HL Deb 29 October 2003 vol 654 cc335-52

7.40 p.m.

Lord Alton of Liverpool rose 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.

The noble Lord said: My Lords, as your Lordships will be aware, October is breast cancer awareness month. This is therefore a timely debate and I am grateful for the opportunity to ask this Unstarred Question today.

Breast cancer is the most common cancer in the United Kingdom and affects some 41,000 women every year. It claimed 13,000 lives in 2001, making it the second most common cause of cancer death in women after lung cancer. As the honorary chairman of the Forget Me Not Appeal for Liverpool's Royal Teaching Hospital, I am glad to report that our appeal raised £ 4 million for cancer treatment facilities, including the Linda McCartney Centre for Breast Cancer, which I invited Cherie Booth QC to open.

Throughout the country substantial progress has been made in detection and improved treatment of breast cancer. I hope that what I say today will further help to reduce the incidence of breast cancer among women.

I have never made any secret of my position on abortion. I have always believed in the right to life of the unborn. I do not believe that many of those who supported the Abortion Act 1967 ever anticipated that it would lead to some 6 million legal abortions or to the one in five pregnancies that now end in an abortion. I have also argued that being pro-life is not about choosing between a woman and a child. It should surely be about caring for both and affirming life and human dignity at every stage of life from conception to natural death.

So the issue is not whether you are for or against abortion; it is about its possible consequences. My remarks rely entirely on published studies, evolving medical knowledge, judicial settlements and freedom of information.

For some time now, I have been studying the effects of abortion on women and the evidence linking induced abortion to breast cancer. I find the evidence quite compelling, and it is that evidence that I lay before your Lordships' House today.

Twenty-eight out of the 37 independent studies that have been carried out world-wide have linked induced abortion with breast cancer. Thirteen out of 15 studies conducted on American women report increased risk. Seventeen studies are statistically significant, 16 of which found increased risk.

In 1996, Professor Joel Brind of Baruch College in New York and his colleagues at Pennsylvania State Medical College conducted a review and meta-analysis of the studies. It is important to note that half of the Brind team were abortion law supporters. That study found an overall 30 per cent elevated risk among women choosing abortion after their first full-term pregnancy, and a 50 per cent elevated risk among women choosing abortion before their first lull-term pregnancy.

It is thought that there are two ways in which abortion may cause breast cancer. First, an induced abortion causes biological changes to occur in a woman's breasts which make her more susceptible to breast cancer. During pregnancy, a hormone called estradiol, a type of oestrogen, causes both the normal and pre-cancerous cells in the breast significantly to multiply. By seven to eight weeks gestation, the estradiol level has increased by 500 per cent over what it was at the time of conception.

If the pregnancy is aborted, the woman is left with more undifferentiated— and therefore cancer vulnerable— cells than she had before she was pregnant. On the other hand, a full-term pregnancy leaves a woman with more milk-producing differentiated cells, which means that she has fewer cancer-vulnerable cells in her breasts than she had before the pregnancy.

A second way in which it is claimed that induced abortion can cause breast cancer is through delayed first full-term pregnancy. One of the most common ways in which women delay their first full-term pregnancy is of course by abortion.

In February 2000, the New England Journal of Medicine, possibly the world's most influential medical journal, acknowledged evidence of the link between induced abortion and breast cancer in an article written by researchers at the University of Pennsylvania School of Medicine. By contrast, the major studies cited as undermining any link, such as the Lindefors-Harris and others study of 1989 and the Melbye and others study of 1997, are seriously flawed by misclassification and methodological errors.

Over the past six years I have had meetings with Ministers and with the Royal College of Obstetricians and Gynaecologists and I have corresponded with the department. For more than two years now my colleagues and I have been told that Cancer Research UK is looking at this issue and will be producing a report. That report has yet to see the light of day.

In the RCOG's 2000 guidelines on the Care of Women Requesting Induced Abortion and in a recent Written Answer in another place, the RCOG and the Government maintain that evidence of a link between induced abortion and breast cancer is "inconclusive". Yet the RCOG has also acknowledged that the meta-analysis by Professor Brind, had no major methodological shortcomings and could not be disregarded".

It is impossible to reconcile the RCOG's two statements and I hope that the Minister will be able to clarify that issue today.

