Studies of the association between induced abortion and breast cancer risk have been inconsistent, perhaps due to underreporting of abortions. Induced abortion is a well-accepted family planning procedure in China, and women who have several induced abortions do not feel stigmatized. The authors used data from a population-based case-control study of breast cancer among women age 25-64 conducted between 1996 and 1998 in urban Shanghai to assess whether a history of and the number of induced abortions were related to breast cancer risk. In-person interviews were completed with 1,459 incident breast cancer cases ascertained through a population-based cancer registry, and 1,556 controls randomly selected from the general population in Shanghai (with respective response rates of 91% and 90% Studies of induced abortion and breast cancer risk have been inconsistent. Underreporting of induced abortion is suspected, 1 which may be reflected in the low reported percentages of women who had undergone the procedure in these studies. In the majority of previous studies of this association fewer than 20% of women have reported induced abortions. The Iowa Women's Health Study, a cohort study, had the lowest percentage of reported induced abortions (2%), and found no association between induced abortion and breast cancer risk (OR ϭ 1.1, 95% CI 0.8 -1.6). 2 An intermediate percentage of reported induced abortions (39%) was found in a Greek case-control study that reported an elevated risk of breast cancer associated with induced abortion (OR ϭ 1.51, 95% CI 1.28 -1.84). 3 The highest percentage of reported induced abortions (76%) was seen in a Russian case-control study that reported no association for 1 abortion (OR ϭ 1.0, 95% CI 0.7-1.4) and a borderline reduced risk for 2 or more abortions (OR ϭ 0.7, 95% CI 0.6 -1.0). 4 Remennick 5 postulated that should induced abortion be related to breast cancer Russian women may be at a greater risk given the extremely frequent use of the procedure. The same may be true of women in China that had 1 of the highest induced abortion rates in the world during the childbearing years for the majority of women in this study. 6 This study was conducted to assess whether a history of and the number of induced abortions were related to breast cancer risk. The lack of social stigma associated with induced abortion in China may limit the amount of underreporting of the procedure and present a clearer picture of this association.
MATERIAL AND METHODSDetailed methods of this population-based case-control study appear elsewhere. 7 Briefly, all women age 25-64 years who were permanent residents of urban Shanghai at the time of diagnosis of first primary invasive breast cancer (August 1996 through March 1998) were eligible for the study. Two senior pathologists histologically confirmed all diagnoses. We used rapid case ascertainment supplemented by the Shanghai Cancer Registry to identify breast cancer cases who had no prior history of cancer and were alive at the time of interview. A total of 1,459 breas...