Breast Cancer
In a case-control study of 534 histologically confirmed cases of breast cancer in Chinese women in Shanghai compared to an equal number of age and sex-matched population controls, early age at menarche was positively associated with breast cancer. In contrast, early age at first full term pregnancy, high parity, and long duration of nursing were each negatively associated with breast cancer. Other risk factors for breast cancer included high average body weight especially among women over age 6O, use of oral contraceptives after age 45, personal history of benign breast disease, and history of breast cancer in first degree female relatives. Multivariate analysis showed that each of these risk or protective factors was independently related to breast cancer.43 Similar results were also found in a Taiwanese study.44 The incidence of breast cancer among women in Shanghai has been increasing. During 1972-74 the reported incidence was 18.3 per 10O,000 women. In 199O, the reported incidence was 28.5 per 10O,000 women. Among the stated reasons for an increase were late first newborn and sparsity of giving birth.45
A case-control study of breast cancer in Harbin, China during 1990-1992 among women younger than 45 years of age found a statistically significant increased risk of 2.9 for women who had experienced an induced abortion relative to women without an induced abortion, and an increased risk of 3.6 for women with two or more induced abortions compared to women without an induced abortion. The increased risk was somewhat higher among women diagnosed for breast cancer at age 35 or less compared to older women.46 (Table 4)
| Table 4 | |
| Induced Abortion as a Risk Factor for Breast Cancer, Harbin, China, 1990-1992 | |
| Relative Risk and 95% Confidence Inverval | |
| No prior induced abortion | 1.0 reference |
| One prior induced abortion | 2.9 (1.9 - 4.4) |
| Two or more prior induced abortion | 3.6 (2.2 - 6.0) |
| Women 35 years of less | 4.5 (1.9 - 10.7) |
| Women more than 35 | 2.4 (1.5 - 3.9) |
Ovarian Cancer
A case-control study in Beijing, China by researchers at Peking Union Medical College compared 112 pathologically confirmed epithelial ovarian cancer cases with 224 community matched controls. It was found that compared to nulliparous women, subjects with one, two, or three full-term pregnancies were at 50%, 70% and 90% reduced risk for epithelial ovarian cancer, respectively.47 The findings of this study are consistent with various Western studies which have also found that childbirth is protective against ovarian cancer compared to nulliparous women.48
Cervical Dysplasia
Researchers at the National Taiwan University conducted a questionnaire survey of 17,047 women who lived in the Taipei metropolitan area of Taiwan and who attended an area family planning service in 1991-1992 The survey included reproductive history and Pap smear history. Some 46% of the women had a history of having had an induced abortion with 54.8% of these women with one abortion, 29.7% with two abortions and 15.5% with three or more abortions. Some 55% of the women had a normal Pap smear, 44% had an atypical finding, and 0.9% had dysplasia. The odds ratio for dysplasia significantly increased with the number of prior induced abortions from 17%,34% and 60% with one, two and three or more prior induced abortions respectively, compared to women with no prior induced abortion. The authors concluded that induced abortion has harmful effects on maternal health.49
Poor quality cancer treatment
The quality of treatment for recurrence, persistence or death from various gynecologic malignant tumors was studied in 61 Chinese hospitals between 1983-1993. It was found that pathological grading was not performed in 56.52% of the cases. In malignant tumors requiring surgical treatment, inappropriate operations were performed for 81.68% of ovarian carcinomas, 64.38% of cervical carcinoma, and 70.08% of women with endometrial cancer. Insufficient chemotherapy was found in 55.47% of ovarian cancer cases and 38.31% of cases of choriocarcinoma and malignant mole. Insufficient dosages of radiotherapy were found in 54.90% of cases of cervical cancer.50
Two studies reported considerably higher smoking rates among women in Hong Kong with a history of one or more induced abortions compared to women with no abortion history. In a case-control study conducted at a university teaching hospital in Hong Kong between 1985 and 1989, among chinese women with a history of two or more induced abortions who delivered, 13.0% were smokers compared to only 1.4% smokers among women with no abortion history who delivered.51 In another Hong Kong hospital-based study during 1993-1996, 39% of teenage mothers (age 13-19) with a history of induced abortion who delivered were smokers compared to 14.4% smokers among teenage mothers who delivered but had with no induced abortion history.52
The higher incidence of smoking among Chinese postabortion women compared to women with other pregnancy outcomes is consistent with U.S. and European studies. It has also been shown that women seeking abortion do not reduce their smoking while women intending to deliver will reduce smoking. Also, postabortion anxiety has been correlated with increased incidence of smoking as well as the number of cigarettes smoked. Although far fewer Chinese women smoke compared to Chinese men, one recent study of smoking among males and females in Shanghai found that among women who smoke the tobacco attributable risks of lung cancer and respiratory disease are about the same for men.53 A recent review of studies on smoking and heart disease in China and Hong Kong found that the relative risk for coronary heart disease among women who smoked compared to women who did not smoke was 2.5 to 3.5 although the 95% confidence interval was wide.54
Based upon the available studies, induced abortion by Chinese women is harmful to the psychological and physical health of Chinese women in several respects. There are substantial adverse psychological and relational effects. It increases the incidence of maternal mortality due to postpartum and obstetric hemorrhage. It increases morbidity and mortality in women from infections as well as increasing the incidence of gestational trophoboplastic disease. Induced abortion also limits the protective effects of childbirth from cancer and instead increases the risk of cancer. There is evidence that it may contribute to lung cancer and heart disease in women from increased incidence of smoking. There is evidence that induced abortion also is harmful to infants because it contributes to birth complications and increases the likelihood of various diseases and birth defects in infants, some of which are fatal. Therefore, induced abortion appears to be inconsistent with the stated health goals of China because it is harmful to maternal and infant health.
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1, 2,