24 March 2004).

90 W Chavkin, ‘Topics for our times: public health on the line—abortions and beyond’, Am. J. Public Health, Sept. 1996, 86: 1204–6.

91 Gammon, et al., op. cit., note 54 above, p. 322. The debate continues; see M Gallagher, ‘Minnesota right to know brochure now includes abortion-breast cancer link’, LifeNews.com (8 October 2003), http://www.prolifeinfo.com/state177.html (accessed 30 Oct. 2003); J Elliott, ‘Content of abortion information debated’, Houston Chronicle, 21 October 2003.

92 On this case, see Dave Andrusko, ‘Parental Notification Laws pass in Texas and Florida’, National Right to Life News, 10 June 1999, http://www.nrlc.org/news/1999/NRL699/bushes.html (accessed 24 March 2004); Bill Kaczor (Associated Press), ‘Supreme court strikes down parental notice abortion law’, 10 July 2003, http://www.ledger-enquirer.com/mld/ledgerenquirer/news/local/6276407.htm (accessed 14 Sept. 2003).

93 Joel Brind, ‘ABC in the courts: dramatic ABC testimony in Florida's Parental Notification appeal,’ Abortion-Breast Cancer Quarterly Update, Fall 1999, 2: 1; Joel Brind, ‘An important crack in the wall of denial occurs in Florida Parental Notification case’, National Right to Life News, 2000, http://www.nrlc.org/news/2000/NRL03/brind.html (accessed 26 June 2004); Breast Cancer Prevention Institute, pamphlet, op. cit., note 82 above.

94 Garrow, op. cit., note 34 above, pp. 715–16.

95 F B Charatan, ‘Abortion issue goes to U.S. courts’, Br. med. J., 22 April 1995, 310: 1025–6, on p. 1025.

96 ‘Coalition on abortion/breast cancer applauds Australian settlement’, Life Lines News, 31 Dec. 2001, Archives, http://tennesseerighttolife.org/news_center/archives/12312001-02.htm (accessed 26 Jan. 2004).

97 R Rubin, ‘Abortion and breast cancer: interpreting research makes debate difficult, a real “trial” impossible’, USA Today, 1 March 2001, p. 9D; P Wong, ‘Abortionist settles in landmark malpractice suit’, Concerned Women for America, 19 Nov. 2003, http://www.cwfa.org/articledisplay.as?id=4898&department=cwa&categoryid=life (accessed 17 Jan. 2004).

98 M A Woodbury, ‘Judge to rule on abortion, breast cancer link’, Women's eNews, 17 Feb. 2002, http://www.womensenews.org/article.cfm/dyn/aid/818/context/cover/ (accessed 7 Jan. 2004).

99 K J Lopez, ‘Who cares about women's health?’, NR Comment 1/22/01, http://www.nationalreview.com/nr_comment/nr_commentprint012201a.html (accessed 2 Nov. 2003); Linda Rosenthal, ‘North Dakota Supreme Court to consider abortion-breast cancer scare tactic’, Center for Reproductive Rights, 16 June 2003, http://www.crlp.org/crt_cen_brstcancerqa.html (accessed 2 Nov. 2003).

100 ‘Update: judges rules no link between abortion and breast cancer’, Minnesota Women's Press, Inc., 27 Mar. 2002, http://www.womenspress.com/newspaper/2002/18-1rrwc.html (accessed 2 Nov. 2003).

101 J Torres, ‘Abortion industry: the next target of tobacco-like lawsuits?’, CNSNews.com, 9 Aug. 2000, http://www.cnsnews.com/Nation/Archive/NAT20000809d.html (accessed 11 April 2005).

102 For briefs and other documents relating to the defense, see Center for Reproductive Rights, ‘Abortion breast cancer scare tactics’, 2 Nov. 2003, http://www.crlp.org/crt_cen_cancer.html (accessed 2 Nov. 2003).

103 ‘Update: judge rules no link’, op. cit., note 100 above.

104 Center for Reproductive Rights, ‘Judge rejects abortion-breast cancer scare tactic’, CRR Press, 28 March 2002, http://www.crlp.org/pr_02_0328ND.html (accessed 31 Oct. 2002).

105 S Ertelt, ‘Group condemns decision to dismiss abortion-breast cancer suit’, LifeNews.com 28 September 2003), http://www.lifenews.com/nat139.html (accessed 2 Nov. 2003).

106 D Andrusko, ‘Abortion-breast cancer connection beginning to have its day in court’, 2002, http://www.nrlc.org/news/2002/NRL04/dakota.html (accessed 18 Feb. 2004).

107 For example, see M Sanderson, X O Shu, F Jin, Q Dai, W Wen, Y Hua, Y T Gao, and W Zheng, ‘Abortion history and breast cancer risk: results from the Shanghai breast cancer study’, Int. J. Cancer, 2001, 92: 899–905; G Erlandsson, S M Montgomery, S Cnattingius, and A Ekbom, ‘Abortions and breast cancer: record-based case-control study’, Int. J. Cancer, 2003, 103: 676–9; X Paoletti and F Clavel-Chapelon, ‘Induced and spontaneous abortion and breast cancer risk: results from the E3N cohort study’, Int. J. Cancer, 2003, 106: 270–6.

108 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, 27 March 2004, 363: 1007–16. They also revisited the question of bias, in order to examine the effect of recall bias (by analysing retrospective and prospective studies separately), and to reduce the effect of publication bias (by including the results of unpublished studies).

109 Committee on Gynecologic Practice, American College of Obstetricians and Gynecologists, ‘ACOG committee opinion. Induced abortion and breast cancer risk’, Int. J. Gynecol. Obstet., 2003, 83: 233–5. In the UK, controversy erupted when the actuary Patrick Carroll published the results of a study by LIFE, an anti-abortion group. See BBC News, ‘Anger over abortion cancer study’, 5 Dec. 2001, http://news.bbc.co.uk/1/hi/health/1692144.stm (accessed 28 April 2004); P Carroll, abortion and other pregnancy-related risk factors in female breast cancer, London, Pension and Population Research Institute, 2001.

110 Slater, op. cit., note 87 above, pp. 144, 215.