Exercise, Estrogen, Cancer, and... Jello?

Headlines across the country today announce, "Exercise Can Ease Pain from Breast Cancer Drugs" (USA Today), "Exercise Helps Women Tolerate Breast Cancer Drugs (Boston Globe), "Exercise Eases Common Breast Cancer Treatment Side Effect" (Huffington Post).  Dr. Jennifer Ligibel, at the Susan F. Smith for Women's Cancers at Dana-Farber, just presented her findings on exercise at a major breast cancer symposium. The study is good news for women with breast cancer or at high risk of cancer--and for Dr. Joel Brind, who has a double interest in the results.

The study explored whether regular, supervised exercise might help reduce the aches and pains that tempt so many breast cancer patients to stop taking the estrogen-blocking drugs they need to fight tumors. Women who exercised regularly claimed 20% less joint pain, while a control group that followed normal daily activities claimed 3% less pain. Less pain equals more gain for women whose lives may depend on their ability to gag down a drug that makes them ache all over.

The science behind these cancer drugs is simple--estrogen is the "gasoline" of female physiology. On the one hand, it's what keeps the human race alive--but it has its dangers. In particular, estrogen causes certain types of breast tissue to reproduce rapidly. Women with estrogen-sensitive tumors (as well as women who have no tumors yet but are at high risk of developing them) can be helped with drugs which the body from using estrogen (such as Tamoxifen) or that keep estrogen from being produced in the first place ("aromatase inhibitors" like Letrozole).

That is no surprise to Dr. Brind, who made headlines of his own in 1993 when he claimed that women who choose abortion are more likely to develop breast cancer. Abortion leaves women awash in the estrogen of early pregnancy without the protective effects of third-trimester hormones. (If estrogen is like gasoline, third-trimester hormones are like rain that puts out the fires.) Brind (a professor of human biology and endocrinology at Baruch College of the City University of New York) thought he was just doing science when he connected the dots between research on rats, research on humans, and increasing breast cancer rates around the world. To his dismay, the vast majority of endocrinologists, breast cancer researchers, and women's health advocates rejected his reasoning, even though study after study shows a modest increase in breast cancer risk after induced abortion.

Dr. Brind found himself back in the news recently when Chinese researchers reported a statistically significant 44% increase in breast cancer risk after one or more abortions. Dr.Yubei Huang's "meta-analysis" aggregated data from 37 different studies in China, and found a consistent "dose-response relationship" that greatly strengthens the importance of the findings. Pro-life groups spread the word to their audiences, but the report got little play in big media.

What mainstream coverage that there was downplayed the link, insisting that the Chinese team used a "notoriously misleading method" that depended on women's personal accounts of their abortion history instead of official abortion records. The "recall bias" argument claims that women with cancer are more likely to tell the truth about something as personal as abortion, whereas healthy women might be tempted to conceal their past. This hypothetical bias has been put to the test by Dr. Janet Daling, of Fred Hutchinson Cancer Research Center in Seattle, who included a "control group" of women with cervical cancer to find out whether they showed a link to abortion. If "recall bias" created a false association between abortion and breast cancer, it should create the same mirage with cervical cancer. Dr. Daling found no relationship between abortion and cervical cancer (proving that in her study, at least, healthy women were not lying about their abortions), and a 50% increase in breast cancer risk among young women who chose abortion.

That should have put the so-called "recall bias" argument to rest--but when it comes to abortion, science takes a back seat to politics. Brind was mocked, attacked, and eventually outvoted at a 2003 conference at the National Institute of Health. The abortion/breast cancer link was dead. The science was settled. Those who argue that abortion increases the risk of breast cancer are now in the same category as those who deny that humans cause global warming.

