Abortion & Breast Cancer Hardest Case -- or Cruelest Myth?

We all know that abortion was marketed to American society through appeals based on the hard cases. The hardest of these is when the life of the mother is at stake.

Perhaps the most common indication for a "life of the mother" abortion is the diagnosis of breast cancer in a woman who is pregnant. Heart-rending stories of such cases appear with some regularity in the popular press, most recently last fall in the WebMD Medical News.

Author, Beatrice Motamedi describes the emotionally crushing scenario of "Jana," 38, who was finally pregnant after years of trying, including two years of fertility treatments. However, just three weeks after learning she was pregnant, Jana was diagnosed with an aggressive cancer in her breast.

Typically, the doctors recommended an abortion "to make sure that Jana could be treated as aggressively as possible" with chemotherapy, following surgical removal of the tumor. But "Jana said no," according to Motamedi.

Motamedi then discusses a little-known but highly important development: "a small but growing body of evidence indicates that women who are pregnant can be successfully treated for cancer without compromising the health of their unborn children."

In 1956, Drs. White and White reviewed the worldwide literature on "gestational breast cancer" (as this particular situation is referred to). Their conclusion, published in the Annals of Surgery, was that "no definite benefit could be claimed from therapeutic abortion."

Twenty years later, French doctor P. Juret wrote in his review of the literature that "the total inefficacy of therapeutic abortion is now certain." This conclusion was echoed in the 1980 German review of Schweppe et al.: "There is no medical indication for an abortion."

In 1977, Dr. William Donegan concluded in his review: "Most authorities now deny the value of therapeutic abortion and accumulating data substantiate this view."

But one would never guess, from reading the Web MD story, that such a conclusion had been reached and so long ago. Ironically, a major news event reported in Motamedi's article was the formation, by the Hospital for Sick Children in Toronto, of "an online registry aimed at collecting cases like Jana's and providing more information to women and their doctors."

The irony here is that in the same city of Toronto, the Princess Margaret Hospital has been chronicling such cases since 1931. Consequently, the Princess Margaret has by far the world's largest number of gestational breast cancer case histories. Most recently, Drs Clark and Chua reported on this series in 1989. In this paper, published in the journal Clinical Oncology, they reported on the fate of the 154 patients treated to date.

It should be noted that in gestational breast cancer, the cancer is usually discovered at an advanced stage (since symptoms are masked by the pregnancy), and the prognosis is generally poor. Thus, in the Toronto series, only 20 percent of the patients who carried their pregnancies to term were alive 20 years later. But strikingly, all 21 patients who had undergone "therapeutic abortion" were dead within eleven years!

But why, then, do so many doctors still recommend "therapeutic abortion"?

This question was best answered by Kaiser-Permanente surgeon Dr. Philip Nugent and colleagues in 1985: "Termination of pregnancy we would recommend in these (advanced cancer) groups, not because of the effect of the pregnancy on the breast cancer, but rather the detrimental effect the chemotherapy (or radiation therapy) may have on the fetus."

This widely prevalent line of thinking raises even an even more troubling question, to wit: How can medical practice in a civilized society countenance the use of the word "therapeutic" in the context of killing a fetus?

Notwithstanding the lack of a good answer to this question, there is yet another body of medical evidence which makes the question even more compelling. The unborn child demonstrates a remarkable capacity to withstand aggressive maternal cancer therapy without ill effect.

In her WebMD article, Motamedi reports on the 1999 publication of a series of patients at the MD Anderson Cancer Center in Houston, Texas. The Texas doctors reported that all 24 babies were delivered at term from gestational breast cancer patients, without any abnormalities.

Yet here again, the real news is that this is not news at all! In his excellent 1981 review of the effects on the fetus of cancer chemotherapeutic drugs, Dr. Hugh Barber of Lenox Hill Hospital in New York observed the following clear trends:

1) "After the first trimester, following the anlage (initial formation) for all organs, administration of anticancer drugs singly or in combination does not appear to increase the rate of congenital anomaly (birth defects)."

