Letter to the editor of the Western Journal of Medicine Delayed birth equals more cancers and preterm births. Western Journal of Medicine. Brent Rooney. 2001;174;385-386 [The British Medical Group publishes the British Medical Journal and the Western Journal of Medicine] To the editor, Unknown to them, Stein and Susser, by advocating that is all right to delay birth into a woman's late 30's and early 40's, are encouraging more preterm births and more cancers for mothers.1 BREAST CANCER Consider "Alice" who is first time pregnant at age 20 years. Would it be all right if "Alice" "terminates" this pregnancy and eventually has a first birth, at say, age 35 years? Stein and Susser would have to agree that, in general, such a decision is fine and healthy. I would argue that when Alice signs the consent form for the termination, she should be informed that delaying her pregnancy by 10 to 15 years substantially increases her relative breast cancer risk. A 15-year delay in first full-term pregnancy increases relative breast cancer risk by 67.3% (absolute increase: 8.41%).2 Nancy Krieger wrote, "Conversely, early age at FFTP [First Full-Term Pregnancy] consistently has emerged as the strongest protective factor [against breast cancer]".3 A ten-year delay in age at first full- term pregnancy by terminating earlier pregnancy increases relative breast cancer risk by 41% (absolute increase: 5.13%) PRETERM BIRTH RISK Barbara Luke and Judith Lumley, recognized authorities in the field of premature births, have identified induced abortion as a risk factor for prematurity.4,5 In her book on preventing prematurity Luke discusses her belief that induced abortion leads to an "incompetent cervix,"(4) whereas Lumley believes that induced abortion causes intrauterine infection.5 In 1992 Janet Daling et al. reported that women with previous induced abortions had a 140% elevated risk of intraamniotic infection in subsequent pregnancies.6 To my knowledge at least 16 studies show that previous induced abortions boost risk of prematurity.5,7-21 Therefore, an elective procedure that Stein and Susser sanction increases the risks of breast cancer and subsequent preterm birth.22 Informed medical consent In both the United States and Canada induced abortion is legally considered to be an elective medical procedure.23 For an elective procedure even remote-1 in 100,000- risks of serious adverse side-effects must be disclosed on consent forms. The risks of breast cancer and preterm birth addressed in this letter are orders of magnitude higher than one in 100,000 and must be disclosed on abortion clinic consent forms.2-23 It is a scandal that these risks are not currently disclosed on such consent forms. "FIRST, DO NO HARM" Both medical practitioners and medical researchers have an ethical obligation to, "First, do no harm." For medical researchers this means not 'turning a blind eye' to very serious adverse side-effects. How does this specifically apply to the medical field in the current context? About 2 years ago Stephanie Carter, at the age of 17 years, had an induced abortion performed by Dr. Charles Benjamin. On the consent form the words "breast cancer" did not appear.24 Stephanie Carter has filed a law suit against Dr. Benjamin in a court of law alleging, in part, that Benjamin did not inform her of the breast cancer risks of that induced abortion.24 Brent Rooney Independent Medical Researcher Reduce Preterm Risk Coalition 3456 Dunbar St. (146) Vancouver, Canada V6S 2C2 [email protected] [web: www.vcn.bc.ca/~whatsup] West J Med 2001;174:385-386 .................................................................. References 1 Stein Z, Susser M. The risks of having children in later life. WJM 2000;175:295-296 2 Trichopoulos D, Hsieh CC, MacMahon B, Lin T, Lowe CR, Mirra AP, Ravnihar B, Salber EJ, Valaoras VG, Yussa S: Age at any birth and birth and breast cancer risk. Int J Cancer 1983;31:701-704 3 Krieger N. Exposure, susceptibility, and breast cancer risk. Breast Cancer Research and Treatment 1989;13:205-223 birth and breast cancer risk. Int J Cancer 1983;31:701-704 4 Luke B. Every Pregnant Woman's Guide To Preventing Premature Birth. 1995. (Publisher: Times Books, New York). 5 Lumley J. The association between prior spon- taneous abortion, prior induced abortion and preterm birth in first singleton births. Prenat Neonat Med 1998;3:21-24. 6 Daling JR, Krohn MA, Miscarriage or Termination in the Immediately Preceding Pregnancy Increases the Risk of Intraamniotic Infection in the Following Pregnancy. American J Epi 1992;136:1013 [SER Abstracts] 7 Zhou W, Sorenson HT, Olsen H. Induced Abortion and Subsequent Pregnancy Duration. Obstetrics & Gynecology 1999;94:948-953 8 Pickering RM, Forbes J. Risk of preterm delivery and small-for-gestational age infants following abortion: a population study. British J Obstetrics and Gynecology 1985;92:1106-1112 9 Michielutte R, Ernest JM, Moore ML, Meis PJ, Sharp PC, Wells HB, Buescher PA. A Comparison of Risk Assessment Models for Term and Preterm Low Birthweight. Preventive Medicine 1992;21:98-109 10 Berkowitz GS. An Epidemiologic Study of Preterm Delivery. American J Epidemiology 1981;113:81-92 11 Lieberman E, Ryan KJ, Monson RR, Schoenbaum SC. Risk Factors Accounting For Racial Differences in the rate of premature birth. NEJM 1987;317: 743-748 12 Lang JM, Lieberman E, Cohen A. A Comparison of Risk Factors for Preterm Labor and Term Small-for-Gestational-Age Birth. Epidemiology 1996;7:369-376 13 Mueller-Heubach E, Guzick DS. Evaluation of risk scoring in a preterm birth prevention study of indigent patients. Am J Obstetrics & Gyn 1989;160:829-837 14 Shiono PH, Lebanoff MA. Ethnic Differences and Very Preterm Delivery. Am J Public Health 1986;76:1317-1321 15 Pantelakis SN, Papadimitriou GC, Doxiadis SA. Influence of induced and spontaneous abortions on the outcome of subsequent pregnancies. Amer J Obstet Gynecol. 1973;116:799-805 16 Van Der Slikke JW, Treffers PE. Influence of induced abortion on gestational duration in subsequent pregnancies. BMJ 1978;1:270-272 [significantly increased risk of preterm birth under 32 weeks' gestation] 17 Richardson JA, Dixon G. Effect of legal termination on subsequent pregnancy. British Med J 1976;1:1303-1304 18 Pickering RM, Deeks JJ. Risks of Delivery during 20th to the 36th Week of Gestation. Intl. J Epidemiology 1991;20:456-466 19 Koller O, Eikhom SN. Late Sequelae of Induced Abortion in Primigravidae. Acta Obstet Gynecol Scand 1977;56:311-317 20 Bognar Z, Czeizel A. Mortality and Morbidity Associated with Legal Abortions in Hungary, 1960- 1973. AJPH 1976;66:568-575 21 Papaevangelou G, Vrettos AS, Papadatos D, Alexiou C. The Effect of Spontaneous and Induced Abortion on Prematurity and Birthweight. The J Obstetrics and Gynaecology of the British Commonwealth. May 1973;80:418-422 22 Rooney B. Racism, Poverty, Abortion, and Other Reproductive Outcomes. EPIDEMIOLOGY 2000;11:740-741 23 Picard EI, Robertson GB. Legal Liability of Doctors and Hospitals in Canada. 1996 (Publisher: Carswell) 24 Brind J. Case filed by PA teen for NJ abortion with no ABC warning. Abortion Breast Cancer Quarterly Update. 2000;4(2):3 & 8