So--what does a professional endocrinologist do after the National Institute of Health tells him to sit down, shut up, and stop talking about the effect of estrogen on breast tissue? In Brind's case, he keeps on researching. Dr. Brind started studying amino acid metabolism and discovered that a single amino acid--glycine--has a big effect on aches and pains. As it turns out, chicken soup is good for more than the soul--the proteins in chicken broth are rich in glycine, and they really do relieve the symptoms of the common cold. Brind encourages people with chronic pain to eat more jello, drink more soup, or use "Sweetamine," his own glycine-based supplement.

Which brings us back to today's news. Several hours of exercise each week may help women take their cancer drugs because it reduces joint pain by 20%. What if a daily dose of sweetamine reduces joint pain even more? Exercise is good in its own right, but if it is only a means to the end of helping women tolerate their medication, sweetamine might be far better. It's easy to make sure women take their sweetamine each day. It's hard to crack the whip to make them exercise!

It should be obvious what the next research project ought to be. Somebody needs to compare three groups of women: some taking sweetamine, some who exercise, and a "control group" of women who do neither. If sweetamine reduces joint pain more than exercise does, it may well be prescribed along with the estrogen-blockers it enables women to take.

This world is a funny place. We might yet see the very experts who mocked Brind's claim that estrogen raises the risk of cancer prescribe his remedy for the aches caused by estrogen-blockers!

Affordable Care for More Americans

This blog has explored how Obamacare affects Americans with serious illnesses such as multiple sclerosis, end-stage kidney disease, and AIDS, and earlier discussed its effect on Medicaid recipients. I'm tired of complaining about what doesn't work. How about a post on what would?

We've tried meeting America's health care needs through big business (any company that can insure millions against a risk as expensive as cancer is "big" by any definition). Now we're trying to meet America's needs through a loveless marriage between big business and big government--but the honeymoon is over and the bride is talking to her lawyer. Progressives who held their noses to support Obamacare are now pushing for big government to do the job alone, through a single-payer system. While that makes sense (to them) in theory, the latest polls suggest that putting it into practice could be impossible for the time being.

Those polls suggest that neither the Republicans nor Democrats will have a commanding majority before 2016, leaving Obamacare the law of the land no matter how many "glitches" affect how many Americans. Big goals (repeal and replace! Switch to single payer!) will fire up the base on the left and right, but that won't help middle-of-the-road, middle-class folks for the next three years. We aren't going to get anything that can guarantee affordable care for all Americans--so how about finding something that would provide affordable care for more Americans? Especially if all we have to do is find something that works and make it work better?

There is already something that works. Obamacare provides an explicit exemption for healthcare sharing ministries ("healthshares"). Senator Max Baucus of Montana included a provision that recognizes not-for-profit healthshares as a valid way to comply with the Patient Protection and Affordable Care Act. That provision, which can be found at 26 USC 5000A(d)(2)(b), allows certain tax-deductible charities to share the costs of medical care among people with shared religious or ethical beliefs. More than 170,000 families currently participate in the three groups that were intentionally grandfathered in (Medi-Share, Samaritan Ministries, and Christian Healthcare Ministries) and membership seems to be rising since the new law took effect.

Healthshares aren't big business or big government, but they have been successful at meeting needs for more than thirty years. Between what members share and donors give, they have paid the bills for hundreds of thousands of patients--despite the fact that they are prohibited by law from paying salesmen, setting specific underwriting amounts, or using many of the other tools that the insurance industry has developed to serve their customers. Healthshares have succeeded with no direct government assistance and without the tools that insurance companies use--because members helping members is a better way to pay.

The Secular Coalition for America opposed Senator Baucus' plan to include healthshares in the law--but not because they disagree with healthshares. They wrote:

For centuries, numerous mutual aid societies in the United States have sponsored insurance and social services organized around a shared ethnic background, occupation, geographical region or religion. For example, in 1787 African Americans released from slavery organized a nondenominational benefit society called the "Free African Society of Philadelphia." By stating that only people belonging to religious mutual aid societies can be exempt from mandated health insurance this provision privileges Christian Americans over non-Christian Americans.

