As an oncologist, I feel frustrated on behalf of patients who harbour the fear that they somehow brought the cancer upon themselves by having an abortion
The incautious words of the Australian senator Eric Abetz linking abortion to breast cancer on a television show were still being digested when the calls began.
“Can I ask you something personal?” a patient asks.
“What’s the matter?”
“Do you think you could talk to my mother-in-law? She can’t stop hinting that my breast cancer is related to my previous abortion – it’s making me upset and worried that she now won’t help.”
I listen in disbelief as she continues, “I am sorry I hid it from you but I had an abortion years ago when I lost my job, couldn’t afford rent, and felt insecure about the future. I am not religious but it’s awful enough to be considered a sinner without being told that the breast cancer is a by-product of that decision.”
“Firstly, I don’t need to know about your abortion”, I say, thinking furiously about how to salvage the situation quickly. “Secondly, there is no plausible scientific evidence to back this claim. We can discuss how to approach your family but please be clear on one thing – although old reports exist, there is no proven link between abortion and breast cancer.”
The prolonged silence prompts me to ask if she is still there.
“But a senator said this”, she replies. “I mean, they have access to all kinds of fact-checks and he was on national TV. Could it be that he knows something doctors don’t?” I can almost hear the misgivings creep into her tone.
It’s my turn to plead with her. “I am not shielding you from the truth, in fact the opposite. I can show you extensive and reputable research that quashes this theory. You have reasons to be upset but this shouldn’t be one. Your abortion did not cause your breast cancer.”
“Okay”, she says, leaving me in no doubt that my reassurance has done little to assuage her distress. I feel frustrated not only on behalf of my patient but countless other women who harbour the fear that they somehow brought the cancer upon themselves.
The senator’s words are not merely incautious; I believe they demonstrate a striking lack of judgement as to how mere sound bites uttered by powerful people can affect ordinary individuals who, like my patient, have neither the time nor the wherewithal to conduct a meaningful study of the published research and arrive at their own conclusion.
Elevating radical, religiously driven ideology to the same platform as methodically studied, scientific evidence and then claiming that distinguished professional bodies such as the Australian Medical Association, the American Cancer Society and the World Health Organisation can agree to disagree is not merely careless; it is downright disingenuous. In my experience, such words can cause immediate consternation and sow longer-term doubts in the minds of patients.
Abortions and breast cancer are both common to women. The Better Health Channel Victoria states a 2005 estimate of between 70,000 and 80,000 abortions in Australia annually. Cancer Australia estimates that in 2014, just over 15,000 women will be newly diagnosed with breast cancer. With improved treatment, many will join the approximately 160,000 survivors. The question at the front of every patient’s mind is what causes cancer.
While there is a well-established association between smoking and cancer, it remains frustrating but true for many cancers that their trigger is yet undisclosed, waiting for research to illuminate us. Amidst the maelstrom of emotions usually associated with a cancer diagnosis, who would want to add shame, disgust and self-condemnation to the list? Yet, this is precisely what the senator’s comments might achieve for many current patients who are already vulnerable to the suggestion that something other than a random genetic event triggered their cancer.
Every day in my office, I hear men and women with cancer blame themselves. Could it be the stress, they wonder, from their son’s messy divorce or their grandchild’s drug addiction? Maybe it was their diet or exercise which they let slip away. Perhaps it was the strong chemicals from the factory next door or the pollutants in the local water supply. Now, there will be abortion on the list, steering an already emotive conversation into an unnecessary direction. I fear that it will nibble away time from discussing other vital and relevant issues that would actually help patients.
An even greater concern is the way in which this false assertion will continue to creep stealthily into public consciousness long after the media storm has dissipated. For this, one only has to turn to the furore created by a publication in the Lancet linking childhood vaccination to autism. The research was quickly discredited, the paper was partially, then fully retracted, and finally, the researcher was struck off the medical register in 2010. The full dismantling took 12 years and the scientific community was throughout at pains to disavow the fraudulent research. Yet, to this day, the issue is a live one in mothers’ groups and on parenting blogs, clothed as a dilemma for conscientious parents who invoke a global conspiracy theory while dismissing their doctors’ evidence-based advice that childhood immunisation saves lives. It takes enormous work to undo the results of a false assertion.
Nulliparity, or the lack of any childbearing, is understood to be associated with a slightly higher risk of breast cancer. Nuns experience breast cancer more commonly than other groups of women. However, nulliparity is not the same as abortion and the medical community has worked diligently over the years to disprove the link between abortion and breast cancer. Oncologists do not ask about abortion when assessing risk factors for breast cancer. They do not factor in a history of abortion in their cancer management plan. Their practice won’t change as a result of the senator’s comments but a woman’s extent of silent guilt may well do.
Later reports suggest that the remarks were unfairly edited and the senator feels “sheepish”. Unsurprisingly, medical bodies have reacted strongly and angrily to the remarks. The acute anger has to do with the ridiculous content of the claim but those of us who regularly counsel cancer patients also feel dismayed by the undermining of medical integrity that went along with it. We will have to work hard at reassuring women that abortion and breast cancer are not linked.