The recent scare with HRT supports the argument for a link between induced abortion and breast cancer. HRT and induced abortion share one thing in common— they raise oestrogen levels. A low fat diet and avoidance of alcohol also reduce a woman's exposure to the hormone oestrogen, which is the key trigger for breast cancer.

Women have a right to know about every possible risk factor for breast cancer, so why the silence on what appears to be a significant risk factor for breast cancer— induced abortion?

If the Government do not place sufficient weight on the mounting evidence of a link between induced abortion and breast cancer, there will be class-action law suits similar to those we are witnessing against the tobacco industry. Years of denial and complacency could lead to claims for billions of pounds in compensation.

In the United States, two more states, Minnesota and Texas, have just passed informed consent statutes requiring abortion clinics to warn potential clients about the link between induced abortion and breast cancer. The world's first known abortion-breast cancer settlement was reported in Australia 2001 because a young woman had been denied information about the possible link. Here at Westminster last year I met the lawyers who acted in that case.

Yesterday, in Washington DC, at the American Senate, I was briefed on the case of a 22 year-old woman from Philadelphia who had an abortion when she was aged 17. Last week she became the first person in the United States successfully to settle a medical malpractice case based on a claim for the failure of her doctor and the abortion clinic to inform her of the increased risk of breast cancer due to abortion.

I also spoke two days ago to Norma McCorvey, who used the pseudonym Jane Roe in the Supreme Court case Roe v Wade in 1973. She is now a leading opponent of abortion, not least because of its effect on women's health.

Today I urge the Government to do two things. First, the Department of Health should, as a matter of urgency, review and publish all the research. Secondly, the Government should press the Cancer Research UK working party to publish its report or at least its interim findings.

Obviously not all women who have breast cancer have had abortions, and no one should imply that. Similarly, not all women who have had abortions will get breast cancer. However, induced abortion causes women to change their childbearing patterns, which in turn leads them to forgo the protective effects of an early first full-term pregnancy. Young girls and women who abort before they have had a child— that is, the majority of abortion patients in the United Kingdom— are at most danger.

The independent evidence linking induced abortion with breast cancer should be— and I am sure will be— of concern to every Member of your Lordships' House. Whatever our views on abortion may be, we should surely all oppose the suppression of evidence and debate. We should all be in favour of freedom of information and empirical research. The Abortion Act 1967 gives women the right to choose, but women also deserve the right to know.

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 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 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.

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 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 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 in 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 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.

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 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 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.

Baroness Hayman

My Lords, the noble Baroness is right, but for such a highly contested issue, it is important that we get the research right. An extensive, international analysis of all the available evidence, some of which is published and some of which is not, takes time. That time has to be used properly and we will then have data on which we can hopefully all agree.

Baroness Noakes

My Lords, I thank the noble Baroness for that intervention. I wish to imply no criticism of Cancer Research UK. I was merely reiterating what I believe most women feel; namely, that the issue has been raised and they would like some more certainty about it as soon as possible.

I want to touch briefly on research. That being carried out by Cancer Research UK is not funded by the Government and we must thank such organisations for undertaking it. I believe that the Government should be providing the bedrock of funding for this kind of important research. I invite the Minister to say how much government money will go into medical research this year and what proportion of the total amount likely to be spent on medical research they will fund. Will she reflect on whether that is the right proportion, given the huge importance of issues such as breast cancer?

The Question tabled by the noble Lord, Lord Alton, raises the question of how much information should be given to women about potential risks. I believe that patients should be given a balanced explanation of the risks associated with any medical intervention. But a line has to be drawn between giving information on the basis on which informed choices can be made and overloading the patient with information. Information should not be given on the basis of unproven hypothesis. It is into that category that abortion and a breast cancer link falls. Indeed, I believe that it would be positively harmful to concentrate on risks that are not proven.

I wish no disrespect to the honestly held views of the noble Lord, Lord Alton, and my noble friend Lady Knight, but it is difficult to resist the notion that reducing the incidence of breast cancer is not the key concern of those who are behind the use of the so-called "evidence" of a link between abortion and breast cancer. Their target is the reduction in or the elimination of abortion. As many noble Lords have said, many other factors are associated with the incidence of breast cancer—

Baroness Knight of Collingtree

My Lords, I thank my noble friend for giving way and I want to intervene only briefly. What she has said could cause great worry. I cannot speak for the noble Lord, but I can say that nothing I have said today or was trying to do today was intended to do what she has described. I merely want all research examined and details when they emerge to be given frankly to women. That is my aim and that is all.