I couldn't agree more. That's why we need a Federal Health Union Act, which would amend the language of 26 USC 5000A(d)(2)(b) to include any not-for-profit organization united by any shared interests with an objective effect on health. Under such a law, Vegans as well as Hindus could share the health savings of a meat-free diet, while smokers could band together to cover their care without paying the 50% penalty Obamacare imposes.

Expanding healthshares to Vegans and smokers would make the law more just, but to make it more effective we need two additional changes. First, healthshares need to be able to use the same tools that health insurance companies need without apologizing for it or dancing around state regulations. Healthshares need to be expressly exempt from state insurance regulations in the same way that federal credit unions are exempt from state banking regulations.

That is why the Federal Health Union Act would be directly modeled on the Federal Credit Union Act of 1934, which created federally-chartered not-for-profit credit unions during the banking crisis of the Great Depression. The National Credit Union Association has been able to keep credit unions serving customers for many years--and a National HealthShare Association could ensure financial stability and consumer protection for not-for-profit health cooperatives.

The problem with allowing healthshares to compete directly with for-profit plans is that insurance companies are now required to accept all comers, even those with pre-existing conditions. This drives up the cost of healthcare, but low-income Americans are offered subsidies to help them cover the cost of these "free-market plans." If healthshares don't have to pay for pre-existing conditions, they won't be competing with for-profit plans--they'll be taking advantage of them. On the other hand, if plans sold on the exchange get subsidies and healthshares don't, it's the insurance companies that are taking the advantage.

The Federal Health Union Act funds pre-existing conditions and low-income insurance without forcing anybody to buy anything they don't want or pay for anything they detest. It does so through a "matching-funds" approach to fund-raising. Taxpayers who donate money to a federally-chartered healthshare will be eligible for a 50% tax credit for their gift. This saves taxpayers money (it costs taxpayers 50 cents to subsidize the poor and sick) and takes the politics out of healthcare. The Susan G. Komen Foundation could raise a lot more money for breast cancer in a very short time--and so could patients with less politically-prominent diseases, like Lyme Disease and multiple sclerosis.

Changing the tax law is not a simple matter--but in this case, it would be worth it. Medicare is a financial time bomb, and Medicaid has even more problems. Among other things, changes to Medicaid are raising the demand for healthcare while cutting the supply. Tax credits for healthshares could move millions of people off Medicaid onto non-profit plans, especially if not-for-profit hospitals can operate their own healthshare. A hospital healthshare could dramatically reduce the number of uninsured patients in a service area, reducing the amount that other patients pay. With a 50-cent-on-the-dollar tax credit, local businesses would have every reason to build good will by helping out their neighbors.

That's all it takes to provide affordable care for more Americans, including the poor, sick, and elderly. All we have to do is (a) expand healthshares, (b) allow them to compete directly with for-profit insurers, and (c) save 50 cents on donated dollars. It's a plan that Americans can understand, politicians can support, and the President can sign.

I hope to share this with my Senator (Joe Manchin of West Virginia) and Congresswoman (Shelley Moore Capito) at the earliest opportunity. If you think your representative might be interested in co-sponsoring such legislation, leave a comment explaining why. If we all work hard and work together, we can help millions of our neighbors in distress.

Obamacare and AIDS

One would assume that if anybody should benefit from Obama's changes to the healthcare laws, it would be people with AIDS. HIV positive people have been lobbying for government assistance since the nature of the disease first became evident in the 1980s, and Democratic politicians have led the charge to find a cure--or at least a treatment--for a disease that now affects millions of people, heterosexual and homosexual alike, around the world.

So it comes as something of a shock to learn that AIDS advocates are unhappy with Obamacare, as the Washington Post notes today:

But people who expected the new plans to provide pharmaceutical coverage comparable with that of employer-sponsored plans have been disappointed. In recent years, employers have compelled workers to pick up a growing share of the costs, especially for brand-name drugs. But insurers selling policies on the exchanges have pared their drug benefits significantly more, according to health advocates, patients and industry analysts. The plans are curbing their lists of covered drugs and limiting quantities, requiring prior authorizations and insisting on “fail first” or “step therapy” protocols that compel doctors to prescribe a certain drug first before moving on to another — even if it’s not the physician’s and patient’s drug of choice.

