For ease newcomers following along , please consult the glossary of terms that I’ve written to make the terminology very understandable. Also, consult the post that explains the essential background
Today’s paper is actually Saturday’s post. I seized a last minute opportunity to drive to Boston with my son to attend the BC-Notre Dame football game, and was busy all day yesterday. So today’s article, which covers a great deal of ground, will be considered in two posts to make the reading more manageable.
Title: Risk Factors for Triple-Negative Breast Cancer in Women
Under the Age of 45 Years
Authors: Jessica M. Dolle,1 Janet R. Daling,1 Emily White,1,3 Louise A. Brinton,4 David R. Doody,1 Peggy L. Porter,2 and Kathleen E. Malone1,3
Divisions of 1Public Health Sciences and 2Human Biology, Fred Hutchinson Cancer Research Center; 3Department of Epidemiology, University of
Washington, Seattle, Washington; and 4Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
Journal: Cancer Epidemiology Biomarkers and Prevention 2009;18(4): 1157-1166
The current study investigates the etiologic (causal) factors for triple negative breast cancer, which is an extremely aggressive form of the disease. The cancer cells are negative for estrogen receptor/progesterone receptor/human epidermal growth factor. I won’t be delving into the molecular biology of the disease in the posts in order to keep the focus of the project. However, we can discuss anything in the comments below.
The paper uses the data on patients from two previous population-based, case-control studies by the authors in the early 1990’s:
17. White E, Malone KE, Weiss NS, Daling JR. Breast cancer among
young United States women in relation to oral contraceptive use.
J Natl Cancer Inst 1994;86:505 – 14.
18. Daling JR, Malone KE, Voigt LF, White E, Weiss NS. Risk of breast
cancer among young women: relationship to induced abortion. J Natl
Cancer Inst 1994;86:1584 – 92.
“In-person interviews of comparable format, covering a broad range of risk factors that included lifestyle/demographic factors, reproductive history, and oral contraceptive use, were administered to participants in both studies. Tumor specimens were obtained for 1,019 of the 1,286 cases with invasive breast cancer who were accrued in the two previous studies. Tissue collection, pathology review, and testing for prognostic markers have been discussed previously.”
Tissue samples taken from the tumors in those women were frozen for future study and analyzed in the current study.
As we shall see in this 2009 paper, the risks for BC arising from induced abortion are consistent with earlier findings from the authors, and in the literature we have examined to date. In a sleight of hand that carries no merit in the scientific community, the authors seek to indemnify Dr. Louise Brinton from responsibility for the data refuting her NCI panel’s declaration that there is no credible link between induced abortion and BC. They note at the bottom of the first page:
“ Note: J.M. Dolle had full access to all of the data in the study and takes responsibility
for the integrity of the data and the accuracy of the data analysis.”
While it is true that in large collaborative studies such as this one not every author can rigorously argue and defend every aspect of the study, it is nevertheless accepted that signing one’s name to the submitted paper is an indication that one takes ownership of ALL the data and stated conclusions. Thus the disclaimer may well make Dolle the principle author for a defense of the end-product of data analysis, but Louise Brinton has given her implicit agreement with Dolle’s contribution, and is thus responsible for now placing herself in the untenable position of either needing to withdraw thia paper, or withdraw her 2003 NCI “Fact Sheet”.
The note does not simply direct questions about the data analysis to Dolle. It suggests that she bears the responsibility for the data analysis in a manner that is disproportionate to the ownership of that analysis by every author who subscribed their name.
In this study, the authors boast of its robust size (which is no larger than most of the other retrospective studies claiming an ABC link) as being a strength:
“We undertook this study to evaluate the contribution of known and suspected breast cancer risk factors to triple-negative breast cancer in a large population-based study.” (pg. 1158)
“Our study has the strength of being population based and is the largest of its kind to evaluate breast cancer subtypes and etiologic differences in young women.” (pg. 1165)
These are important claims, as the authors invalidate the critique suggestive that only huge prospective studies involving scores of thousands to hundreds of thousands of subjects have the strength of numbers for making claims such as an ABC link. Further, if the authors dismiss the self-reports of women as regards abortion, then why would they have cause to believe the integrity of those self-reports regarding anything else? The authors list the known risk factors for BC, including OC use and induced abortion:
“In analyses of all 897 breast cancer cases (subtypes combined), the multivariate-adjusted odds ratios for examined risk factors were consistent with the effects observed in previous studies on younger women (Table 1). Specifically, older age, family history of breast cancer, earlier menarche age, induced abortion, and oral contraceptive use were associated with an increased risk for breast cancer. Risk was decreased in relation to greater number of births and younger age at first birth. Oral contraceptive use >1 year was associated with a modest increased risk for breast cancer, and among oral contraceptive users only, earlier age at first use further elevated the risk.” (1162-1163)
This statement validates all that we have covered together up until this point in our analysis of the literature, and Dr. Louise Brinton has accepted ownership of this statement. We shall consider this all in greater detail in Part II.
