ABC goes to Australia, New Zealand


This past August, at the behest of the Melbourne, Australia-based women’s organization Endeavour Forum, I spent two weeks touring Australia and New Zealand giving public lectures and seminars to physicians and surgeons on the ABC link. It was a very intensive tour, as I spoke in Canberra, the nation’s capital, every Australian state capital (except the Northern Territory), and both islands of New Zealand. My visits were sponsored variously by a number of ‘pro-life, pro-family’ groups and local affiliates, as well as
Endeavour Forum.

In addition to a general summary of the issues involved, several of the stops highlighted particular aspects of the issue that made its relevance to the ABC link unique in some way.

In the Australian Capital Territory (ACT, where Canberra is), there was a recent political battle about a new abortion law which would require health warnings to be given to women seeking abortion. I had participated in the debate myself in the Australian media last fall, regarding the issue of including abortion on the list of potential health consequences (see Fall 1998 ABCQ Up date). As it turned out, ABC was not included in the statute after all, and the highlight of my visit to Canberra was a chance to brief
about 20 federal legislators on the ABC link. A 52-reference bibliography that I supplied was subsequently read into the official record (known as Hansard). This will make the issue harder for the Health Minister and other federal officials to avoid acknowledging.

The centerpiece of my visit to Melbourne (Victoria state) was a meeting and debate with Dr. Robert Burton, director of the Anti-Cancer Council of Victoria. Dr Burton is probably the highest-ranking voluntary anti-cancer organization administrator in Australia. He has also been one of the major detractors of the ABC link, and so it was quite an
accomplishment to have him agree to share the podium with me.

In my view, the most important part of the ABC link that is particularly relevant to Australia is the fact that the only published study with ABC data on Australian women21,
was published in 1988 without any mention of abortion. (It was primarily concerned with dietary risk factors, although all the other, reproductive factors were included.) Only
seven years later did the data from the original 1988 study of Rohan first appear22 and it turned out that induced abortion was in fact the strongest and most significant risk factor observed, with a relative risk of 2.6 (see Summer 1997 ABCQ Update).

Dr. Burton and I had already staked out our ground on ABC, with the Rohan study in the middle, through some correspondence this past spring and summer, and our debate presented a prime opportunity for a showdown. Sorry to say, Dr. Burton did then, and continues to the present, to stand on untenably contradictory ground.

Dr. Burton prefers to think that the main culprit in the breast cancer epidemic is cigarette smoke: Specifically, childhood exposure to passive smoke, followed by active smoking. Although many studies have looked at smoking and breast cancer, results have been truly contradictory, with some showing protective effects which are explainable in terms of smoking’s effect on estrogen metabolism. But Dr. Burton believes that cigarette smoke carcinogens actually cause breast cancer as well, and he rests this belief almost entirely on a recent study by Lash and Aschengrau23 of Boston University. Published in the American Journal of Epidemiology, this study shows a statistically significant relative risk of 7.5 for active smokers who were exposed to passive smoke before age 12. Although that is a strong relative risk estimate, two points are crucial to note: l) The raw (i.e., unadjusted) relative risk is only 2.74, and the astronomical magnitude of its statistical adjustment is not addressed in the paper; and 2) the statistic is based on only 26 breast cancer cases with this exposure (compared to 33 controls).

Meanwhile, Dr. Burton continues to justify the omission of the ABC data from the Rohan study, saying he "would be ashamed to publish that", because it is based on so few cases of breast cancer: 22 women? Moreover, the Rohan study was published in the context of several other studies showing similar data—even back in 1988.

Not surprisingly, there was a great deal of interest in my speaking on the topic in Adelaide, South Australia, since it was the women of Adelaide who were the subjects of
the original Rohan study. This journal will keep track of any developments that follow the exposure of the 7-year cover-up of these Australian data.

Moving on to Perth in Western Australia (WA), I spoke at a press conference to launch an excellent booklet put out by a coalition of doctors and lawyers called the "Doctors’ Legal Safeguards Group" (DLSG). The book let is essentially a counterweight to the booklet that is given to doctors (A much smaller one is given to patients.) by the WA
Health Dept., which purports to inform doctors about all the risks of abortion. The DLSG booklet has an excellent summary on the ABC link, compared to the Health Dept.’s
booklet, which is grossly misleading. I believe the DLSG is quite right to suggest that doctors who simply accept the Health Dept’s information will indeed end up in legal
trouble in referring for abortions. As I said at the press conference, the Health Dept. is most vulnerable for its reliance on the Danish study by Melbye et al.1, not so much
because it is fatally flawed, but because of the peculiarities of the new abortion law in WA. Essentially, abortion is available on demand before 20 weeks gestation, but after 20 weeks, an abortion must be approved by two physicians from a committee of six physicians. The trouble is that even the Melbye study acknowledges a significant risk increase of 89% beyond 18 weeks gestation. Hence, failure of doctors to inform patients seeking abortions beyond 20 weeks would be ignoring the findings of the study the Dept. of Health finds authoritative. It will be interesting to see if such patients are indeed in formed, or—if not—what legal consequences develop in WA.

In New Zealand, the most prominent current aspect of the ABC link is a recent study by McCredie et al24. of the University of Otago in Dunedin, NZ. (This study was reviewed in the Spring 1998 ABCQ Update.) Althouth the authors concluded: "Overall, there was no association with ... abortion (spontaneous or induced, whether considered together or separately) ", they do not show the data for induced abortion separately. Moreover, the fact that abortion (spontaneous or induced) before first full-term pregnancy shows a relative risk of 1.2 that is almost significant, hints at evidence of the link which the authors preferred to keep in the proverbial ‘file drawer’. There is
now an active correspondence between some concerned citizens and the NZ public health authorities in this matter.

The most thought-provoking part of the ABC tour down under was the five seminars I gave for doctors at their hospitals in Victoria and Queensland. One doctor remarked,
after hearing my talk, that "we’ll just have to put all the 12-year-olds on oral contraceptives". I replied that such a regimen also raises breast cancer risk, and that the
answer may be in adopting a more traditional value-oriented education. Or, I suggested getting the girls interested in marathon-running, which would reduce estrogen levels—in
many cases actually stopping menstrual cycling—and reduce breast cancer risk, and render the girls too tired to bother with boys.

At another seminar, one of the physicians expressed resentment at having to bear the bad tidings of breast cancer to patients who clearly had enough bad news. I agreed that this was indeed an unfair burden for doctors, but that this burden was a direct consequence of what Dr. Stuart Donnan called "excessive paternalistic censorship of the data"25 on the ABC link. and that this was one good reason for such censorship to end. -JB-