There is no credible link between breast cancer and abortion. But the looming threat of developing the second-deadliest cancer in women is a more effective tool than most at preventing women from terminating a pregnancy, it would seem.
That is, at least, the handiest explanation for the Texas Department of State Health's decision to include a section on the breast cancer risks in a recently updated pamphlet on abortion being distributed by doctors in line with the state's "informed consent" policy, which mandates that physicians brief patients on the risks of terminating a pregnancy. State law requires that a link between breast cancer and abortion be mentioned "when medically accurate."
The pamphlet, titled "A Woman's Right to Know," warns readers:
Your pregnancy history affects your chances of getting breast cancer. If you give birth to your baby, you are less likely to develop breast cancer in the future. Research indicates that having an abortion will not provide you this increased protection against breast cancer. In addition, doctors and scientists are actively studying the complex biology of breast cancer to understand whether abortion may affect the risk of breast cancer. If you have a family history of breast cancer of breast disease, ask you doctor how your pregnancy will affect your risk of breast cancer.
It's true that doctors and scientists have studied this question, but their research efforts tend to end in the same answer: There is no link between elevated incidence of breast cancer and induced abortion. The American Cancer Society, the National Cancer Institute and the American College of Obstetricians and Gynecologists all agree on this point.
And yet, while the conclusion Texas draws about abortion and breast cancer — that one might cause the other — is unsubstantiated, the science behind it isn't wrong so much as irrelevant to the procedure at hand. As the ACS points out, women who give birth before the age of 20 tend to have lower breast cancer rates than women who never give birth or do so in their 30s, and women who carry more pregnancies to term also tend to have lower cancer risks. However, women who give birth after 30 may be more likely to develop breast cancer than those who never give birth at all.
In any case, it's invalid to suggest that if a woman of a certain age carries a pregnancy to term, she is less likely to develop breast cancer; thus, it'd be similarly invalid to suggest that if a woman does not carry a pregnancy to term, irrespective of her age, she is more likely to develop breast cancer. It's just shoddy logic.
A woman's pregnancy history is not decisive of her getting or not getting breast cancer, as "A Woman's Right to Know" suggests. The overwhelming majority of research, according to the ACS, has found that having an abortion has no effect on a woman's likelihood to develop the disease.
"We very carefully reviewed the booklet for accuracy and took to heart the feedback we received over the summer," Carrie Williams, chief press officer for the Texas Department of Health and Human Services, said in an emailed statement.
"Our focus was on making sure the booklet is helpful, user friendly and medically accurate, and we carefully studied the medical and scientific research available to us along the way," she continued. "In the end, it's about making sure pregnant women have access to the information they need to make the best decisions for themselves."
But the aim of informed consent seems more about increasing access to misinformation, with an eye to deterring women from terminating their pregnancies. Texas is far from the only state propagating misleading information about abortion: According to a Dec. 1 report from the Guttmacher Institute, 29 of the 35 states that require women receive counseling before an abortion determine the information said counseling will cover.
Of those, 28 mandate that the information be made available in written form, like the Texas pamphlet, sometimes given to the patient and sometimes offered. According to a separate Dec. 1 Guttmacher report, five states — Alaska, Kansas, Mississippi, Oklahoma and Texas — included misleading information on the link between breast cancer and abortion in their informed consent material, 12 states propagated misinformation about fetal pain and 9 purported that abortion was associated with lasting and detrimental mental health effects.
Texas' "A Woman's Right to Know" checks all three boxes, making specific mention of a suicide risk allegedly associated with abortion, warning that women might experience "depression or thoughts of suicide" after the procedure. Yet research suggests that most women who get abortions are confident in their decision going into the procedure and tend not to regret it later. And as the Guttmacher Institute reported, the American Psychological Association, academics and the U.K.'s Academy of Medical Royal college have all investigated the potential mental health damage abortion could do women. Again and again, researchers have come up empty-handed.
Fabricating risks isn't the only way states perpetuate false information. The Informed Consent Project at Rutgers University investigated the medical accuracy of informed consent materials in 23 states and found that 31% of the statements in those materials was medically inaccurate, most frequently when it came to the first trimester — incidentally, the period when the vast majority of abortions occur — and when it came to bodily descriptions. Embryos and fetuses were often painted as being far more mature than they were — Texas' pamphlet refers to both the embryo and the fetus as "your baby" — likely as a means of playing on women's emotions.
But the bottom line is that health care providers are obligated by state legislatures to wittingly provide patients with false information, flipping the concept of informed consent — the belief that a patient has a right to say what happens to their body, and should fully understand the potential costs and benefits of a procedure before agreeing to it — on its head. According to the Stanford Encyclopedia of Philosophy, the doctrine gained traction over the 20th century "in reaction to abuses" by doctors (for example, those that carried out wildly inhumane medical tests on involuntary subjects in Nazi Germany).
The predominant approach of medical professionals today, at least in the U.S., is to tell patients everything they need to know — the good, the bad and the gory — so that those patients can be comfortable with the bodily decisions they make.
"The whole point of informed consent is to provide medically accurate information and then to work with the patient to come up with a treatment plan that's agreeable to them," Dr. Diane Horvath-Cosper, a reproductive health advocacy fellow with Physicians for Reproductive Health, told Broadly. "If we're having to give people incorrect information and then saying, 'Well, you know, the state requires me to say this. It's not actually true,' it undermines the patients' confidence in us as providers."
Horvath-Cosper told the outlet that in her previous role at a South Dakota abortion provider she was obligated to inform patients that abortion was associated with increased risk of breast cancer and suicide — "false information," she said, which destroyed the possibility of trust between doctor and patient. It's also in all ways unnecessary, because as a medical professional she would discuss the risks and benefits of a procedure with a patient as a matter of course.
Practicing ethical medicine — and upholding the binding Hippocratic Oath of "Do no harm" — would not seem to be the point, though. The point is scaring women into carrying their pregnancies to term, adding another layer of difficulty to the decision to get an abortion. It's a particularly dubious move on Texas' part, the state that was at the center of the U.S. Supreme Court's most recent decision on abortion rights.
In Whole Woman's Health v. Hellerstedt, the court ruled that two common abortion restrictions — admitting privileges and the requirement that abortion clinics meet the standards of outpatient surgical facilities — posed undue burdens on women's right to safe and legal abortion, were unconstitutional.
But these are not the only two ways in which the state attempts to burden women seeking to end pregnancies — in Texas, a woman must wait 24 hours between her counseling session and procedure. She cannot legally terminate a pregnancy after 20 weeks (except in cases of rape, incest or threat to her life), despite the fact that abortion is legal until viability (23 or 24 weeks). She must receive an ultrasound before getting an abortion and, if she lives within 100 miles of the provider, wait 24 hours before having the procedure. Starting Dec. 19, providers will be obligated to bury or cremate aborted fetuses, which is expected to drastically increase the cost of the procedure, quite possibly putting it outside the financial reach of many women.
None of these provisions are medically necessary, and none exist to make abortion safer for women. The requirement that physicians knowingly give their patients false information cannot be construed as in the patient's best interests. It's just another undue burden on women.
Restrictions like these are in no way unique to Texas — other iterations have proliferated throughout the country as right-leaning states seek to find new ways around Roe v. Wade, the landmark 1973 Supreme Court decision that legalized abortion up to viability. The anti-abortion faction would argue that it's protecting women; that they should have all the facts before electing to do something they'll regret.
But as Texas' abortion pamphlet demonstrates, facts can be malleable things, molded to fit whatever conclusion the state deems best.