Coming Home 
“Oral contraceptive use >1 year was associated with a modest increased risk for breast cancer, and among oral contraceptive users only, earlier age at first use further elevated the risk.”
I thought this was interesting since many young girls are put on the pill by their mothers/doctors. 😦
I, too, found the part about the pill interesting, since I was on it from 16 (I was certainly not put on it by my pro-life mother, though!). I would like to know more, because in a few years, it’s quite possible I will be giving advice about contraception to my own teenage daughter.
I also wonder about the effects of all the soy I consume here in Japan, which some studies suggest could be raising my BC risks, and others suggest could be lowering it.
L.,
The Steinem generation may be aging, but they hold the reigns to publication and grant funding. Worse yet, they have mentored a generation of like-minded acolytes who will not cede the ill-gotten ground handed to them by their mentors. Part of the third wave mentality is that early contraception and delayed childbearing are the most logical means toward having it all. OC’s, delayed childbearing and abortion in the event of failed contraception all set these women up for frighteningly high increased risk of BC.
Stay tuned for part three on the pill’s effects. It’s eye-popping.
“Part of the third wave mentality is that early contraception and delayed childbearing are the most logical means toward having it all. ”
Again — I invite you to read more on third-wave feminism before you make statments like the one above.
Most young women today probably know a few older women undergoing fertility treatments, and can see for themselves that delayed childbearing sometimes means no childbearing.
And a U.S. Government Accountability Office study released just last month showed that there is no pay gap between men and childless women, but a significant gap between men (with or without children) and mothers. The MSM reaction to this study that I observed was not, “Women should stop having children,” but rather, “We need to make more policies to help working mothers.”
What is “having it all,” anyway? “All” means different things to different people.
And oral contraception had its critics even among second-wave feminists — have you ever heard of Barbara Seaman?
http://en.wikipedia.org/wiki/Barbara_Seaman
L.,
Contrary to popular opinion, I really don’t live in a desert cave 😉
I have ample family and friends in academia, government and the corporate world, and have spent decades there myself. I don’t see the repudiation of Steinem’s means to achieve success. Rather, oral contraception, condoms, and abortion are accepted as part of the fabric as women advance themselves. Those repudiating OC’s and abortion are derided as extremists, such as your humble host.
Perhaps your long years in academia, Dr. Nadal, exposed you to the more extreme elements? 🙂
All I’m saying is that the feminist agenda doesn’t move in lockstep anymore (and arguably, it never did, but there’s even more variation of opinion these days).
While reproductive choices are generally perceived as positive, I think informed consent is a big part of this.
My pro-life, Catholic mother, for instance, started taking the pill (or something like it) in 1967. Her choices were either undergoing a hysterectomy to stop her severe dysfunctional uterine bleeding, or trying hormone supplements and keeping her reproductive organs. She had a degree in chemistry, so she read up on the risks first, and continued to follow the subject as new data became available.
Those who seek to outlaw all contraception are extemists. But those who study and promote the risks thereof do a public service.
And those who oppose abortion on moral grounds are not extemists, either — they are a significant percentage of the population.
On the other hand, the pro-life side doesn’t move in lockstep, either. A Gallup poll taken in July showed 47% of Americans called themselves “pro-life” and 46% “pro-choice.” But the same polled showed that more than 57% thought abortion should be “legal under certain circumstances” — that doesn’t sound like “pro-life” to me. (http://www.gallup.com/poll/122033/u.s.-abortion-attitudes-closely-divided.aspx )
L.,
Academia is where the firebrands nestled in for a reason. They form the intellects of the teachers, scientists, politicians, medical professionals, etc. The research is done in academia. The editors and peer reviewers are all academics. Over 90% voted for Clinton and Obama, which tells you that they are not representative of the nation, but are the radicals who control research and intellectual formation.
I welcome any feminism that is open to the truth of science and is willing to militate for public health policy predicated on the truth in the data. I’m not holding my breath.
I hope you clicked on the Barbara Seaman link.
I consider myself a feminist, and yet I would have been a very bad fit in academia. Heck, when I lived in San Francisco, I was right of center.
And if academics really control intellectual formation, wouldn’t over 90% of the higher-educated population have voted for Clinton and Obama? Besides, presidential voting is a poor indicator of whether someone is “radical,” since there are so few choices. My conservative father held his nose and voted for Obama just because he thought he was the lesser of the two evils.
Thankfully, the electorate matures as time goes on. However, far too many students fall victim to the propaganda and bullying while still in school. That’s where OC’s and abortion do their greatest damage. Tell dad to write me in next time. He’ll only have to hold one nostril 🙂
Hope all is well overseas!
