Dr. Coburn also cited the 1989 study of Holly Howe, et al., as the only American study which used prospective data (and in which, reporting bias is therefore impossible). In particular, he noted that the NCI web page contained no mention of this study, which showed a 90% risk increase.

Dr. Coburn’s conclusion on the bias issue could hardly have been more unambiguously expressed: "And when I read your web page, what I find is what seems to be a bias for lack of what the facts are."

Dr. Liu’s response to all this was telling: "I have to admit my ignorance in terms of our, that specific web site section, so I think if you’ll allow us to explore this a little more carefully, and then have an opportunity to discuss with you on a more equal basis..."

Interestingly, Dr. Coburn is not the only member of this particular Congressional subcommittee who is also a physician. Not surprisingly, the foregoing discussion also drew the interest of Iowa Congressman Dr. Greg Ganske, who asked the following question:

"I've always wondered on this issue why there would be, if there is any, a difference between a spontaneous abortion and an induced abortion. I mean, would not the biology be the same?"

Although the question was ostensibly directed toward Dr. Liu, it was Dr. Coburn who jumped in with the answer:

"Absolutely not. A spontaneous abortion is associated with much lower levels of estrogen, whereas an induced abortion is not. And we know estrogen in high levels and unopposed estrogen have (are) risk factors for breast cancer." (See "The Estrogen Connection", Spring 1997 ABCQ Update.)

Of course, Dr. Ganske also wanted to know what Dr. Liu had to say on this point. Dr. Ganske: "When these epidemiological studies are done, do they control for spontaneous abortion or not? Or do you know?

Dr. Liu: "Some do and some don’t. And that’s part of the problem. In some of these studies is that many times, the larger the study is, the more difficult it is to determine the mode of the abortion".

Forgive me again, dear readers, for this statement is absolute nonsense!

The size of an epidemiological study has as much to do with its differentiation between induced and spontaneous abortions as the size of a house has to do with whether its kitchen floor is covered with linoleum or tile: the two characteristics are completely unrelated! The way to differentiate the two types of abortion in epidemiological studies is to examine the data separately for each type, if the study makes such a distinction, and to omit data which do not embody the distinction.

Within each study, the distinction is either made in the medical record or the questionnaire or interview, or it is not. In fact, the NCI web page on abortion and breast cancer is a perfect example of combining the two types of abortion so that an inconclusive result can be claimed. That is because, as Dr. Coburn stated, induced abortions raise breast cancer risk, while most spontaneous abortions do not. Importantly, Dr. Liu’s final remark on the issue, in answer to Dr. Ganske’s question, was: "In terms of the biology, I’ll have to defer to the reproductive biologists, my colleagues, to give the exact answer, but there is some truth to what Dr. Coburn has mentioned..."

A lot more than "some", Dr. Liu! And as of this time, a series of hard questions has already been submitted by Dr. Coburn in writing to the NCI. It is high time for this inquiry to have begun. After all, it is Congress' constitutional duty to oversee the workings of this federal agency. Stay tuned! –JB-


Home