Baroness Noakes

My Lords, I am pleased that my noble friend has said that because I am sure that all noble Lords around the Chamber feel the same way. But many other factors are associated with the incidence of cancer. Family history is an important one, as are controllable issues such as obesity and the decision to take HRT. There are other unproven links through alcohol and even through organo-chlorine insecticides.

However, these are not the targets of the campaigners— and I stress the campaigners outside your Lordships' House— because they have the abolition of abortion in their sights and not the health and well-being of women, which should be our primary concern.

Having taken two interventions, I must be brief. As regards reproductive health in this country, we are fortunate in having contraceptive services and the availability of abortion. There are many issues which we on these Benches do not believe the Government have got right. There are issues about the way in which breast cancer is currently being treated, which we do not believe the Government have got right. Our outcomes are among the worst in Europe; certainly below average. Our waiting times for breast cancer treatment are not improving, even after the reduction in time to first consultant appointment. For example, only 80 per cent then receive treatment within five weeks. And if one wants radiotherapy, one has to be one of the 53 per cent.

We believe that those issues about breast cancer are by far the more important for your Lordships' House to concentrate on, rather than the link between abortion and breast cancer. I look forward to hearing the Minister's reply.

8.29 p.m.

Baroness Andrews

My Lords, I am very grateful to the noble Lord for introducing a debate which has sparked such vital exchanges. I am sure that that was absolutely predictable and understandable, and I am grateful to all noble Lords who have spoken. I am conscious that we do not have enough time to address all the issues. I wish that we had the rest of the evening.

It is a timely debate for all kinds of reasons, and it provides an opportunity to pay tribute to Breakthrough Breast Cancer and Breast Awareness Week and also to the work of the voluntary societies, including the one in which the noble Lord, Lord Alton, himself is involved— the Forget Me Not Appeal. It is timely because breast cancer is a major preoccupation for every woman and is something that we think about for much of the time. If we have friends or members of the family who have suffered from it, there is always the overshadow of fear that we might get it ourselves. It is the second biggest cause of deaths from cancer among women, with 41,000 new cases each year.

It is absolutely right that we are rigorous and determined in identifying risks and, as my noble friend Lady Massey eloquently said, in providing the essential information that women need both to reduce risks and to make informed choices. But it is vital that we do nothing to raise unfounded fears and anxiety. As many noble Lords said, we know that there is a whole range of known risk factors relating to genetics, the environment, lifestyle, obesity and, as recent research has suggested, high alcohol intake. In addition, there are reproductive and hormonal factors, such as having children at a late age, early puberty or late menopause.

I want to say at the outset that the Government are entirely committed to ensuring that women are as fully aware as possible of the risk factors. If the weight of expert evidence suggested a causal link between abortion and the risk of breast cancer, we would make that information widely available to women as soon as possible. But, as many noble Lords have said— particularly my noble friend Lady Gould— the weight of evidence is not stacking up. That evidence comes not only from the UK but from the US and now, increasingly, from other countries.

I believe we must be alert to some of the issues raised by the research quoted. For example, the Patrick Carroll study was reviewed by the RCOG. That study was not peer-reviewed, and the RCOG concluded that it failed to establish a causal association between abortion and breast cancer. The study by Joel Brind in 2000 was subject to other analyses. Other researchers analysed the literature and reached the opposite conclusion.

However, in this very brief overview of the great deal of evidence that has been made available thus far, I want to be able to show that there is a wealth of international research. Studies have involved many women of different ages and varying reproductive histories. As the noble Baroness Lady Thomas, said and as the American College of Obstetricians and Gynaecologists said recently, the results of the early studies were slightly inconsistent. But they were difficult to interpret because of methodological considerations— not least the varying patterns of recall of women and self-referral. That explains some of the inconsistency in those studies. However, more recent and more robust studies, whether they were case-controlled through the control group examining what happened to women who did not have cancer or abortions, or cohort— that is, large population— studies, have found no link between abortion and breast cancer.

I turn to what we in the UK, and the RCOG in particular, are doing. In 1999, the RCOG reviewed all the research evidence available at the time. Many noble Baronesses this evening have referred to the RCOG's guidelines produced in August 2000, which, I understand, were inspired by Dr Brind's study and which, indeed, reassured women who have had an abortion or breast cancer that the research evidence on this question to date is inconclusive. A long quotation was read from that set of guidelines.