The disruption to the existing market leaves many AIDS patients who were covered worse off than they were before:

Paul Prince, 52, a former information technology manager from Houston, said he was surprised that some of the health plans in the new federal marketplace wouldn’t pay for one or more of his HIV medications. The policy that seemed to provide the best coverage, he said, would cover only about two-thirds of his monthly $2,400 drug tab, leaving him responsible for $840.

“There was no way I could pay that,” said Prince, who is studying to become a teacher after being laid off from his previous job and losing his insurance.

Insurers have responded Obamacare's prohibition against discrimination on the basis of pre-existing conditions by cutting costly benefits--like expensive drugs.  The Post cites a study by Avalere Health:

A new analysis of health plans sold in the federal exchange — which covers 36 states — and 14 state exchanges found that the benefits tend to be skimpier than in most other private insurance in the United States, with drug benefits a particular weak spot.

Right now, this only affects the 5% of Americans who get their insurance on the individual market, but the Post reports that many employers are already thinking about cutting costs the same way.

Dan Mendelson, Avalere’s chief executive, predicted that employers may soon adapt some of the benefit designs in the exchanges’ health plans. “We are already seeing interest,” he said, because they are less expensive for companies, shifting more of the expense to patients.

The Washington Post article makes it clear that (a) this problem affects a larger group of illnesses, including cancer, multiple sclerosis, rheumatoid arthritis and autoimmune disease and (b) AIDS activists are working hard to change the rules to solve the problem--for people with HIV.

If you care about someone with AIDS, read the Washington Post article and pass it on.

If you care about someone with cancer, multiple sclerosis, rheumatoid arthritis, autoimmune disease, or another disease that involves expensive medications, you may want to subscribe to this blog.

Healthcare and Kidney Failure

America is the most generous nation on earth. Of course, we are also the richest nation on earth, so we ought to be.  How about giving until hurts? How about giving something money can't buy--like a kidney?

Over 600,000 Americans suffered from end stage kidney disease in 2008, and the number is rising. Kidneys are the body's toxic waste disposal units--a mission so critical that God gave us two of them. If one fails, the other is there for back-up. If both kidneys fail, the only option is to pipe the blood out of the body through a dialysis machine that does the filtering for them or get a kidney transplant.  More than 50,000 living people have given a kidney to save a life. I am proud to claim one of them in my own extended family.  My niece's brother-in-law has one less kidney and one more brother than he would have had without modern medicine. Thanks to that heroism, my nephew hopes to live as long as any other American.

With only 6,000 living donors each year and 10,000 kidneys from other sources, most end-stage kidney disease patients depend on dialysis. According to official figures reported in the New York Times, in 2008 over 380,000 Americans were receiving dialysis, at a cost of just under $40 billion.

Kidney failure is the only chronic disease that automatically qualifies an individual for Medicare, regardless of age. According to the American Kidney Fund, other Medicare patients can choose to continue their own private insurance as long as they are willing to pay for it, but dialysis patients are limited to 30 months of coverage under an employer-provided plan even if that plan offers better care than Medicare.

It gets worse for transplant patients. The American Kidney Fund reports:

Patients who receive a kidney transplant must take anti-rejection or immunosuppressive drugs for the life of their kidney transplant. However, Medicare will only pay for these drugs--which average $17,000 per year--for the first 36 months after a patient receives their transplant. Patients who are unable to pay for the medications are often forced to discontinue their use, resulting in kidney rejection and a return to Medicare-covered dialysis treatments at an annual cost of nearly $71,000 per patient.

That's rough on my nephew, but now there's Obamacare--or is there? Millions of Americans who were expecting more security and better care have been unsettled by the spectacular failure of HealthCare.gov.  How does the new system work for kidney patients?

