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Baroness Hayman: My Lords, before the noble Lord sits down, I should be grateful if he would give me the opportunity, as chair of Cancer Research UK, to assure him that there will be no need for the Department of Health to press for publication of the results. This is a major international study designed to find exactly the evidence and conclusions that the noble Lord seeks. It will be peer reviewed appropriately and then—and only then because it is an important subject for women—it will be made available in the same way as all our research.

Lord Alton of Liverpool: My Lords, I am extremely grateful to the noble Baroness. I am glad that we are fighting on the same side in this particular battle.

7.50 p.m.

Baroness Gould of Potternewton: My Lords, I must, first, declare an interest as chair of the all-party choice group and chair of the Independent Advisory Group on Sexual Health and HIV.

The Motion put down by the noble Lord, Lord Alton, on the link between abortion and breast cancer is one that, as he himself said, he has raised on

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a number of occasions, having spent some time examining the issues. He is perfectly entitled to do so, but my concern is that what he is doing has the potential to cause a great deal of unnecessary anxiety among women.

The noble Lord said that this was not a debate for or against abortion, but there appears to be a concerted campaign by LIFE as part of its continuing action to remove a woman's right to choose. Professor Jack Scarisbrick, LIFE's national chairman, said on 23rd June this year:

    "Political correctness means that the 'sacred cow' or abortion can never be blamed in any circumstances".

Such a statement criticises the many men and women who supported the 1967 Act, which eliminated real tragedies that killed women and maimed many of them for life. I certainly do not wish to go back to the days before the 1967 Act. I have great respect for the noble Lord's views, but I disagree with him fundamentally. I believe that the 1967 Act, to use its own words, cares for life—it cares for those women's lives.

It is true, as the noble Lord said, that there has been an increase in breast cancer since the 1980s, but much of that increase has occurred in women between the ages of 50 and 64 who have been invited to have breast cancer screening for the first time. As the noble Lord also said, many factors increase the number of women diagnosed with breast cancer. Breast cancer risk is strongly related to age, with more than 80 per cent of cases occurring in women over 50. The risk of breast cancer for current users of HRT is 66 per cent higher than for never-users. Being overweight and obese increases the risk of post-menopausal breast cancer. Other risks identified are women's reproductive history, excessive alcohol intake, and only today we heard on the news that there was a risk of breast cancer from a high fat diet. Last Sunday's Observer highlighted the fact that girls whose periods began at 11 are 50 per cent more likely to develop breast cancer than girls who began their periods at the age of 15. All these factors have to be considered.

A substantial proportion of breast cancer cases can be explained by factors which influence exposure to oestrogen, and hormonal factors. During any pregnancy, hormone levels are high and this results in a short-term increase in breast cancer risk for the years following a full pregnancy, after which there can be a long-term decrease in risk. Therefore, pregnancy itself can create risk.

Research in respect of any of these factors is crucial, but it is also crucial that that research is credible and not influenced by the views of those carrying it out. For instance, one piece of research evidence that I read was by someone called Patrick Carroll. The research document did not say that LIFE had funded that piece of research. It is terribly important that the people asking for research to be carried out are identified.

Because I am very biased on the question of abortion, I intend to rely not on evidence from pro-choice groups, which I could have done, but on the impartial views of health professionals. It is essential that any woman considering an abortion must have

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the facts accurately presented, including all the possible alternatives, so that she can give genuinely informed consent.

As the noble Lord said, in March 2000, the Royal College issued evidence-based guidelines on the care of women requesting an abortion. That included the question of the association between breast cancer risk and abortion. After considering the Brind evidence that the noble Lord referred to, the Royal College specifically reassured women who have had an abortion or who have breast cancer that the research evidence on this question is to date inconclusive. Indeed, it identified that studies based on the linkage of national registers on induced abortion and breast cancer, which are less open to bias than case control studies that rely on the recall of subjects, have not shown any significant association.

In December 2001, Professor Allan Templeton of the Royal College said:

    "Life are mischief making, we reiterate our advice to women that no causal link between abortion and breast cancer has been proven".

