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 

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%)

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.

   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


 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:

12 Lang JM, Lieberman E, Cohen A.  A  Comparison 
   of Risk Factors for Preterm Labor and Term 
   Small-for-Gestational-Age Birth. Epidemiology  

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  

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

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