Dr. Angle’s prescription

Republican U.S. Senate nominee Sharron Angle tried to enact legislation requiring physicians to tell women they could get breast cancer if they went ahead with abortions.

The Angle measure, Assembly Bill 580 of the 1999 Nevada Legislature, would have required doctors to tell women seeking abortions about “the scientifically reported link between an induced abortion and an increased risk of developing breast cancer later in life.”

There is no such link, according to the scientific consensus of that time, a consensus that endures today in spite of a substantial amount of pseudo-scientific material circulated by anti-abortion activists.

“As I recall the bill, the problem was that there was no science behind it,” said Nevada Medical Association executive director Lawrence Matheis.

Angle’s legislation read in part, “WHEREAS, Breast cancer is a life-threatening illness that may be precipitated by an induced abortion even years after the abortion is performed; and WHEREAS, There have been at least 22 scientific studies from 1957 to the present on induced abortion and breast cancer, and a majority of these scientific studies show that aborting any pregnancy, regardless of a woman’s age, increases her risk of developing breast cancer later in life…”

The alleged link, known informally as the ABC link, received a good deal of news coverage in the late 1980s and early ’90s, but by the time Angle introduced her legislation, the notion had been discredited.

The reference in the bill to 22 studies is difficult to assess because the measure does not name them. But all studies are not created equal, and in 1996 the Journal of the National Cancer Institute had criticized what it called “wish bias” in research, probably a shot at Joel Briand, a City College of New York biochemist who had undergone a religious conversion and publicly stated that he would put science in the service of his religion. “With a new belief in a meaningful universe, I felt compelled to use science for its noblest, life-saving purpose,” Brind wrote in a conservative evangelical publication. His subsequent “studies” fueled the debate on the ABC link thereafter.

But Angle’s use of studies to support the bill did not reflect the latest research. In the bill’s text, she cited the initial, 1994 round of a study in support of her measure while ignoring the subsequent, 1996 round, which did not support her claims. The research on this project was generated by a team headed by Janet Daling, an epidemiologist at the Fred Hutchinson Cancer Research Center at the University of Washington.

Assembly Bill 580 read, “The study published by Janet Daling, Kathleen Malone, Lynda Voight, Emily White and Noel Weiss in an article entitled ‘Risk of Breast Cancer Among Young Women: Relationship to Induced Abortion’ in the Journal of the National Cancer Institute in November 1994 concludes that for many minors, developing breast cancer later in life is too remote a risk to evaluate effectively when deciding whether to have an abortion and, therefore, a physician’s duty to warn minors is crucial, especially considering the medical research that has found an extremely elevated risk of breast cancer among girls under 18 years who have had an abortion.”

What Angle omitted from this section is that Daling’s 1994 study was preliminary, that Daling herself warned against using it to reach “a firm conclusion,” and that Daling and her team subsequently published a final, more in-depth study that found no ABC link.

In the Daling team’s follow-up study, published in the American Journal of Epidemiology in 1996 (three years before Angle’s legislation), it was reported that “there was no excess risk of breast cancer associated with induced abortion among parous women” (women who had borne one or more children) and that there were no other groups of women “in whom the relative risk associated with induced abortion is unusually high.”

In 1997, two years before Angle introduced her legislation, the New England Journal of Medicine published a huge Danish study of 1.5 million women born between 1935 and 1978 that found no link between abortion and breast cancer.

The ABC link initially was bandied about in scientific circles, prompted by some early surveys such as a 1950s Japanese study, without attracting much attention outside those circles. That debate was prompted by small early studies, but there was very little conclusive evidence. Eventually, in the late 1980s and early ’90s, abortion opponents picked up on the debate just as serious study was underway. In a 2005 article on the ABC link in the journal Medical History, Canadian scholar Patricia Jasen observed that uncooked scientific information is often used for political reasons by people who do not understand it or the terminology.

“In epidemiological literature, when interest in a potential risk factor is developing, its possible significance sometimes gains credibility from early, tentative evidence which seems to provide some shaky support for the hypothesis being tested,” Jasen wrote. “In this manner, a historical process begins, common in scientific research, whereby these early studies are cited again and again, without due attention to the context in which they were conducted, the validity of their results, or even the precise nature of their conclusions. This was very much the case with the abortion-breast cancer debate.”

Matheis said physicians are already required to inform patients of risk factors surrounding their care, factors that are better defined by physicians than politicians.

“In fact, that is [part of] the standard of care,” he said. “Failure to meet the standard of care is malpractice. So they’re supposed to give the latest information.”

By omitting the second Daling study, Angle’s bill used stale information.

The Angle bill was part of a nationwide effort over many years of trying to legislate obstacles to abortion. Nevada in 1985 enacted a parental consent law that was overturned by the courts. One of its supporters, Assembly Judiciary Committee chair Robert Sader, later withdrew his support because he concluded that it was part of a wider effort to deny access to abortion altogether. Subsequently, abortion opponents succeeded in enacting bills in South Dakota requiring doctors to inform women about the risks of abortion, in Oklahoma requiring doctors to perform ultrasounds and offer women detailed information about the tests, and in Georgia requiring three doctors and a hospital staff committee to approve an abortion procedure.

But such efforts largely came to an end in Nevada after the state’s voters in 1990 endorsed the state’s legal abortion law by 63 percent of the vote. Angle’s bill was an exception to that trend. The measure was virtually ignored by the legislators. According to legislative records, it did not get a hearing, and no votes were held.

It did, however, indicate a willingness on the part of the supposedly conservative Angle to use the power of government to intervene in the doctor/patient relationship.

Angle did not return calls seeking comment.