Early studies by an American cancer organisation showed variable results, and these have been used as evidence in many instances. But many of those studies were flawed in a number of ways that led to unreliable results. Small numbers of women were involved, no medical records were used and data were collected only after breast cancer had been diagnosed. The organisation has since conducted better designed studies, using larger numbers of women and consulting medical records. These studies consistently showed that there is no association between induced and spontaneous abortions and breast cancer risk.

In February this year, the National Cancer Institute in the United States brought together 100 of the world's leading experts who study pregnancy and breast cancer risk. Their conclusions were clear: having an abortion or miscarriage does not increase a woman's subsequent risk of developing breast cancer.

Cancer Research UK, in its briefing for this debate, identifies many of the differences in studies between case-controlled studies and cohort studies. It found that three out of four case studies showed that there was no significant increase in risk and that the cohort studies showed no link. I appreciate that that work is ongoing and I hope, as the noble Lord does, that we will soon be able to have the findings. We may well be satisfied about different conclusions, because I am fairly certain that, from the evidence so far, the conclusions will not be what the noble Lord is looking for.

In conclusion, the weight of unbiased scientific evidence indicates that induced abortion does not influence a woman's likelihood of developing breast cancer. The efforts of anti-abortionists to scare women away from exercising their legal right to choose abortion is not based on any causal relationship.

I repeat the words of Professor Allan Templeton of the Royal College in reassuring women who might be worried about these tactics that the research evidence on the question to date is inconclusive.

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7.57 p.m.

Baroness Knight of Collingtree: My Lords, I am bound to say that I think the noble Baroness was a little unfair to the noble Lord, Lord Alton. He did not, in any part of his speech that I heard, indicate that he wished to inhibit a woman's right to choose, as the noble Baroness said he did. I do not like abortion either, but both the noble Lord, Lord Alton, and I are democrats; we recognise that when a law is passed, it is a law, and that is what happened. I do not think that the noble Lord was asking this House, this country, or all our women to go back to a point when abortion was illegal.

I think the House is indebted to the noble Lord for bringing these factors to our attention. I am sure that others were as shocked as I was to hear some of the things he said. For instance, it is 50 per cent more likely, say some researchers—only some, of course—that women who have had an abortion will develop breast cancer. Surely that must be taken seriously. If the woman has a family history of breast cancer, the risk of her contracting it rises to 80 per cent after an abortion. Of course there will be some who seek to deny that there is any truth in these revelations. I am so sorry that the noble Baroness, Lady Gould, is leaving the Chamber. Actually, I see she is taking her place on the Woolsack, and I am grateful to her for remaining with us.

I do not think it is reprehensible for any group to fund research. What is wrong with that? Surely we are broad-minded enough to say that anyone can fund research and then we will listen to what everybody who funds research has to say. I read all the information that we have been given so far. China, for instance, strongly denies that there is any link between abortion and breast cancer. Well, I am not surprised at that, given that the Chinese government make abortion not something that a woman can choose but something that is absolutely compulsory. We have all been horrified by the rights of women in China being ignored in that way. They would have looked pretty silly if they had said that there was a link with breast cancer when they themselves are imposing it on women.

Those who seek to deny that there is any truth at all in these revelations remind me of the fact that, for years and years, people who did not want to believe it pooh-poohed the research that showed that smoking caused cancer. "Rubbish!" they said, and smoked their way to an early grave—not all of them, of course, but many did. Eventually it was recognised that they must at least be warned. They have the choice: they can choose to carry on smoking, but at least they are warned that there is a danger attached to it. However, it has taken years and years to get to that point.

There can be no shadow of a doubt that it is now made supremely easy for young girls to get abortions, and many people believe that that is a very good thing. I read somewhere recently that Britain is the abortion capital of the world. We are now told by researchers that the cancer risk they run is "incalculable"—that was the word used—if they had a history in their family

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of breast cancer and had an abortion before the age of 18. That is not something that one can easily just argue away. At least, let us consider it, and of course let us look at whatever other research is carried out on the issue.

The researcher that came up with that fact studied 12 women, all of whom were diagnosed with breast cancer by the time they were 45. Surely, even those who reject such findings should acknowledge that, at the very least, the girl presenting for an abortion should be warned. That is all that the noble Lord, Lord Alton, is asking for. She should be asked at least about her family history. Even if there is only a tiny amount of suspicion that there is a danger, surely it does not do any harm at least to ask her whether she has any such history in her family.