However, I can tell the House that, after reviewing the most recent and refereed studies, the RCOG is now even more confident than it was in 1999 that there is no association between abortion and breast cancer. That should be reflected in new guidelines from the RCOG which are in the process of preparation.

Lord Alton of Liverpool

My Lords, perhaps I may intervene before the noble Baroness proceeds. I am grateful to her for giving way. Can she explain why the RCOG also said that that evidence cannot be disregarded? Perhaps she can refer to the successful court action last week based on the same evidence, laid before the British Government, in both the United States and previously in Australia, where women have now won their cases for the right to have information.

Baroness Andrews

My Lords, I cannot comment on those cases because I am not aware of them. The RCOG guidelines state that professionals involved in abortion care should be equipped to provide women with information on, among other things, the long-term effects of abortion, which are rare or unproven, including breast cancer. So, it is aware of the need for women to be informed even where there is a remote or inconclusive risk. That is part of the whole scope of the information. I think it would be safer if I write to the noble Lord about the Brind study as I do not have the full RCOG report before me, simply the résumé.

We have had additional confirmation from the USA. The November 2003 edition of the International Journal of Gynaecology and Obstetrics includes a committee opinion from the American College of Obstetricians and Gynaecologists (ACOG) which reviewed the same peer review papers as those recently reviewed by the RCOG with one exception and concluded that there was no evidence in this body of medical research to suggest any causal link.

In addition, and cited in the briefing we had from Cancer Research UK, were cohort studies from Germany and Sweden and of large populations in France, Denmark and China. The noble Baroness, Lady Knight, referred to China. I cannot comment on what she said but have in front of me only what was said by the researchers. Those studies, which in one case involved over 1 million women, found either a non-significant increase, no correlation, no increase in risk or even a slight protective effect in some instances where women had had an abortion. I am happy to let noble Lords have that review.

Reference was made to Cancer Research UK's world class review. I am grateful to my noble friend Lady Hayman for her intervention. She knows so much more than I do about such matters. It is a vast and complex study. As she said, it is reviewing not just a potential link between abortion and breast cancer but a whole range of reasons why women contract breast cancer. We are anxious to have the results, but we also recognise that the results must be validated and confident. Therefore, we look forward to them being published as appropriate.

I turn to some of the wider issues raised, in particular by the noble Baroness, Lady Noakes. There is good news about breast cancer research. Research from Cancer Research UK published last year showed that in the past decade British women have had the world's biggest decrease in deaths from breast cancer thanks to better diagnosis and treatment. We want to build on that. It is not good enough and there is a long way to go but we are moving in the right direction and building up a knowledge base. Only last week we announced that the number of patients entering clinical trials has doubled over the past three years. That will have a major impact on helping cancer patients to benefit sooner from new development.

As a Government we spend about £ 190 million on cancer research. Sadly, I cannot tell the noble Baroness what proportion of that goes to breast cancer because it is not broken down by tumour sites. One of our great successes is the expansion of the cancer screening programme. Breast cancer mortality decreased by 21 per cent in 1998. Thirty per cent of that reduction was attributed to breast screening. Quality improvements and the expansion of the programme now to women aged 65 to 70 will make a big difference.

The cancer networks are contributing, as are the cancer collaboratives. We know that there are some problems along the way. Noble Lords did not mention the postcode lottery. Yesterday in another place the Secretary of State addressed that very firmly and stated that the national cancer director has been asked to look at the NHS in every region to ensure that drugs and treatment which have been approved nationally by NICE are available.

The Cancer Plan and the extra £ 570 million for cancer services are major initiatives to ensure that the money gets to where it is needed. Just as we have tracked it now for two years to ensure that it does, so we shall track it again for another year.

On abortion our policy remains as it has been since 1967. Let me make clear that our aim is to reduce the number of unplanned pregnancies. I am pleased to say that our teenage pregnancy strategy is having an effect. We have had a 10 per cent drop in teenage pregnancies. That is to the great credit of those working in this field.

I must finish. I do so by reiterating that for the vast majority of women who seek to terminate a pregnancy, the decision is not an easy one. Accurate information is absolutely vital, but I cannot state too strongly that ethical and emotional issues should not be compounded by introducing fears about the possible risks of breast cancer in the future on inconclusive evidence. I am very grateful to all noble Lords who have taken part in the debate.