It isn't clear.

I visited HealthCare.gov to see whether kidney patients who are currently on Medicare can sign up for private insurance through the new exchanges. The online search tools told me all about Medicare and assured me that the new law would not take away my Medicare but had nothing to say about people who want off Medicare and on to private insurance that can no longer discriminate against people with pre-existing conditions.

So I called the 800 number and got the automated menu as I expected. One push of the "0" button broke me out of my robocall and I quickly got a very pleasant person who looked up the same articles I had been reading as she tried to figure out the answer with me. "Amanda" (not her real name) was able to tell me that it is illegal to sell insurance to somebody who is on Medicare (except for supplemental policies like Medicare Advantage). She figured out that a person who is eligible for Medicare (such as a kidney patient) is not eligible for any of the Obamacare subsidies. She couldn't say whether the system would allow a person who is currently on Medicare to pay their own way for a private plan.

Medicare.gov assures me that Obamacare won't take away my Medicare and offers me free colonoscopies. Their website indirectly alludes to $700 billion in cuts in Medicare through this optimistic paragraph:

The ACA ensures the protection of Medicare for years to come. The life of the Medicare Trust fund will be extended to at least 2029—a 12-year extension due to reductions in waste, fraud and abuse, and Medicare costs, which will provide you with future savings on your premiums and coinsurance.

Medicare's 800 number employs more robots than HealthCare.gov and insists that I type in my Medicare number. I could cheat and use my Mom's number, but that would be wrong. "If you do not have your Medicare number, you may wish to hang up." I hang up.

Searching for "Can Medicare patients choose Obamacare" gives me tons of hits--and they all promise me that I won't lose my Medicare. As far as I can tell, somebody at the very top made it clear that if you like your Medicare, you can keep your Medicare. (With so many people making the same promise, it sounds like this could turn into a post of its own, but that's for another day.)

How about Medicare supplemental insurance? That's usually the right answer for a person who wants more than Medicare. Now things get more troubling. According to "Beth" (not her real name), there are no options for "end of life treatment" for kidney failure in Minnesota. I'm hoping that doesn't mean what I think it means. Perhaps Beth got confused--it's a confusing situation. Fortunately, Beth's doctor in Saint Paul (who is as shocked as I am) is trying to find the answers. 

I hope there's a better answer for kidney patients than I've found yet. If you think I've stumbled onto the famous "death panels" here, you're wrong. Somebody is going to have to reduce the costs of all this care some time, and "death panels" may be the most accurate description of the body that tackles that terrible task, but this is just bureaucracy as usual. There should be a right answer to this question--we just haven't found it yet.

I appeal to readers from all points on the political spectrum to help out Beth. How does a patient with end-stage kidney disease take advantage of the new law? If Obamacare doesn't help them, are there private alternatives that do? Let's put our brains together, people, and make this world a better place!

Obamacare and Multiple Sclerosis

Obamacare was always expected to result in some "winners" and some "losers." The argument for the new law was that some people (especially the young and healthy) should pay a little more so that other people (the old and sick) could get the help they need. It's troubling to discover that some of the people who may get hurt the worst are those who are the sickest.

Approximately five percent of multiple sclerosis sufferers (those who were covered by individual insurance policies) have begun to discover how Obamacare affects them personally. Whitney Johnson had a policy that covered her medical bills even though they added up to $350,000 per year. Her existing insurance was cancelled and she was invited to pick a new policy from HealthCare.gov. She had not been able to get what she needed through the Exchange, so she went directly to her insurer--only to discover that all her new options were unaffordable.  She writes:

I know I have five more IVIG treatments coming up over the next six months that cost $40,000 each. My insurance coverage ends in December, and I have to have these treatments. As a mother with a brand new baby, it’s a little unnerving to know that I may not be able to receive the care I need. It’s a little unnerving to know my health insurance that was working just fine for me was taken from me. The doctors I have used for years that have kept me this healthy will be taken from me.