Abortion is championed by many to be no more significant or dangerous than having a tooth out. I believe that people who say that are wrong. Just as some smokers do not get cancer, some women who have a termination of pregnancy will not get it either. But the danger is there, and women deserve to be told about it. I have been concerned for many years that women who have severe psychological problems after abortion have never been warned about the risk. Not all of them suffer in that way, of course; a tough woman will not be bothered particularly, but a sensitive woman often is. That worries me, too, because those are the women who suffer—particularly if they do not conceive afterwards.

There is no packet on which we can print a warning, but we owe it to those women to ensure that every abortion clinic and every hospital carrying out the operation must look at the facts—all the facts. If they find significance in those facts, they must be open and honest with their patients and give them information about what a termination might bring in its wake.

8.3 p.m.

Baroness Massey of Darwen: My Lords, I am pleased that the noble Lord, Lord Alton, has raised an issue related to women's health. I shall take the question at its face value, as it relates to the welfare of women. I shall not get in to the ethics or morality of the abortion issue. It is sad that sometimes women's health issues are used to fuel controversy about contraception, abortion and even hormone replacement therapy.

On Monday of this week, there was a debate in your Lordships' House, which I took part in, about inequalities in health, particularly in the North West of England. There are significant differences in the quality of health in different parts of the UK, let alone the world. Where general health is poor due to diet, lack of exercise, smoking and drinking, underpinned by poor socio-economic conditions, then specific health conditions are likely to be poor, too. In the North West, coronary heart disease, strokes, respiratory diseases and life expectancy rates are worse than in the rest of the country. So are the rates for breast cancer. Hereditary factors, referred to by noble Lords, and socio-economic factors, are by far the greatest determinants in poor health, together with

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genetic factors, which must not be forgotten. I suggest that the inequalities are what governments should concentrate on.

There has been much debate on the causes of cancer. Some seem indisputable, in association with the socio-economic factors to which I have just referred. Smoking is the cause of much ill health, as well as cancer. We all know the stories of people of 90 who have smoked 40 cigarettes all their lives and are fit and well. Here genetic factors are clearly strong; but by and large, the link between lung cancer and smoking seems irrefutable.

That is not so with breast cancer. We can all be selective about evidence, but I have read a considerable number of reports in connection with this debate. The noble Baroness, Lady Gould, referred to some of those reports. The Royal College of Obstetricians and Gynaecologists and the US National Cancer Institute have evaluated studies and published evidence-based guidelines. The American study tells us that,

    "induced abortion is not associated with an increase in breast cancer risk".

I now turn to the national evidence-based clinical guidelines for induced abortions, which tell us that the vast majority of induced abortions—more than 98 per cent—take place because the pregnancy threatens the mental or physical health of the woman or her children. These are not mainly young girls. The guidelines go on to offer very specific guidance for clinicians which state that,

    "verbal advice must be supported by accurate, impartial information which the woman considering an abortion can understand and may take away and read before the procedure . . . Professionals providing abortion services should possess accurate knowledge about possible complications and sequelae of abortion. This will permit them to provide women with the information they need in order to give genuinely informed consent".

The only advice that could be given in relation to the link with breast cancer at the moment is that it is not proven.

Women need information to make health choices; so do men. But women choose abortion because they see it as the only option in their current difficult situation.

Discussions about the link between breast cancer and anything that affects hormonal balance are not new. Women who choose to delay their first pregnancy beyond the age of 30 for very good reasons appear to have a greater risk of developing breast cancer. Women who choose not to breast feed also appear to increase their risks. I have read that breast cancer rates in nuns are very high due to their not having pregnancies and not breast feeding, whereas their cervical cancer rates are low due to lack of sexual activity. I have also read about possible links between breast cancer, alcohol consumption and certain foods. It is all very complex and very speculative.

But now let me move on to women's health choices. Let us suppose—I repeat "suppose"—that there were a link between breast cancer and abortion, and let us make an analogy with the link between breast cancer

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and hormone replacement therapy—a link much better established so far as I know. Should women be denied a choice? I have had friends who were so devastated by menopausal symptoms that they were suicidal from lack of sleep due to night sweats, from hair falling out and hot flushes. Some women have horrendous reactions to the menopause, some do not. The friends I know who have been made miserable would have done anything to relieve those symptoms. They took hormone replacement therapy. That was their choice even though they may have known of potential risks.