2) Although avoidance of chemotherapy in the first trimester is recommended, "the data reviewed herein do not indicate that harmful effects are inevitable. When chemotherapy is required in early pregnancy, the physician may be able to minimize the additional risk of congenital malformation by avoiding combination therapy or use of folic acid antagonists  such as methotrexate."

Hard data back up these conclusions. A lengthy 1983 review by Dr. Marc Wallack et al. of Washington University School of Medicine in St. Louis, Missouri, cited data from a 1968 review by Nicholson, which documented fetal outcome in 123 pregnancies in which chemotherapy had been given. >TXIn the 58 cases in which such therapy was given in the second or third trimester, all the babies were born normal. In the 55 cases in which chemotherapy (other than with folic acid antagonists, as noted above) was given in the first trimester, only four babies were born with abnormalities.

How about radiation therapy during pregnancy? Wallach et al. noted a similar fetal resistance to damage, citing reviews from the 1970s. They observed that the incidence of fetal abnormalities (mainly microcephaly, or decreased brain size) was uncommon after eight weeks' gestation, and "extremely rare" after 30 weeks. Human data are scant, Wallach et al. acknowledged, but they parallel the effects observed experimentally in rodents.

There is a corollary situation in which abortion is routinely recommended. That is the situation in which a woman who has previously been treated for breast cancer, and is in remission, becomes pregnant.

But here again, there is evidence--largely gathered by the same doctors who reported on gestational breast cancer--which indicates BETTER survival in women who keep their babies.

Thus, in 1977 W.L. Donegan reviewed four earlier studies dating back as far as 1956, and observed that "women who become pregnant subsequent to mastectomy survive surprisingly well, ... and often better than mastectomy patients overall." He also concluded that unless some other indication is present, "there is nothing to be gained therapeutically by interrupting the pregnancy."

Likewise, in 1980, K.W. Schweppe et al. reviewed data from the previous 40 years and concluded: "in cases of completed carcinoma therapy, the survival rates in women who became subsequently pregnant and stood through the entire period of gestation, are distinctly improved. There is no medical indication for an abortion."

Not surprisingly, in 1989 the Princess Margaret Hospital in Toronto reported on the largest series of such patients - - 122, to be exact. Of the 32 women who chose abortion, only eight (25%) were alive 20 years later. But of the 90 who carried the child to term, 50 (55%) were still alive 20 years after the delivery.

The statistics are indeed compelling, but there is also a sound biological basis to the beneficial effects of a full-term pregnancy, even when breast cancer has already occurred.

Although the first two trimesters see explosive, estrogen-driven proliferation of breast tissue (which can aggravate tumor growth), the last eight weeks provide a sort of "natural chemotherapy." This comes in the form of other hormones (and we're not sure yet exactly which ones they are) which cause the breast cells to differentiate into milk-producing tissue.

This process necessarily includes the switching off of the cells' capacity to multiply, leaving them permanently resistant to cancerous change. This theory has been widely accepted for decades as the explanation for the fact that a full-term pregnancy lowers a young woman's future breast cancer risk.

One wonders when the standards of clinical practice will be updated to reflect what is so clearly reflected in the medical literature. Educating doctors as to all the connections between abortion and breast cancer was a major impetus in the formation of the Breast Cancer Prevention Institute, which I founded with three physician colleagues in 1999.

It was, after all, over 20 years ago that Dr. Donegan, in reference to the proven futility of "therapeutic abortion," passed on the then 15-year-old advice of Byrd et al. "that rather than concentrating on terminating the pregnancy, physicians should direct their efforts toward terminating the cancer."

Joel Brind, Ph.D., is a professor of human biology and Endocrinology at Baruch College of the City University of New York. He is also founder and president of the Breast Cancer Institute at 9 Vassar St, Poughkeepsie, NY 12601, a non-profit, 501(c)(3) public charity. The institute may be contacted toll free at 1-86-NO CANCER (1-866-622-6237).>EN