Whitney is one of "small percentage" who have had their policies cancelled, but many more Americans with MS will be affected next November, when employer-provided policies must comply with the new law.  The Multiple Scerosis Association of America highlights the particular questions MS patients need to consider. These include:

• Are my needed medications covered, and what are my costs?
• Can I keep my doctor and are there restrictions on which doctors I can choose?
• What plans can I afford and am eligible for?
• Can I afford my deductible?
• What are my expected out-of-pocket costs for equipment I may need?
• Do I have to try lower-cost medications before I will be approved for the drugs I use now?

Forbes Magazine worked through the cost of MS medications in today's article, "No, You Can't Keep Your Drugs Either Under Obamacare."

Take, for example, the drug Copaxone for multiple sclerosis.

Someone on a bronze plan would be responsible for paying about 40% of the drug’s costs out of pocket, on average. That comes out to about $1,980 a month.

If you buy the highest cost platinum plan, the out of pocket costs drop to $792 a month.

But you’re probably better off with the cheaper bronze plan anyway. Since you’re going to hit your out of pocket cap regardless of your plan, you might as well save money on the premium (which doesn’t count against your deductible or out of pocket limits) and race to the $12,700 spending cap as quickly as your family can.

After all, the provider networks used by low cost bronze and high cost platinum plans are often the same. The only thing that varies between different “metal” plans is often the co-pay structure. The benefits are similar. So why pay higher premiums just to lower your co-pays when you know you’ll hit the out of pocket limits anyway.

By purchasing a costlier, gold or platinum plan, you typically can’t buy up the benefit much, if at all. What you’re doing is just prepaying the cost sharing.

That's assuming the drug you use is on the government's "formulary list, the list of drugs that are included in Obamacare. Even if it is on the government list, it may not be on your plan's list. Betaseron, for example, will not be available through ExpressScripts starting January 1. Forbes notes the out-of-pocket effects:

If the drug isn’t on this formulary list, then the patient could be responsible for its full cost (with little or no co-insurance to help offset that cost). Moreover, the money they spend won’t count against their deductibles or out of pocket limits ($12,700 for a family, $6,350 for an individual).

If you are an MS patient who has adequate employer-provided insurance today, don't wait until next November to find out how this works for you. Talk to your human resources department soon! If your employer is even thinking about changing your plan, call Washington! (All you need is your zipcode to find your Congressman, and you can find your Senators here.)

Not one single elected official wants you to lose coverage--but it's up to people with MS and the people who love them to help busy politicians understand the implications of this law. Whether you're Republican, Democrat, or terminally-turned-off by all things political, please speak out and spread the word!

Does Childbirth Cause Cancer?

There's no scientific debate on this one--women who give birth have an increased risk of breast cancer for the next fifteen years. Journals reporting this link include:

• New England Journal of Medicine (1994)
• American Journal of Epidemiology (2000)
• Cancer Causes Control (2002)

Why haven't you heard about this? First, because it's only temporary, and second, because the overall effect of childbirth is to reduce a women's lifetime risk. Young women have a very low risk of breast cancer, so a small increase in a very low risk is not a big problem. Older women have a much greater risk of breast cancer, so a long-term reduction in risk makes a big difference. That's why having children is generally associated with lower breast cancer risk.

 That's good news. But it leaves us with two questions. Why does breast cancer risk go up after childbirth? Why does it go down again after 15 years?

Jose and Irma Russo, of Fox Chase Cancer Center in Philadelphia, have done countless studies on the physiology of breast tissue. They have demonstrated that breast tissue specializes during the latter stages of pregnancy, leaving mature tissue at a lower risk of cancer. The early stages of pregnancy, by contrast, are a time of rapid cell division. (Women who have had babies know about this--tender breasts are one of the earliest signs of pregnancy.) These rapidly-replicating cells are a higher risk of mutation.