The contraceptive pill has been associated with risk yet many women, for one reason or another, do not want a pregnancy. They are prepared to weigh up the risks and benefits. Professionals can give information only to help them make choices.

As I said earlier, women who make the choice of abortion do not make it lightly. I repeat that in 98 per cent of cases abortion is chosen because of a threat to the physical or mental health of the woman or her family. They have this right to choose even if there is risk involved. We all take risks every day. We drive, we cross roads and we perform tasks in the home or garden which may lead to accidents. We choose to take those risks.

We all know the risks of unsafe abortion. In the developing world it is the risks of maternally related mortality and morbidity as the result of poorly spaced pregnancies and complications from unsafe abortions—nearly half—that are major health concerns. I have worked in the former Soviet Union where at one time women had few reproductive health choices. The deaths were not from cancer.

Abortion is a women's health issue. A woman's reproductive health is what is best for her after being given all the information and weighing up evidence, risks and benefits. Let us be quite clear that women are generally very concerned about their health and that of their families. They do not take decisions lightly. They are entitled to choice.

8.10 p.m.

Baroness Billingham: My Lords, the topic before us tonight is,

    "To ask Her Majesty's Government what evidence links breast cancer with abortion; and what measures they are taking to alert women to any risks involved".

I have two answers to the proposition posed by the noble Lord, Lord Alton. The first is a very brief one. So far as the first part of the Question is concerned, I hope that the Government will do nothing until they have reliable and accredited information which they should then pass on to women in order to inform them of the risks. It is entirely irresponsible to alert women to risks unless there is proper accreditation.

So far the research to which the noble Lord, Lord Alton, alluded has no credibility whatever. The research upon which he depends is so flimsy as to be damaging. I take a sad view of this debate tonight. The noble Lord, Lord Alton, is flying a very dangerous and damaging kite.

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The noble Lord, Lord Alton, has rightly been honest and open about abortion tonight. It has been his main interest for many, many years. I was going to use the word "obsession" but I shall not do so; it is an interest. Let us pluck out of the air the most frightening of abortion outcomes for women. That would probably be breast cancer. Why those two matters should be linked in this debate is self-evident: in linking the two matters we could be regarded as validating that link. That in itself is incredibly damaging and frightening.

Let us consider the two categories that we are debating. Speakers have already said quite rightly and properly that women do not undertake abortion lightly. A termination is a very big decision. It is often taken for purely medical reasons, sometimes for social reasons or a combination of the two. To put into the minds of such women the concept that termination could put their lives at risk at a later stage is a matter that ought to be looked at very critically indeed. It is grossly unfair to put such pressure on a woman who is making such a fundamentally important decision in her life.

Let us also look at the woman who has had a termination and might pick up a tabloid paper tomorrow. One of my fears is that, by having this debate, we could see the sort of tabloid headlines that we have all seen before. We have seen scares about HRT—in many ways, that is an ongoing debate—and many other such headlines. I saw one recently that said that having a scan and early diagnosis was in some way unnecessary and unhelpful.

I speak with some authority on the subject. I can tell the House that any woman who has had breast cancer becomes an immediate expert. Every part of her brain is on the lookout for any further information. Any such headlines that come into the public domain as a result of the debate would be appalling. I can only hope that other matters going on in this House today will make sure that that does not happen. We do not want publicity to be given to the issue, because it is not founded on fact or sound research. We have already heard about pregnancy, oestrogen and hormones. All that is known to us. We know that oestrogen is a factor not over weeks, but over a different period of time. We accept the problem. Certain scientific evidence is acceptable.

Suddenly putting the two factors—breast cancer and abortion—together is done for a very cynical reason. It is done to act as a stimulant to the case of the noble Lord, Lord Alton. It is not a way in which he should manipulate women's rightful fears. I very much hope that the debate gets very scant recognition. I certainly hope that no women—young or old—who have been or will be involved with termination and breast cancer will be unnecessarily alarmed by the half-baked research that he attributes and quotes and on which he seems reliant. It is very dangerous, damaging and cynical.

8.16 p.m.