I think that over time, as people develop more solid opinions, they also develop more nuanced opinions — and my father is a good example.
He’s approaching 70, and over my lifetime, I have watched his views evolve on feminism, civil rights for homosexuals, interracial/interfaith marriage (thank GOD for that one!), and women working outside the home. I would still characterize him as very conservative, but he views many issues on a case-by-case basis now.
(He also rejects the Catholic Church as an institution, and has stopped going to mass, because of the sex scandals. He gives 10% of his income to a local homeless shelter instead.)
And sorry, but it might be too late for him to write you in as a candidate in the next presidential election — he lives in Nevada and insists he is going to vote for Sharron Angle, so my mother says she might have to kill him. 😉
“I have watched his views evolve on feminism, civil rights for homosexuals, interracial/interfaith marriage (thank GOD for that one!), and women working outside the home.”
ah yes, that’s right. Those of us who believe women might WANT and DESIRE to work in the home are neanderthals and haven’t evolved AT ALL. You really must watch your language more L. You betray yourself every time! 😉
I would imagine your prolife Catholic mother must be rather full of consternation after having learned that her pills may have caused her to have many abortions. (unless of course she was too old to get pregnant) And she couldn’t have been reading the lit, because most of the effects about the pill were white-washed in the 1960’s in order to get it approved. Scientists in the late ’50’s knew there were serious side-effects to the pill.
“Those who seek to outlaw all contraception are extemists. But those who study and promote the risks thereof do a public service.”
yup that’s me! 🙂 And proud of it too!
Contraception is THE single most important factor that leads to abortion. Contraception creates the mindset that the couple is not expecting the conception of a child. Almost 50% of abortions occur in couples using some form of contraception. In the other cases, abortion is not used as back-up birth control. It is THE principal form of birth control for these women.
But we’ve been over all this before.
I do predict there will come a day when contraception will be very difficult to come by.
“While reproductive choices are generally perceived as positive, I think informed consent is a big part of this. ”
“reproductive choices” include the option to murder one’s child. The only reason this is perceived as a positive thing is because the women’s movement has sold a lie to its sisters. It told us first that we carried blobs of cells. Now it tells us that babies can’t feel pain (as if that makes a difference), aren’t sentient (????) and now lately that yes babies are people but women walking around have more rights than persons at an earlier stage in their development who can’t defend themselves.
We’ve come a long way baby! 😦
*******************
Part of the third wave mentality is that early contraception and delayed childbearing are the most logical means toward having it all.
Couldn’t agree more!
Except that now women are finding out that they can’t have it all if they do it this way.
Unless they are willing to accept major medical interventions into their lives, sometimes at great financial and bodily cost.
Some doctors are not telling women, if they want to have a family the best time is when they are in their 20’s. And some women ARE paying attention.
🙂
My mother knew there were serious side effects to hormones, but decided severe bleeding was worth risking them. As for the possible abortificiant effects of the pill, I have no idea what my mother thought, since she was both a pro-life Catholic and a scientist herself. Unfortunately, I am not close enough to my mother to discuss details like this, but I assume that she had reason to believe she wasn’t ovulating, or I can’t imagine she would have opted to take it.
“I do predict there will come a day when contraception will be very difficult to come by.” — > Really? I doubt this very much, but if does come to pass, I would certainly contribute to the resistance, and be a collaborator with the “diaphragm underground.”
“Those of us who believe women might WANT and DESIRE to work in the home are neanderthals and haven’t evolved AT ALL. You really must watch your language more L. You betray yourself every time!” —>
I was talking about my father’s opinions evolving, not the women themselves evolving. Please read my entire sentences, not just a few words, before you jump to your conclusions.
Besides, since I have said in previous comments that I was a stay-at-home mom for many years myself, and have a daughter who aspires to be a wife and mother (and not work outside the home if she can help it), there is nothing to “betray” on this particular subject. You can take offense at plenty of my other statements, but there’s really nothing in that one.
“I do predict there will come a day when contraception will be very difficult to come by.” — > Really? I doubt this very much”
it WILL come about because quite simply there will not be enough people to run society and government.
A country that has a below replacement birth-rate is a dying nation as many European countries are now discovering.
If people won’t voluntarily begin to have families again, the state will look at other measures that will help rebuild their countries otherwise they will see their nations absorbed and their culture lost.
One way will be to restrict the availability of contraception.
And not to worry L; you won’t be around to witness the rebirth of reason, virtue and self-sacrifice. 🙂
“If people won’t voluntarily begin to have families again, the state will look at other measures that will help rebuild their countries otherwise they will see their nations absorbed and their culture lost.
One way will be to restrict the availability of contraception.”
Yes, this plan worked SO well in Ceausescu’s Romania.