The prime suspect for the transient risk after childbirth is estrogen.  Estrogen helps prepare a woman's body for birth. It is the "gasoline" that keeps the human race going--but gasoline can be dangerous. All it takes is a spark to create an explosion. If you add enough estrogen to just one abnormal breast cell you can grow a tumor.

The good news is that the hormones of later pregnancy may actually stop some tumors in their tracks. The research to date is consistent with research on rats which indicates that tumors which have already begun to grow are redirected into normal tissue. (If you enjoyed biology in high school, read this article--it spells out the mechanism by which stem cells of one type are converted to another, and zeroes in on the precise tissue types that are at risk in early pregnancy.) If estrogen is the "gasoline" that catches fire, the hormones of later pregnancy are "rain" that puts fires out.

These are plausible answers to our two questions (why does risk go up after childbirth? Why does it go down after 15 years?), but if they turn out to be correct, they lead directly to a third question. What happens if a woman's breast cancer risk is raised by early pregnancy without the protective effect of later pregnancy? What if there's gasoline but no rain?

Research on rats proves that an interrupted pregnancy confers no protective effect. How about humans? If women have an elevated risk after any pregnancy (not just a full-term pregnancy), then women who choose abortions should have an elevated risk for at least 15 years after the procedure, just like other women who were pregnant. Carefully designed studies of breast cancer in young women find exactly that. Dr. Janet Daling, of Seattle's Fred Hutchinson Cancer Research Center, found:

Among women who had been pregnant at least once, the risk of breast cancer in those who had experienced an induced abortion was 50% higher than among other women (95% CI = 1.2-1.9). While this increased risk did not vary by the number of induced abortions or by the history of a completed pregnancy, it did vary according to the age at which the abortion occurred and the duration of that pregnancy. Highest risks were observed when the abortion was done at ages younger than 18 years—particularly if it took place after 8 weeks' gestation—or at 30 years of age or older. 

To answer the question posed by the title: childbirth does not cause cancer. Pregnancy does--in the sense that it adds "gasoline" that can burst into flame. Full-term pregnancy is the rain that puts fires out and reduces the risk of fire thereafter.

Chinese Breast Cancer Trends

The latest meta-analysis from China shows that breast cancer is 44% more likely among Chinese women who have had one or more abortions. Critics claim this study is flawed because it relies on "case-control studies" which match a woman with cancer to a woman without cancer. The "recall bias" theory holds that women with cancer tend to tell the truth about their abortion history, while healthy women tend to conceal their abortions--even in China, where abortion is anything but "a private matter between a woman and her doctor."

It is easy to put the recall bias theory to the test. China has traditionally had a low breast cancer rate (only one out of forty Chinese women expect to get the disease, a mere fraction of the American rate).  If abortion does not increase the risk of breast cancer, tens of millions of Chinese abortions should have no impact on cancer incidence in China. But breast cancer in China is rising, and rising rapidly, as this public service simulation from General Electric shows.

This could be mere coincidence. Logicians recognize the post hoc ergo propter hoc fallacy--"after something, therefore because of something." There could be other causes of China's rising cancer rate. Oral contraceptives are known to have carcinogenic effects--but less than 2% of Chinese women have access to the Pill.

Perhaps pollutants are causing the increase. When the pesticide DDT breaks down to DDE, it mimics some of the effects of estrogen, leading some researchers to suspect it as a cause of cancer. China used to use DDT extensively in agriculture. If DDT caused breast cancer, one would expect peasant women in China to have elevated rates, while urban women might be spared. If abortion increases the risk of cancer, the results should be the opposite, because urban women in China are more likely to abort than peasant women are. As it turns out, breast cancer rates are rising more rapidly among urban women in China than among peasants.

Something is causing Chinese breast cancer cases to rise. It isn't the Pill, and it isn't DDT. What, then?

The latest meta-analysis says that women who choose abortion are 44% more likely to get breast cancer than do those that don't. Multiply that small number by millions and you get exactly what China is now experiencing--a rise in breast cancer all over the country with the highest rates in the urban centers.