Baroness Thomas of Walliswood: My Lords, the noble Lord, Lord Alton, has directed our attention to

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an interesting and, as it turns out, highly controversial subject. I share his concern about the level of breast cancer—I do not think that any woman could fail to do so—but three points seem clear from the briefs provided to me by the Library. First, some people genuinely thought in the past that there might be a causal connection between early abortion and breast cancer later in life. Secondly, the weight of the most recent, largest and most academically careful research projects, such as the Danish study, now suggests that there is no proven link. Thirdly, some people have used the research to boost their message that abortion is dangerous as well as morally wrong, a matter with which the noble Baroness has just dealt.

I want to say straightaway that I have supported access to induced abortion on the NHS for many years. Indeed, years ago I played a part in determining my own party's policy in the area. On the other hand, I am shocked to learn that, every year in England and Wales, 180,000 women seek that way out of their difficulties and problems. I hope that the Minister will agree that it is very important for schools to provide effective and serious sex and personal-relationship education, starting in primary and continuing into secondary education with teaching to suit the age group. Both boys and girls—I repeat, boys and girls—need to learn how to understand and manage their developing bodies and emotions in ways which minimise both the risk of pregnancy and disease and fear of the unknown.

I shall return to the subject of the debate. Of course we know that there is protection against breast cancer associated with early child-bearing and breast-feeding. That is relatively well-established now, but the opposite—a causal connection between early abortion and additional risk of cancer later in life—is not proven.

Like the noble Baroness, Lady Gould, I was particularly interested to read the national evidence-based clinical guidelines on the care of women requesting induced abortion, which were published three years ago. The authors of those guidelines explain that their most robust recommendations must be supported by,

    "at least one randomised controlled trial as part of a body of literature of overall good quality and consistency addressing the specific recommendation".

The evidence has to be well done and relevant. Clearly, the available research did not provide them with that level of certainty about the point of today's debate, because they concluded that,

    "available evidence on an association between induced abortion and breast cancer is inconclusive".

That is how they suggest that women should be advised.

That conclusion is reached in response to the guidelines' insistence that professionals who provide abortion services should be able to provide patients with accurate and comprehensive information about

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the possible complications and consequences of abortion. I entirely concur. Patients should always have access to such advice. I hope that attention to supplying that need would be a sufficient defence against malpractice actions such as those mentioned by the noble Lord. My guess is that such professional advice would be more impartial than some of the highly coloured outpourings of pro-life writers.

Finally, however much we may deplore the number of induced abortions, we should also understand that, sometimes, the continuation of a pregnancy to term can also be fraught with danger—to the woman, to any existing children and to the new baby. Nobody could wish to return to the situation before the legalisation of abortion, where women died, or became infertile or diseased, as a result of back-street abortions.

We should teach young men and women to approach sexual relationships responsibly. We could do worse than to study why the levels of induced abortion among very young girls are so high in the UK and to learn how we can reduce their number. The noble Baroness, Lady Massey, indicated that social factors might prove a fruitful area of research. However, to try to scare young women into bearing children against their will on the basis of flawed research into the consequences is not the way to go about it.

8.22 p.m.

Baroness Noakes: My Lords, I thank the noble Lord for giving the House an opportunity to debate the link between breast cancer and abortion. I also congratulate him on his bravery in being the sole noble Lord to speak among so many noble Baronesses.

Noble Lords who have spoken have traded the available scientific evidence on the link between induced abortion and breast cancer and I will not try to add to that. To my untutored eye, the evidence is far from compelling that there is a causal link between abortions and breast cancer. The view of the Royal College of Obstetricians and Gynaecologists that there is no proven link carries huge weight. I note the recent findings of the American National Cancer Institute, to which the noble Baroness, Lady Gould, referred. A workshop held this year found no evidence of increased risk. Regrettably, the evidence cited by the noble Lord, Lord Alton, does not seem to stack up.

However, if there is any genuine suspicion of a link between abortion and breast cancer, it is clearly right that it is researched. I welcome the research study being undertaken by Cancer Research UK's epidemiology unit at the University of Oxford and hope that it will report quickly. I was pleased to hear about the progress of the research from the noble Baroness, Lady Hayman, but the timescale is still in doubt and many women are anxious to see the results as soon as possible.

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